Abstract
Health, illness, and health care are the very arenas in which people struggle daily. China’s health care reform concerns the life of the world’s largest population. Through an ethnographically-based study from a distinctive geographical and historical context, the book shows the logics and modes of governance in the Chinese health sector, reviews the continuities and changes of multiple values in the health sector, outlines people’s moral experience of health care transformation, and explores the government’s ability to reinvent itself and its limitations. Hearing directly from the voices of patients and health professionals, this research shows people’s articulation of their worries and hopes as they experience the healthcare reforms. Health care contestation can be understood in a broad sense as people’s search for a meaningful life. Within that search and exploration, an ethical and moral space emerges that allows one’s very sense of being to find a (temporary) dwelling place in the transformational Chinese society. Health care change thus supplies a window for viewing people’s search for their moral and political existence in China today. The ongoing reform also provides a window for seeing the political rationales, governance, and ideologies within China’s transformation. The understanding of the hybridity of Chinese governance may illuminate the wider discussions of the direction of China’s social, political and economic reforms.
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Notes
- 1.
I got inspiration from reading Saxer (2013) research of Tibetan Medicine. He describes that the Tibetan medicine industry as an assemblage both spatially and temporally.
- 2.
I got ideas about the ‘socialist equality’, the ‘equality of opportunities’, and the ‘equality of redistribution’ from reading ‘A Conversation with Wang Hui’ (Battaglia 2013).
- 3.
The ‘three represents’ also legitimate the introduction of capitalism and market mechanism to the government itself, legitimate the accepting of entrepreneurs into the party, and produced many entrepreneur party-members. It is very market-oriented, enables the alliance of economic and political elites.
- 4.
Researching on communist party cadres’ training in contemporary China, Pieke (2009) notes that the party-state has developed specific disciplinary, educational and surveillance techniques which are part of a larger strategy of governmentality that takes the party-state and its leaders themselves as its object. This book gets many inspirations from his work.
- 5.
The author got inspiration from reading Brown (2006), who writes that in America the combination, collisions and convergences of neoliberalism and neoconservatism are the coming together of a market political rationality and a moral-political rationality. The moralism, statism, and authoritarianism of neoconservatism are enabled by neoliberal rationality, even the two are not concordant. The intersection of neoliberal and neoconservative rationalities produced new political form: ‘(1) the devaluation of political autonomy, (2) the transformation of political problems into individual problems with market solutions, (3) the production of the consumer-citizen as available to a heavy degree of governance and authority, and (4) the legitimation of statism’ (2006: 703).
- 6.
Stability, material prosperity, and the sense of national pride are viable sources of legitimation due to the recent Chinese history of humiliation in the world, the experiences and memories of many elderly and middle-aged people about deprivations, scarcity, instability, wars, and political movements during the Mao era and the time before Mao. Other researcher such as Pei (2014) writes that the party’s survival strategy relies on four pillars—robust growth, sophisticated repression, state-sponsored nationalism and co-opting of social elites.
- 7.
The traditional moral exemplar is different from the moral exemplar in current discourses. As Festa (2006) writes, while the conception of traditional Chinese model derived from a heavenly mandate, the modern moral regulation in the post-reform era is grounded in the secular rationality of the market economy, which is open to multiple appropriations within micro practices of everyday life.
- 8.
Many factors contribute to this disparity. The up-ward performance based political system makes local officials tend to respond to the upper level government, but show poor performance in the provision of public goods for the people below who lack power in surveillance and decision making. The discrepancy between the central and local images is also due to the conflicting policies promulgated at the centre which produce many ‘unfunded mandates’ to the local government (Birney 2014). Without being financially backed by the central government, the local government frequently directs their loyalty to the central but discounts its policy (Zhang 2011).
- 9.
It explicates that the patient should be at the centre of health care and the nature of health care as public goods should be restored.
- 10.
As an official from the Medical Reform Office of the State Council expressed in an interview: people’s dissatisfactions and complaints are the authority’s motivation for reform, health care reform cannot accomplish its intended result at one stroke, it needs to be carried out in practice and in many steps. The reform is an endless circle. It will be always on the way, always on-going without an end. (see ‘Liang Wannian interview: health care reform is always ongoing without an end’, from http://politics.people.com.cn/n1/2018/0305/c1001-29847274.html, retrieved 1 April, 2018).
- 11.
As Bloom et al. (2001) notes, China, compared with many other ex-command economies, has preserved a more effective health sector during a time of great transition, which was largely due to its management of transition—most changes have taken place under local experimental initiatives and then emulated by other localities.
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Tu, J. (2019). Conclusion: Moral Experience in a Socialist Neoliberal Polity. In: Health Care Transformation in Contemporary China . Springer, Singapore. https://doi.org/10.1007/978-981-13-0788-1_8
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