My interest in David Graeber’s extraordinary book “Debt: The First 5, 000 Years” stems from my work on incentives in healthcare. I don’t have much to say about debt and political economy. On these matters I am an ordinary citizen-punter and the most sophistication I can muster is to parrot John Lanchester’s better lines. But I know a little bit about incentives, and here I want to say a few things about the connections.
The current debate about incentives in healthcare can be split in half. One half concerns the use of incentives to motivate professionals and institutions to provide better, or different, care and services to patients and clients, citizens and customers. This is a very important debate, with roots in Adam Smith’s suspicion of professions as conspiracies against the public, the public choice theorists’ suspicion of regulation by rule-making, and the management consultant’s belief that people’s behaviour at work is driven principally by the available rewards.
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