CASE STUDY : GOURMAND AND FOOD-A FABLE

The people of Gourmand loved good food. They ate in good restaurants, donated money for cooking research, and instructed their government to safeguard all matters having to do with food. Long ago, the food industry had been in total chaos. There were many restaurants, some very small. Anyone could call himself or herself a chef or open a restaurant. In choosing a restaurant, one could never be sure that the meal would be good. A commission of distinguished chefs studied the situation and recommended that no one be allowed to touch food except for qualified chefs. "Food is too important to be left to amateurs," they said. Qualified chefs were licensed by the state, and there were severe penalties for anyone else who engaged in cooking. Certain exceptions were made for food preparation in the home, but those meals could be served only to the family. Furthermore, a qualified chef had to complete at least 21 years of training (including 4 years of college, 4 years of cooking school, and a I-year apprenticeship). All cooking schools had to be first class.

These reforms did succeed in raising the quality of cooking, but a restaurant meal became substantially more expensive. A second commission observed that not everyone could afford to eat out. "No one," they said, "should be denied a good meal because of income." Furthermore, they argued that chefs should work toward the goal of giving everyone "complete physical and psychological satisfaction." The government declared that those people who could not afford to eat out should be allowed to do so as often as they liked, and the government would pay. For others, it was recommended that they organize themselves into groups and pay part of their income into a pool that would be used to pay the costs incurred by members in dining out. To ensure the greatest satisfaction, the groups were set up so that members could eat out anywhere and as often as they liked, their meals could be as elaborate as they desired, and they would have to pay nothing or only a small percentage of the cost. The cost of joining such prepaid dining clubs rose sharply. Long before this, most restaurants had employed only one chef to prepare the food.

A few restaurants had been more elaborate, with chefs specializing in roasting, fish, salads, sauces, and many other things. People had rarely gone to these elaborate restaurants because they had been so expensive. With the establishment of prepaid dining clubs, everyone wanted to eat at these fancy restaurants. At the same time, young chefs in school disdained going to cook in a small restaurant where they would have to cook everything. Specializing and cooking at a very fancy restaurant paid much better, and it was much more prestigious. Soon there were not enough chefs to keep the small restaurants open. With prepaid clubs and free meals for the poor, many people started eating three-course meals at the elaborate restaurants. Then restaurants began to increase the number of courses, directing the chefs to "serve the best with no thought for the bill." (Eventually, a meal was served that had 317 courses.) The costs of eating out rose faster and faster. A new government commission reported as follows:

1. Noting that licensed chefs were being used to peel potatoes and wash lettuce, the commission recommended that these tasks be handed over to licensed dishwashers (whose 3 years of dishwashing training included simple cooking courses) or to some new category of personnel.

2. Concluding that many licensed chefs were overworked, the commission recommended that cooking schools be expanded, that the length of training be shortened, and that applicants with lesser qualifications be admitted.

3. The commission also observed that chefs were unhappy because people seemed to be more concerned about the decor and service than about the food. (In a recent taste test, not only could one patron not tell the difference between a 1930 and a 1970 vintage, but he also could not distinguish between white and red wines. He explained that he always ordered the 1930 vintage because he knew that only a very good restaurant would stock such an expensive wine.)

The commission agreed that weighty problems faced the nation. They recommended that a national prepayment group be established, which everyone must join. They recommended that chefs continue to be paid on the basis of the number of dishes they prepared. They recommended that the Gourmandese be given the right to eat anywhere they chose and as elaborately as they chose and pay nothing.

These recommendations were adopted. Large numbers of people spent all of their time ordering incredibly elaborate meals. Kitchens became marvels of new, expensive equipment. All those who were not consuming restaurant food were in the kitchen preparing it. Because no one in Gourmand did anything except prepare or eat meals, the country collapsed.

QUESTIONS

1. Read and analyze the fable of Gourmand. Does the allegory fit delivery of healthcare in any country?

2. What other arrangements did you come across? ( consider an example of another health system)

3. What is, and what should be, the role of the consumer in healthcare?