Demarcation problem

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Demarcation_problem 

In philosophy of science and epistemology, the demarcation problem is the question of how to distinguish between science and non-science. It also examines the boundaries between science, pseudoscience and other products of human activity, like art and literature and beliefs. The debate continues after more than two millennia of dialogue among philosophers of science and scientists in various fields. The debate has consequences for what can be termed "scientific" in topics such as education and public policy.

The ancients

An early attempt at demarcation can be seen in the efforts of Greek natural philosophers and medical practitioners to distinguish their methods and their accounts of nature from the mythological or mystical accounts of their predecessors and contemporaries.

Aristotle described at length what was involved in having scientific knowledge of something. To be scientific, he said, one must deal with causes, one must use logical demonstration, and one must identify the universals which 'inhere' in the particulars of sense. But above all, to have science one must have apodictic certainty. It is the last feature which, for Aristotle, most clearly distinguished the scientific way of knowing.

— Larry Laudan, "The Demise of the Demarcation Problem" (1983)

G. E. R. Lloyd noted that there was a sense in which the groups engaged in various forms of inquiry into nature attempt to "legitimate their own positions", laying "claim to a new kind of wisdom ... that purported to yield superior enlightenment, even superior practical effectiveness." Medical writers of the Hippocratic tradition maintained that their discussions were based on demonstration of logical necessity, a theme developed by Aristotle in his Posterior Analytics. One element of this polemic for science was an insistence on a clear and unequivocal presentation of arguments, rejecting the imagery, analogy, and myth of the old wisdom. Some of their claimed naturalistic explanations of phenomena have been found to be quite fanciful, with little reliance on actual observations.

Cicero's De Divinatione implicitly used five criteria of scientific demarcation that are also used by modern philosophers of science.

Logical positivism

Main article: Logical positivism

Logical positivism, formulated during the 1920s, is the idea that only statements about matters of fact or logical relations between concepts are meaningful. All other statements lack sense and are labelled "metaphysics" (see the verifiability theory of meaning also known as verificationism).

According to A. J. Ayer, metaphysicians make statements which claim to have "knowledge of a reality which [transcends] the phenomenal world". Ayer, a member of the Vienna Circle and a noted English logical-positivist, argued that making any statements about the world beyond one's immediate sense-perception is impossible. This is because even metaphysicians' first premises will necessarily begin with observations made through sense-perception.

Ayer implied that the demarcation occurs when statements become "factually significant". To be "factually significant", a statement must be verifiable. In order to be verifiable, the statement must be verifiable in the observable world, or facts that can be induced from "derived experience". This is referred to as the "verifiability" criterion.

This distinction between science, which in the opinion of the Vienna Circle possessed empirically verifiable statements, and what they pejoratively termed "metaphysics", which lacked such statements, can be considered as representing another aspect of the demarcation problem. Logical positivism is often discussed in the context of the demarcation between science and non-science or pseudoscience. However, "The verificationist proposals had the aim of solving a distinctly different demarcation problem, namely that between science and metaphysics."

Falsifiability

Main article: Falsifiability

Karl Popper considered demarcation as a major problem of the philosophy of science. Popper articulates the problem of demarcation as:

The problem of finding a criterion which would enable us to distinguish between the empirical sciences on the one hand, and mathematics and logic as well as 'metaphysical' systems on the other, I call the problem of demarcation."

Falsifiability is the demarcation criterion proposed by Popper as opposed to verificationism: "statements or systems of statements, in order to be ranked as scientific, must be capable of conflicting with possible, or conceivable observations."

Against verifiability

Popper rejected solutions to the problem of demarcation that are grounded in inductive reasoning, and so rejected logical-positivist responses to the problem of demarcation. He argued that logical-positivists want to create a demarcation between the metaphysical and the empirical because they believe that empirical claims are meaningful and metaphysical ones are not. Unlike the Vienna Circle, Popper stated that his proposal was not a criterion of "meaningfulness".

Popper's demarcation criterion has been criticized both for excluding legitimate science ... and for giving some pseudosciences the status of being scientific ... According to Larry Laudan (1983, 121), it "has the untoward consequence of countenancing as 'scientific' every crank claim which makes ascertainably false assertions". Astrology, rightly taken by Popper as an unusually clear example of a pseudoscience, has in fact been tested and thoroughly refuted ... Similarly, the major threats to the scientific status of psychoanalysis, another of his major targets, do not come from claims that it is untestable but from claims that it has been tested and failed the tests.

— Sven Ove Hansson, The Stanford Encyclopedia of Philosophy, "Science and Pseudo-Science"

Popper argued that the Humean induction problem shows that there is no way to make meaningful universal statements on the basis of any number of empirical observations. Therefore, empirical statements are no more "verifiable" than metaphysical statements.

This creates a problem for the demarcation the positivists wanted to define between the empirical and the metaphysical. By their very own "verifiability criterion", Popper argued, the empirical is subsumed into the metaphysical, and the demarcation between the two becomes non-existent.

The solution of falsifiability

In Popper's later work, he stated that falsifiability is both a necessary and sufficient criterion for demarcation. He described falsifiability as a property of "the logical structure of sentences and classes of sentences", so that a statement's scientific or non-scientific status does not change over time. This has been summarized as a statement being falsifiable "if and only if it logically contradicts some (empirical) sentence that describes a logically possible event that it would be logically possible to observe".

