Reading Response for 11/18

I found the paradox of IMF "aid" discussed in this article very interesting and also shocking. The way the authors presented the conflict between IMF anti-inflation policies and investment in social services cast the IMF in a definite negative light. I would like to learn more about the justifications behind the IMF policies so that I can better understand the issue and make an informed judgment about this IMF/social services paradox. It does seem pretty ridiculous that a country would be in a position to lose aid by accepting aid!

It seems to me that the best, most moral way to approach all of this is to devote far more resources to the development of infrastructure and the overall health system in underdeveloped settings. I also firmly believe that citizens themselves must take ownership of reform and development of their own countries; impositions from outside continue power structures and colonialist legacies that are usually far from morally acceptable. It appears that powerful countries are still effectively tying the hands of those they are supposedly trying to help through stringent IMF policies and funds that come with strings attached. The complexity lies in what those strings are - the requirement of use of expensive, patented US drugs is an inappropriate imposition of US interests in my opinion, but there are other conditions such as the equitable use of the funds that are far more justifiable. It is due to nuances such as these that there is no rationing consensus, as the authors note.

One of the most interesting and telling ideas in this article was the authors' hope that healthcare providers are not "slaves to the rules." I found this statement slightly contradictory; if the authors are arguing for the necessity of rationing and a rationing ethic to accompany it, how can they advocate bending the very rules that they say must be in place? Though I would tend to agree with them in practice - as a doctor I certainly would not want to turn away a needy patient - I am cautious of their principles. They seem to be saying that the rules are unreasonable enough that it is permissible to disregard them. If this is the case, there should be a different set of rules! I think this hope that providers are not "slaves to the rules" demonstrates an underlying moral/ethical belief that care should be provided to all who truly need it. If that is the moral conclusion, we should be now be working to make that vision possible.