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Discretionary power is commonly defended by denial of its existence, the allegation of inevitability. Objective external conditions and forces are claimed to dictate policy decisions with tangible distributional effects. In health policy, such forces include the aging of the population, the extension of technology, and the demands of ethical standards. Taken together, these forces create relentless upward pressure on costs, to levels which society "cannot afford," necessitating sacrifice of the interests of the "less eligible." Yet quantitative analysis of these forces does not sustain the argument; in each case the source of cost escalation is not external pressure but the way in which the health care system itself reacts. Less costly and equally effective options are demonstrably available, but would threaten provider interests and broader ideologies. A spurious cloak of inevitability serves to promote and justify political choices.
This article has been cited by other articles:
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  R. G. Evans Tension, Compression, and Shear: Directions, Stresses, and Outcomes of Health Care Cost Control Journal of Health Politics Policy and Law, March 1, 1990; 15(1): 101 - 128. [Abstract] [PDF]
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J. P. Newhouse Has the Erosion of the Medical Marketplace Ended? Journal of Health Politics Policy and Law, June 1, 1988; 13(2): 263 - 278. [Abstract] [PDF]
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