Kuhnian postpositivism

Thomas Kuhn, an American historian and philosopher of science, is often associated with what has been termed postpositivism or postempiricism. In his 1962 book The Structure of Scientific Revolutions, Kuhn divided the process of doing science into two different endeavors, which he termed normal science and extraordinary science (sometimes known as "revolutionary science"), the latter of which introduces a new "paradigm" that solves new problems while continuing to provide solutions to the problems solved by the preceding paradigm.

Finally, and this is for now my main point, a careful look at the scientific enterprise suggests that it is normal science, in which Sir Karl's sort of testing does not occur, rather than extraordinary science which most nearly distinguishes science from other enterprises. If a demarcation criterion exists (we must not, I think, seek a sharp or decisive one), it may lie just in that part of science which Sir Karl ignores.

— Thomas S. Kuhn, "Logic of Discovery or Psychology of Research?", in Criticism and the Growth of Knowledge (1970), edited by Imre Lakatos and Alan Musgrave

Kuhn's view of demarcation is most clearly expressed in his comparison of astronomy with astrology. Since antiquity, astronomy has been a puzzle-solving activity and therefore a science. If an astronomer's prediction failed, then this was a puzzle that he could hope to solve for instance with more measurements or with adjustments of the theory. In contrast, the astrologer had no such puzzles since in that discipline "particular failures did not give rise to research puzzles, for no man, however skilled, could make use of them in a constructive attempt to revise the astrological tradition" ... Therefore, according to Kuhn, astrology has never been a science.

— Sven Ove Hansson, "Science and Pseudo-Science", in the Stanford Encyclopedia of Philosophy

Popper criticized Kuhn's demarcation criterion, saying that astrologers are engaged in puzzle solving, and that therefore Kuhn's criterion recognized astrology as a science. He stated that Kuhn's criterion results in a "major disaster ... [the] replacement of a rational criterion of science by a sociological one".

Feyerabend and Lakatos

Kuhn's work largely called into question Popper's demarcation, and emphasized the human, subjective quality of scientific change. Paul Feyerabend was concerned that the very question of demarcation was insidious: science itself had no need of a demarcation criterion, but instead some philosophers were seeking to justify a special position of authority from which science could dominate public discourse. Feyerabend argued that science is not in fact special in terms of either its logic or method, and no claim to special authority made by scientists can be sustained. He argued that, within the history of scientific practice, no rule or method can be found that has not been violated or circumvented at some point in order to advance scientific knowledge. Both Imre Lakatos and Feyerabend suggest that science is not an autonomous form of reasoning, but is inseparable from the larger body of human thought and inquiry.

Thagard

Paul R. Thagard proposed another set of principles to try to overcome these difficulties, and argued that it is important for society to find a way of doing so. According to Thagard's method, a theory is not scientific if it satisfies two conditions:

1. The theory has been less progressive than alternative theories over a long period of time, and has many unsolved problems; and...
2. The community of practitioners makes little attempt to develop the theory towards solutions of the problems, shows no concern for attempts to evaluate the theory in relation to others, and is selective in considering confirmations and disconfirmations.

Thagard specified that sometimes theories will spend some time as merely "unpromising" before they truly deserve the title of pseudoscience. He cited astrology as an example: it was stagnant compared to advances in physics during the 17th century, and only later became "pseudoscience" in the advent of alternative explanations provided by psychology during the 19th century.

Thagard also stated that his criteria should not be interpreted so narrowly as to allow willful ignorance of alternative explanations, or so broadly as to discount our modern science compared to science of the future. His definition is a practical one, which generally seeks to distinguish pseudoscience as areas of inquiry which are stagnant and without active scientific investigation.

Some historians' perspectives

Many historians of science are concerned with the development of science from its primitive origins; consequently they define science in sufficiently broad terms to include early forms of natural knowledge. In the article on science in the eleventh edition of the Encyclopædia Britannica, the scientist and historian William Cecil Dampier Whetham defined science as "ordered knowledge of natural phenomena and of the relations between them". In his study of Greek science, Marshall Clagett defined science as "first, the orderly and systematic comprehension, description and/or explanation of natural phenomena and, secondly, the [mathematical and logical] tools necessary for the undertaking". A similar definition appeared more recently in David Pingree's study of early science: "Science is a systematic explanation of perceived or imaginary phenomena, or else is based on such an explanation. Mathematics finds a place in science only as one of the symbolical languages in which scientific explanations may be expressed." These definitions tend to emphasize the subject matter of science rather than its method and from these perspectives, the philosophical concern to establish a demarcation between science and non-science becomes "problematic, if not futile".

Laudan

Larry Laudan concluded, after examining various historical attempts to establish a demarcation criterion, that "philosophy has failed to deliver the goods" in its attempts to distinguish science from non-science—to distinguish science from pseudoscience. None of the past attempts would be accepted by a majority of philosophers nor, in his opinion, should they be accepted by them or by anyone else. He stated that many well-founded beliefs are not scientific and, conversely, many scientific conjectures are not well-founded. He also stated that demarcation criteria were historically used as machines de guerre in polemical disputes between "scientists" and "pseudo-scientists". Advancing a number of examples from everyday practice of football and carpentry and non-scientific scholarship such as literary criticism and philosophy, he considered the question of whether a belief is well-founded or not to be more practically and philosophically significant than whether it is scientific or not. In his judgment, the demarcation between science and non-science was a pseudo-problem that would best be replaced by examining the distinction between reliable and unreliable knowledge, without bothering to ask whether that knowledge is scientific or not. He would consign phrases like "pseudo-science" or "unscientific" to the rhetoric of politicians or sociologists.

