On Hippocrates, Thomas Jefferson and Max Weber: The Bureaucratic, Technologic Imperatives and the Future of the Healing Tradition in a Voluntary Society

ROGER J. BULGER
THE TANNER LECTURES ON HUMAN VALUES

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It is my purpose to reflect upon the current status of health care and health policy in the United States, exploring some essential human values considerations with an eye toward the future and the possibility of attaining the highest quality humanistic health care. In this attempt to ascertain where we Americans have been in health care delivery, where we are, and where we might be going, there will be ample opportunity for me to make comparisons with the situation here in Great Britain. However, I shall not yield to those temptations, trusting that my colleagues in their commentaries will take on the challenge of comparative examinations of the British system. Many Americans have what I call the Alexis de Tocqueville Syndrome, which is founded in deep envy of that wonderful Frenchman who came to America in the midnineteenth century and described it peerlessly. The patient suffering from the de Tocqueville Syndrome is characterized by an extraordinary certainty that he or she fully understands another culture or another nation after having been there for a few weeks or months or even a few years. The most severely afflicted believe they know how to solve all of the major problems in the other country and are annoyingly outspoken in their efforts to enunciatethose solutions for all to hear. During my years at Emmanuel College in 1955, I received a permanent immunization to the de Tocqueville Syndrome. Thus, I trust you will understand why I shall limit myself to occasional observations about diff erences in health care between England and the United States and shall leave the value judgments and things I don’t know about to others.
This lecture is an attempt at an interpretive analyis of the current and future American health care delivery system with all its problems and challenges. Inevitably, there will be comparisons made with the British system, but it is important to note at the
onset that the inevitable cross-cultural thinking I have had to do in preparation has led me to a deeper appreciation of differences
between the two countries. I seek not to preach a kind of societal moral relativism; rather, I seek only to observe that in contrast to the British, Americans currently give more weight to individual choice than to fairness
of distribution of health services. In 1981, Kingman Brewster defined “the Voluntary Society” (which included the United Kingdom
and the United States) as one which permitted the lives of its citizens to be as voluntary as possible.1 For Brewster, as probably
for most of us, freedom of the individual is the cornerstone of both our nations. But for Americans, newly arrived in a rough
and inhospitable world, the Declaration of Independence held out something more — “certain unalienable rights . . . life, liberty and
the pursuit of happiness.”
There are two other basic values worth remembering about the foundations of the values of America: the first is that people didn’t come to America because they were rich, satisfied with their lot, and happy; and the second is that people didn’t come to
America because they were in love with governments. Thus, no matter how bad the ghetto into which the American immigrant
arrived, there was never a doubt that he or she or the children would be able to get out — hope for a better tomorrow seems encoded in our genes. Also, the early Americans hated governments; in 1987, the distrust of centralized power is almost as strongly felt by many Americans toward Washington, D.C., as it was by those Americans of two hundred years ago toward England.

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