You’d Better Suffer for a Good Reason: Existential Economics and Individual Responsibility in Healthcare

Christian Arnsperger and Christian Léonard

Table of Contents


This article brings the approach of existential economics to bear on issues of collective distribution of health care and of personal responsibility in health policies. After outlining an existential perspective on economic life, according to which economic rationality is underpinned by a fundamental quest of agents for immortality rooted in a deep-seated denial of death, we suggest a critical analysis of the logic of contemporary capitalism and then apply these insights to the issue of individual responsibility in contemporary health care systems. Within the context of deepening inequality generated by an economic system driven by widespread existential anxiety, the idea of individual responsibility through financial incentives turns out to be extremely unfair: the same basic existential fears, which make all of us either addictive and careless or hypochondriac and obsessively careful, translate into quite different economic situations depending on one’s personal pro-systemic resilience to fear. In other words, we may all share the same human condition and harbor the same more or less unconscious terror of fragility, suffering, and death, but within the economic system this shared condition can go along with wildly disparate socioeconomic situations, depending on how the repercussions of everyone’s fear within the system are distributed among all agents. The current ideology of patient incentives and responsibility amounts to stigmatizing one particular category of the population for the all-too visible effects of its existential anguish, while overlooking and even condoning the anguish of other categories who equally participate in the whole health care system. We end up with a proposal for rethinking the notion of responsibility along the lines of Foucault and Illich, emphasizing the key ideas of autonomy and existential lucidity.

JEL Classification: D 01, I 11, I 18, Z 13


  • health care
  • individual responsibility
  • incentives
  • terror management theory
  • existential analysis of economic mechanisms