Modern proposals

Others have disagreed with Laudan. Sebastian Lutz, for example, argued that demarcation does not have to be a single necessary and sufficient condition as Laudan implied. Rather, Laudan's reasoning at most establishes that there has to be one necessary criterion and one possibly different sufficient criterion.

Various typologies or taxonomies of sciences versus nonsciences, and reliable knowledge versus illusory knowledge, have been proposed. Ian Hacking, Massimo Pigliucci, and others have noted that the sciences generally conform to Ludwig Wittgenstein's concept of family resemblances.

Other critics have argued for multiple demarcation criteria, some suggesting that there should be one set of criteria for the natural sciences, another set of criteria for the social sciences, and claims involving the supernatural could have a set of pseudoscientific criteria. Anthropologist Sean M. Rafferty of the University at Albany, SUNY in his text Misanthropology: Science, Pseudoscience, and the Study of Humanity contrasts science and pseudoscience within his discipline thusly:

[E]ven for those subfields where there is a significant element of interpretation, those interpretations are still based on and constrained by physical evidence. And interpretations are always provisional, pending possible refutation by contradictory evidence ... Pseudoscience, by comparison, is scornful of evidence. The pseudoscientist reaches a preferred conclusion in advance, then selects evidence, often removed from any relevant context, to lend supposed support for their conclusions. Often the preconceived conclusion is one that justifies some closely held identity or ideology. Contradictory evidence is waved away or ignored, and as a last resort, one can always claim conspiracy to keep pseudoscientific ideas suppressed.

In 2025, Springer Nature published the monograph A Working Scientific Demarcation, by Damian Fernandez-Beanato, which purports to use multi-criterial meta-analyses to offer the first working general solution to the demarcation problem.

Significance

Concerning science education, Michael D. Gordin wrote:

Every student in public or private schools takes several years of science, but only a small fraction of them pursue careers in the sciences. We teach the rest of them so much science so that they will appreciate what it means to be scientific – and, hopefully, become scientifically literate and apply some of those lessons in their lives. For such students, the myth of a bright line of demarcation is essential.

Discussions of the demarcation problem concern the rhetoric of science and promote critical thinking, which is important for democracy. For example, Gordin stated: "Demarcation remains essential for the enormously high political stakes of climate-change denial and other anti-regulatory fringe doctrines".

Philosopher Herbert Keuth [de] noted:

Perhaps the most important function of the demarcation between science and nonscience is to refuse political and religious authorities the right to pass binding judgments on the truth of certain statements of fact.

Concern for informed human nutrition resulted in the following note in 1942:

If our boys and girls are to be exposed to the superficial and frequently ill-informed statements about science and medicine made over the radio and in the daily press, it is desirable, if not necessary, that some corrective in the form of accurate factual information be provided in the schools. Although this is not a plea that chemistry teachers should at once introduce the study of proteins into their curricula, it is a suggestion that they should at least inform themselves and become prepared to answer questions and counteract the effects of misinformation.

The demarcation problem has been compared to the problem of differentiating fake news from real news, which became prominent during the 2016 United States presidential election.

Sokal affair

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Sokal_affair

The Sokal affair, also known as the Sokal hoax, was a demonstrative scholarly hoax performed by Alan Sokal, a physics professor at New York University and University College London. In 1996, Sokal submitted an article to Social Text, an academic journal of cultural studies. The submission was an experiment to test the journal's intellectual rigor, specifically to investigate whether "a leading North American journal of cultural studies—whose editorial collective includes such luminaries as Fredric Jameson and Andrew Ross—[would] publish an article liberally salted with nonsense if (a) it sounded good and (b) it flattered the editors' ideological preconceptions."

The article, "Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity", was published in the journal's Spring/Summer 1996 "Science Wars" issue. It proposed that quantum gravity is a social and linguistic construct. The journal did not practice academic peer review at the time, so it did not submit the article for outside expert review by a physicist. Three weeks after its publication in May 1996, Sokal revealed in the magazine Lingua Franca that the article was a hoax.

The hoax caused controversy about the scholarly merit of commentary on the physical sciences by those in the humanities; the influence of postmodern philosophy on social disciplines in general; and academic ethics, including whether Sokal was wrong to deceive the editors or readers of Social Text; and whether Social Text had abided by proper scientific ethics.

In 2008, Sokal published Beyond the Hoax, which revisited the history of the hoax and discussed its lasting implications.

Background

Sokal in 2011

In an interview on the U.S. radio program All Things Considered, Sokal said he was inspired to submit the bogus article after reading Higher Superstition (1994), in which authors Paul R. Gross and Norman Levitt claim that some humanities journals will publish anything as long as it has "the proper leftist thought" and quoted (or was written by) well-known leftist thinkers.

Gross and Levitt had been defenders of the philosophy of scientific realism, opposing postmodernist academics who questioned scientific objectivity. They asserted that anti-intellectual sentiment in liberal arts departments (especially English departments) caused the increase of deconstructionist thought, which eventually resulted in a deconstructionist critique of science. They saw the critique as a "repertoire of rationalizations" for avoiding the study of science.

