The intellectual decline of the health care left

The health care left-a traditional source of critique and reform-has become intellectually less competent and politically less effective in carrying out its historic role in the continuing great debate over health policies and programs. Its credibility has diminished in recent years as it has come to operate on a series of undocumented assumptions: 1) that malevolence and greed are at the roots of adverse decision-making in health-care policies and programs; 2) that budgetary constraints are little more than convenient alibis to account for programmatic inadequacies; 3) that treachery, lack of social commitment and careerism are the major explanations for the behavior of public health professionals; and 4) that substantive progress in social legislation and service delivery has not occurred. A self-respecting health care left that wishes to be taken seriously once more will revive its former allegiance to objective empirical data, will abandon simplistic explanations and will eschew inflated rhetoric and habitual invective.