Article

Sokal reasoned that if the presumption of editorial laziness was correct, the nonsensical content of his article would be irrelevant to whether the editors would publish it. What would matter would be ideological obsequiousness, fawning references to deconstructionist writers, and sufficient quantities of the appropriate jargon. After the article was published and the hoax revealed, he wrote:

The results of my little experiment demonstrate, at the very least, that some fashionable sectors of the American academic Left have been getting intellectually lazy. The editors of Social Text liked my article because they liked its conclusion: that "the content and methodology of postmodern science provide powerful intellectual support for the progressive political project" [sec. 6]. They apparently felt no need to analyze the quality of the evidence, the cogency of the arguments, or even the relevance of the arguments to the purported conclusion.

Content of the article

"Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity" proposed that quantum gravity has progressive political implications, and that the "morphogenetic field" could be a valid theory of quantum gravity. (A morphogenetic field is a concept adapted by Rupert Sheldrake in a way that Sokal characterized in the affair's aftermath as "a bizarre New Age idea".) Sokal wrote that the concept of "an external world whose properties are independent of any individual human being" was "dogma imposed by the long post-Enlightenment hegemony over the Western intellectual outlook".

After referring skeptically to the "so-called scientific method", the article declared that "it is becoming increasingly apparent that physical 'reality'" is fundamentally "a social and linguistic construct." It went on to state that because scientific research is "inherently theory-laden and self-referential", it "cannot assert a privileged epistemological status with respect to counterhegemonic narratives emanating from dissident or marginalized communities", and that therefore a "liberatory science" and an "emancipatory mathematics", spurning "the elite caste canon of 'high science'", needed to be established for a "postmodern science [that] provide[s] powerful intellectual support for the progressive political project."

Moreover, the article's footnotes conflate academic terms with sociopolitical rhetoric, e.g.:

Just as liberal feminists are frequently content with a minimal agenda of legal and social equality for women and "pro-choice", so liberal (and even some socialist) mathematicians are often content to work within the hegemonic Zermelo–Fraenkel framework (which, reflecting its nineteenth-century liberal origins, already incorporates the axiom of equality) supplemented only by the axiom of choice.

Publication

Sokal submitted the article to Social Text, whose editors were collecting articles for the "Science Wars" issue. "Transgressing the Boundaries" was notable as an article by a natural scientist; biologist Ruth Hubbard also had an article in the issue. Later, after Sokal revealed the hoax in Lingua Franca, Social Text's editors wrote that they had requested editorial changes that Sokal refused to make, and had had concerns about the quality of the writing: "We requested him (a) to excise a good deal of the philosophical speculation and (b) to excise most of his footnotes." Still, despite calling Sokal a "difficult, uncooperative author", and noting that such writers were "well known to journal editors", based on Sokal's credentials Social Text published the article in the May 1996 Spring/Summer "Science Wars" issue. The editors did not seek peer review of the article by physicists or otherwise; they later defended this decision on the basis that Social Text was a journal of open intellectual inquiry and the article was not offered as a contribution to physics.

Responses

Follow-up between Sokal and the editors

In the article "A Physicist Experiments With Cultural Studies" in the May 1996 issue of Lingua Franca, Sokal revealed that "Transgressing the Boundaries" was a hoax and concluded that Social Text "felt comfortable publishing an article on quantum physics without bothering to consult anyone knowledgeable in the subject" because of its ideological proclivities and editorial bias.

In their defense, Social Text's editors said they believed that Sokal's essay "was the earnest attempt of a professional scientist to seek some kind of affirmation from postmodern philosophy for developments in his field" and that "its status as parody does not alter, substantially, our interest in the piece, itself, as a symptomatic document." Besides criticizing his writing style, Social Text's editors accused Sokal of behaving unethically in deceiving them.

Sokal said the editors' response demonstrated the problem that he sought to identify. Social Text, as an academic journal, published the article not because it was faithful, true, and accurate to its subject, but because an "academic authority" had written it and because of the appearance of the obscure writing. The editors said they considered it poorly written but published it because they felt Sokal was an academic seeking their intellectual affirmation. Sokal remarked:

My goal isn't to defend science from the barbarian hordes of lit crit (we'll survive just fine, thank you), but to defend the Left from a trendy segment of itself. ... There are hundreds of important political and economic issues surrounding science and technology. Sociology of science, at its best, has done much to clarify these issues. But sloppy sociology, like sloppy science, is useless, or even counterproductive.

He claimed that Social Text's response revealed that none of the editors had suspected his piece was a parody. Instead, they speculated his admission "represented a change of heart, or a folding of his intellectual resolve". Sokal found further humor in the idea that the article's absurdity was hard to spot:

In the second paragraph I declare without the slightest evidence or argument, that "physical 'reality' (note the scare quotes) ... is at bottom a social and linguistic construct." Not our theories of physical reality, mind you, but the reality itself. Fair enough. Anyone who believes that the laws of physics are mere social conventions is invited to try transgressing those conventions from the windows of my apartment. I live on the twenty-first floor.

Book by Sokal and Bricmont

Main article: Fashionable Nonsense

In 1997, Sokal and Jean Bricmont co-wrote Impostures intellectuelles (published in the US as Fashionable Nonsense: Postmodern Intellectuals' Abuse of Science and in the UK as Intellectual Impostures, 1998). The book featured analysis of extracts from established intellectuals' writings that Sokal and Bricmont claimed misused scientific terminology. It closed with a critical summary of postmodernism and criticism of the strong programme of social constructionism in the sociology of scientific knowledge.

In 2008, Sokal published a followup book, Beyond the Hoax, which revisited the history of the hoax and discussed its lasting implications.

Jacques Derrida

The French philosopher Jacques Derrida, whose 1966 statement about Einstein's theory of relativity was quoted in Sokal's paper, was singled out for criticism, particularly in U.S. newspaper coverage of the hoax. One weekly magazine used two images of him, a photo and a caricature, to illustrate a "dossier" on Sokal's paper. Arkady Plotnitsky commented:

Even given Derrida's status as an icon of intellectual controversy on the Anglo-American cultural scene, it is remarkable that out of thousands of pages of Derrida's published works, a single extemporaneous remark on relativity made in 1966 (before Derrida was "the Derrida" and, in a certain sense, even before "deconstruction") ... is made to stand for nearly all of deconstructive or even postmodernist (not a term easily, if at all, applicable to Derrida) treatments of science.

Derrida later responded to the hoax in "Sokal et Bricmont ne sont pas sérieux" ("Sokal and Bricmont Aren't Serious"), first published on November 20, 1997, in Le Monde. He called Sokal's action "sad" for having trivialized Sokal's mathematical work and "ruining the chance to carefully examine controversies" about scientific objectivity. Derrida then faulted him and Bricmont for what he considered "an act of intellectual bad faith" in their follow-up book, Impostures intellectuelles: they had published two articles almost simultaneously, one in English in The Times Literary Supplement on October 17, 1997 and one in French in Libération on October 18–19, 1997, but while the two articles were almost identical, they differed in how they treated Derrida.

The English-language article had a list of French intellectuals who were not included in Sokal's and Bricmont's book: "Such well-known thinkers as Althusser, Barthes, and Foucault—who, as readers of the TLS will be well aware, have always had their supporters and detractors on both sides of the Channel—appear in our book only in a minor role, as cheerleaders for the texts we criticize." The French-language list, however, included Derrida: "Des penseurs célèbres tels qu'Althusser, Barthes, Derrida et Foucault sont essentiellement absents de notre livre" ("Famous thinkers such as Althusser, Barthes, Derrida and Foucault are essentially absent from our book").

According to Brian Reilly, Derrida may also have been sensitive to another difference between the French and English versions of Impostures intellectuelles. In the French, his citation from the original hoax article is said to be an "isolated" instance of abuse, whereas the English text adds a parenthetical remark that Derrida's work contained "no systematic misuse (or indeed attention to) science".

Sokal and Bricmont insisted that the difference between the articles was "banal". Nevertheless, Derrida concluded that Sokal was not serious in his method, but had used the spectacle of a "quick practical joke" to displace the scholarship Derrida believed the public deserved.

Criticism of social sciences

Sociologist Stephen Hilgartner, chairman of Cornell University's science and technology studies department, wrote "The Sokal Affair in Context" (1997), comparing Sokal's hoax to "Confirmational Response: Bias Among Social Work Journals" (1990), an article by William M. Epstein published in Science, Technology, & Human Values. Epstein used a similar method to Sokal's, submitting fictitious articles to real academic journals to measure their response. Though much more systematic than Sokal's work, it received scant media attention. Hilgartner argued that the "asymmetric" effect of the successful Sokal hoax compared with Epstein's experiment cannot be attributed to its quality, but that "[t]hrough a mechanism that resembles confirmatory bias, audiences may apply less stringent standards of evidence and ethics to attacks on targets that they are predisposed to regard unfavorably." As a result, according to Hilgartner, though competent in terms of method, Epstein's experiment was largely muted by the more socially accepted social work discipline he critiqued, while Sokal's attack on cultural studies, despite lacking experimental rigor, was accepted. Hilgartner also argued that Sokal's hoax reinforced the views of well-known pundits such as George Will and Rush Limbaugh, so that his opinions were amplified by media outlets predisposed to agree with his argument.

The Sokal Affair extended from academia to the public press. Anthropologist Bruno Latour, who was criticized in Fashionable Nonsense, described the scandal as a "tempest in a teacup". Retired Northeastern University mathematician-turned social scientist Gabriel Stolzenberg wrote essays criticizing the statements of Sokal and his allies, arguing that they insufficiently grasped the philosophy they criticized, rendering their criticism meaningless. In Social Studies of Science, Bricmont and Sokal responded to Stolzenberg, denouncing his representations of their work and criticizing his commentary about the "strong programme" of the sociology of science. Stolzenberg replied in the same issue that their critique and allegations of misrepresentation were based on misreadings. He advised readers to slowly and skeptically examine the arguments of each party, bearing in mind that "the obvious is sometimes the enemy of the true". In her 1998 article "The Sokal Hoax: At Whom Are We Laughing?", philosopher of science Mara Beller compared the "awe" physicists feel for Bohr's obscurity to their "contempt" for Derrida's density.

Influence

Sociological follow-up study

In 2009, Cornell sociologist Robb Willer performed an experiment in which undergraduate students read Sokal's paper and were told either that it was written by another student or that it was by a famous academic. He found that students who believed the paper's author was a high-status intellectual rated it better in quality and intelligibility.

Sokal III

In October 2021, the scholarly journal Higher Education Quarterly published a bogus article "authored" by "Sage Owens" and "Kal Avers-Lynde III". The initials stand for "Sokal III". The Quarterly retracted the article.

Universal health care

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Universal_health_care 

Universal health care by country (2010)

Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

Some universal healthcare systems are government-funded, while others are based on a requirement that all citizens purchase private health insurance. Universal healthcare can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered. It is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship. Then-Director General of the WHO Margaret Chan described universal health coverage as the "single most powerful concept that public health has to offer" since it unifies "services and delivers them in a comprehensive and integrated way". One of the goals with universal healthcare is to create a system of protection which provides equality of opportunity for people to enjoy the highest possible level of health. Critics say that universal healthcare leads to longer wait times and worse quality healthcare.

As part of Sustainable Development Goals, United Nations member states have agreed to work toward worldwide universal health coverage by 2030. Therefore, the inclusion of the universal health coverage (UHC) within the SDGs targets can be related to the reiterated endorsements operated by the WHO.

History

See also: List of countries with universal health care

Note: Links in table are "Healthcare in COUNTRY".

Universal health care start date

Country	Year
Algeria	1975
Armenia	2023
Australia	1975
Austria	1967
Bahrain	1957
Belgium	1945
Bhutan	1970
Brazil	1988
Brunei	1958
Canada	1966
China	2009
Cyprus	1980
Denmark	1973
Finland	1972
France	1974
Germany	1941
Greece	1983
Hong Kong	1993
Iceland	1990
Indonesia	2014
Ireland	1977
Israel	1995
Italy	1978
Japan	1961
Kuwait	1950
Luxembourg	1973
Malaysia	1980s
Netherlands	1966
New Zealand	1938
Norway	1956
Portugal	1979
Russia	1918
Saudi Arabia	2019
Singapore	1993
Slovenia	1972
South Korea	1988
Spain	1986
Sweden	1955
Switzerland	1994
Taiwan	1995
Turkey	2003
United Arab Emirates	1971
United Kingdom	1948

The first move towards a national health insurance system was launched in Germany in 1883, with the Sickness Insurance Law. Industrial employers were mandated to provide injury and illness insurance for their low-wage workers, and the system was funded and administered by employees and employers through "sick funds", which were drawn from deductions in workers' wages and from employers' contributions. This social health insurance model, named the Bismarck Model after Prussian Chancellor Otto von Bismarck, was the first form of universal care in modern times.

Other countries soon began to follow suit. In the United Kingdom, the National Insurance Act 1911 provided coverage for primary care (but not specialist or hospital care) for wage earners, covering about one-third of the population. The Russian Empire established a similar system in 1912, and other industrialized countries began following suit. By the 1930s, similar systems existed in virtually all of Western and Central Europe. Japan introduced an employee health insurance law in 1927, expanding further upon it in 1935 and 1940.

Following the Russian Revolution of 1917, the Bolsheviks established the world's first fully free and universal health care system in Soviet Russia in July 1918. The system was highly centralized, and while nominally any person regardless of his status was covered, the actual coverage, especially in the more remote and impoverished areas was virtually non-existent.

In New Zealand, a universal health care system was created in a series of steps, from 1938 to 1941. In Australia, the state of Queensland introduced a free public hospital system in 1946.

Following World War II, universal health care systems began to be set up around the world. On July 5, 1948, the United Kingdom launched its universal National Health Service. Universal health care was next introduced in the Nordic countries of Sweden (1955), Iceland (1956), Norway (1956), Denmark (1961) and Finland (1964). Universal health insurance was introduced in Japan in 1961, and in Canada through stages, starting with the province of Saskatchewan in 1962, followed by the rest of Canada from 1968 to 1972. A public healthcare system was introduced in Egypt following the Egyptian revolution of 1952. Centralized public healthcare systems were set up in the Eastern bloc countries. The Soviet Union extended universal health care to its rural residents in 1969. Kuwait and Bahrain introduced their universal healthcare systems in 1950 and 1957 respectively (prior to independence). Italy introduced its Servizio Sanitario Nazionale (National Health Service) in 1978. Universal health insurance was implemented in Australia in 1975 with the Medibank, which led to universal coverage under the current Medicare system from 1984.

From the 1970s to the 2000s, Western European countries began introducing universal coverage, most of them building upon previous health insurance programs to cover the whole population. For example, France built upon its 1928 national health insurance system, with subsequent legislation covering a larger and larger percentage of the population, until the remaining 1% of the population that was uninsured received coverage in 2000. Single payer healthcare systems were introduced in Finland (1972), Portugal (1979), Cyprus (1980), Spain (1986) and Iceland (1990). Switzerland introduced a universal healthcare system based on an insurance mandate in 1994. In addition, universal health coverage was introduced in some Asian countries, including Malaysia (1980s), South Korea (1989), Taiwan (1995), Singapore (1993), Israel (1995) and Thailand (2001).

Following the collapse of the Soviet Union, Russia retained and reformed its universal health care system, as did other now-independent former Soviet republics and Eastern bloc countries.

Beyond the 1990s, many countries in Latin America, the Caribbean, Africa and the Asia-Pacific region, including developing countries, took steps to bring their populations under universal health coverage, including China and Brazil's SUS which improved coverage up to 80% of the population. Taiwan implemented its system in 1995. India introduced a tax-payer funded decentralised universal healthcare system as well as comprehensive public and private health insurances that helped reduce mortality rates drastically and improved healthcare infrastructure across the country dramatically. A 2012 study examined progress being made by these countries, focusing on nine in particular: Ghana, Rwanda, Nigeria, Mali, Kenya, Indonesia, the Philippines and Vietnam.

Currently, most industrialized countries and many developing countries operate some form of publicly funded health care with universal coverage as the goal. According to the National Academy of Medicine and others, the United States is the only wealthy, industrialized nation that does not provide universal health care. The only forms of government-provided healthcare available are Medicare (for elderly patients above age 65 as well as people with disabilities), Medicaid (for low-income people), the Children's Health Insurance Program (for children in families of modest income, but too high to qualify for Medicaid), the Military Health System (active, reserve, and retired military personnel and dependants), and the Indian Health Service (members of federally recognized Native American tribes).

Funding models

See also: Health care economics

Health spending by country. Percent of GDP (Gross domestic product). For example: 11.2% for Canada in 2022. 16.6% for the United States in 2022.

Total healthcare cost per person. Public and private spending. US dollars PPP. For example: $6,319 for Canada in 2022. $12,555 for the US in 2022.

Universal health care in most countries has been achieved by a mixed model of funding. General taxation revenue is the primary source of funding, but in many countries it is supplemented by specific charge (which may be charged to the individual or an employer) or with the option of private payments (by direct or optional insurance) for services beyond those covered by the public system. Almost all European systems are financed through a mix of public and private contributions. Most universal health care systems are funded primarily by tax revenue (as in Portugal, India, Spain, Denmark and Sweden). Some nations, such as Germany, France, and Japan, employ a multi-payer system in which health care is funded by private and public contributions. However, much of the non-government funding comes from contributions from employers and employees to regulated non-profit sickness funds. Contributions are compulsory and defined according to law. A distinction is also made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, specialty healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and medications are paid for by a state agency. Universal health care financing can range from premiums to fees which increase with income. Universal health care systems can have redistributive effects.

Compulsory insurance

Main article: National health insurance

This is usually enforced via legislation requiring residents to purchase insurance, but sometimes the government provides the insurance. Sometimes there may be a choice of multiple public and private funds providing a standard service (as in Germany) or sometimes just a single public fund. Healthcare in Switzerland is based on compulsory insurance.

In some European countries where private insurance and universal health care coexist, such as Germany, Belgium and the Netherlands, the problem of adverse selection is overcome by using a risk compensation pool to equalize, as far as possible, the risks between funds. Thus, a fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price and there is no advantage in eliminating people with higher risks because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but they compete mainly on price and service. In some countries, the basic coverage level is set by the government and cannot be modified.

The Republic of Ireland at one time had a "community rating" system by VHI, effectively a single-payer or common risk pool. The government later opened VHI to competition, but without a compensation pool. That resulted in foreign insurance companies entering the Irish market and offering much less expensive health insurance to relatively healthy segments of the market, which then made higher profits at VHI's expense. The government later reintroduced community rating by a pooling arrangement and at least one main major insurance company, Bupa, withdrew from the Irish market.

In Poland, people are obliged to pay a percentage of the average monthly wage to the state, even if they are covered by private insurance. People working under a employment contract pay a percentage of their wage, while entrepreneurs pay a fixed rate, based on the average national wage. Unemployed people are insured by the labor office.

Among the potential solutions posited by economists are single-payer systems as well as other methods of ensuring that health insurance is universal, such as by requiring all citizens to purchase insurance or by limiting the ability of insurance companies to deny insurance to individuals or vary price between individuals.

Single-payer

Main article: Single-payer healthcare

Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs. Single-payer systems may contract for healthcare services from private organizations, or own and employ healthcare resources and personnel (as was the case in England before the introduction of the Health and Social Care Act). In some instances, such as Italy and Spain, both these realities may exist at the same time. "Single-payer" thus describes only the funding mechanism and refers to health care financed by a single public body from a single fund and does not specify the type of delivery or for whom doctors work. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.

Tax-based financing

In tax-based financing, individuals contribute to the provision of health services through various taxes. These are typically pooled across the whole population unless local governments raise and retain tax revenues. Some countries (notably Spain, the United Kingdom, Ireland, New Zealand, Italy, Brazil, Portugal, India and the Nordic countries) choose to fund public health care directly from taxation alone. Other countries with insurance-based systems effectively meet the cost of insuring those unable to insure themselves via social security arrangements funded from taxation, either by directly paying their medical bills or by paying for insurance premiums for those affected.

Social health insurance

Main article: Bismarck Model

In a social health insurance system, contributions from workers, the self-employed, enterprises and governments are pooled into single or multiple funds on a compulsory basis. This is based on risk pooling. The social health insurance model is also referred to as the Bismarck Model, after German Chancellor Otto von Bismarck, who introduced the first universal health care system in Germany in the 19th century. The funds typically contract with a mix of public and private providers for the provision of a specified benefit package. Preventive and public health care may be provided by these funds or responsibility kept solely by the Ministry of Health. Within social health insurance, a number of functions may be executed by parastatal or non-governmental sickness funds, or in a few cases, by private health insurance companies. Social health insurance is used in a number of Western European countries and increasingly in Eastern Europe as well as in Israel and Japan.

Private insurance

See also: Health insurance marketplace

In private health insurance, premiums are paid directly from employers, associations, individuals and families to insurance companies, which pool risks across their membership base. Private insurance includes policies sold by commercial for-profit firms, non-profit companies and community health insurers. Generally, private insurance is voluntary in contrast to social insurance programs, which tend to be compulsory.

In some countries with universal coverage, private insurance often excludes certain health conditions that are expensive and the state health care system can provide coverage. For example, in the United Kingdom, one of the largest private health care providers is Bupa, which has a long list of general exclusions even in its highest coverage policy, most of which are routinely provided by the National Health Service. In the Netherlands, which has regulated competition for its main insurance system (but is subject to a budget cap), insurers must cover a basic package for all enrollees, but may choose which additional services they offer in supplementary plans; which most people possess.

The Planning Commission of India has also suggested that the country should embrace insurance to achieve universal health coverage. General tax revenue is currently used to meet the essential health requirements of all people.

Community-based health insurance

A particular form of private health insurance that has often emerged, if financial risk protection mechanisms have only a limited impact, is community-based health insurance. Individual members of a specific community pay to a collective health fund which they can draw from when they need medical care. Contributions are not risk-related and there is generally a high level of community involvement in the running of these plans. Community-based health insurance generally only play a limited role in helping countries move towards universal health coverage. Challenges includes inequitable access by the poorest that health service utilization of members generally increase after enrollment.

Implementation and comparisons

For a more comprehensive list, see List of countries with universal health care.

See also: Health system and Health care systems by country

Health spending per capita, in US$ purchasing power parity-adjusted, among various OECD countries. For later data see List of countries by total health expenditure per capita.

Universal health care systems vary according to the degree of government involvement in providing care or health insurance. In some countries, such as Canada, the UK, Italy, Australia, and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights, not on the purchase of insurance. Others have a much more pluralistic delivery system, based on obligatory health with contributory insurance rates related to salaries or income and usually funded by employers and beneficiaries jointly. Subnational disparities remain a barrier to achieving total coverage in emerging economies.

Sometimes, the health funds are derived from a mixture of insurance premiums, salary-related mandatory contributions by employees or employers to regulated sickness funds, and by government taxes. These insurance based systems tend to reimburse private or public medical providers, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries, such as the Netherlands and Switzerland, operate via privately owned but heavily regulated private insurers, which are not allowed to make a profit from the mandatory element of insurance but can profit by selling supplemental insurance.

Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually, some costs are borne by the patient at the time of consumption, but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others, tax revenues are used either to fund insurance for the very poor or for those needing long-term chronic care.

A critical concept in the delivery of universal healthcare is that of population healthcare. This is a way of organizing the delivery, and allocating resources, of healthcare (and potentially social care) based on populations in a given geography with a common need (such as asthma, end of life, urgent care). Rather than focus on institutions such as hospitals, primary care, community care etc. the system focuses on the population with a common as a whole. This includes people currently being treated, and those that are not being treated but should be (i.e. where there is health inequity). This approach encourages integrated care and a more effective use of resources.

The United Kingdom National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the United States), and their relative costs and key health outcomes. A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004. In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.

Health Coverage Reports

The 2023 report from the WHO and the World Bank indicates that the advancement towards Universal Health Coverage (UHC) by the year 2030 has not progressed since 2015. The UHC Service Coverage Index (SCI) has remained constant at a score of 68 from 2019 to 2021. It is reported that catastrophic out-of-pocket (OOP) health expenditures have impacted over 1 billion individuals globally. Additionally, in the year 2019, it was found that 2 billion people experienced financial difficulties due to health expenses, with ongoing, significant disparities in coverage. The report suggests several strategies to mitigate these challenges: it calls for the acceleration of essential health services, sustained attention to infectious disease management, improvement in health workforce and infrastructure, the elimination of financial barriers to care, an increase in pre-paid and pooled health financing, policy initiatives to curtail OOP expenses, a focus on primary healthcare to reinforce overall health systems, and the fortification of collaborative efforts to achieve UHC. These measures aim to increase health service coverage by an additional 477 million individuals by the year 2023 and to continue progress towards covering an extra billion people by the 2030 deadline.

Politics

See also: Health politics and Health policy

Critics of universal healthcare claim that it leads to longer wait times and a decrease in the quality of healthcare. They claim that quality is lower due to budget constraints and overburdened medical staff. For example, many patients in Canada may go to the United States for medical care due to the long wait times. Some believe that government-run healthcare systems are less efficient than private ones, leading to potential waste and mismanagement. Other critics point out the potential of overuse and abuse leading to insolvency. Relatedly, some also argue that universal health care can be extremely expensive for governments to maintain, leading to higher taxes and potential strain on public finances, such as those in the Nordic countries, Australia, and New Zealand. For countries that do not currently have universal healthcare like the United States, they argue it would raise healthcare expenditures due to the high cost of implementation that the United States government supposedly cannot afford.

However, most of the resistance to universal healthcare in the United States is rooted in ideology. For example, critics of implementing universal healthcare in the United States claim that it would require healthy people to pay for the medical care of unhealthy people, which goes against the American values of personal responsibility. Also, they argue it represents unnecessary government overreach into the lives of American citizens and employers as it denies them individual choice. In other words, it may limit the choices available to patients, as the government may control which treatments and medications are covered. Lastly, it would unfairly limit the healthcare and health insurance industry.

According to a 2020 study published in The Lancet, the proposed Medicare for All Act would save 68,000 lives and $450 billion in national healthcare expenditure annually. A 2022 study published in the PNAS found that a single-payer universal healthcare system would have saved 212,000 lives and averted over $100 billion in medical costs during the COVID-19 pandemic in the United States in 2020 alone. Given the high prevalence of uninsured and under-insured people in the United States, if implemented, universal health care would increase health care access for more than 25 million Americans.