Lately I have been reflecting upon social issues. It's extremely interesting that in our country we pay between 20-30% in taxes. And what, if anything do we get? Our social programs are foundering. It is expect that by 2016
social security in this country will run out. Medicaid and Medicare are a joke at the lack of comprehensive coverage it provides. The food stamps system is corrupt in the sense that food with no health value can be bought using government money. Public housing is near impossible to attain, and once attained you are placed into crime ridden areas. We have no form of public health care. I must ask again, with this 20-30%, what do we truly get? In the Netherlands they pay between 30-40%!
"An preposterous sum!" most Americans would say. However, what if I said they worked on average 1400 hours per year compared to the United States' 1778. Other countries that work as much or more than us include: Chile, Czech Republic, Greece, Korea, Mexico, and Russia.
Every other Western European country, with the exception of Italy, works less hours per year than the United States. We have less time for our families. In other countries they mandate at least one month off per year for personal vacation time regardless if you are full time or part time. They get national health care, stipends for school tuition and books, and many other benefits above and beyond what we receive in this country. We on the other hand live to work. I follow
Occupy Wall Street on Twitter. I have even had a tweet of mine regarding my hardships in finding a job retweeded by them. I came across
an interesting tweet of theirs the other day.
In New York one would have to work 136 hours per week at minimum wage just to survive and pay for an apartment. How many hours in a week are there? 168. It's chilling to think of it.
One of my pet passions is the issue of health care in the United States and globally. National health care, vaccines, epidemics, and socially related health issues are something that I know a great deal about and wish to share with others. Two years ago I wrote the following as a final paper for my one class. It did wind up losing its original formatting with the copy/paste but the text is still the same. I should also mention that while I was writing this I got to know a lot about Tony Benn and Tommy Douglas and they became my personal heroes. Douglas is credited with saying one of the most profound statements I have ever read, "The religion of tomorrow will be less concerned with the dogmas of theology and more concerned with the social welfare of humanity."
A Comparative Analysis of First World Health Care Methods: Private versus Public
The great Roman poet Virgil once stated that “The greatest wealth is health.” The World Health Organization declared in 1948 that “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” America prides itself on protecting the downtrodden as is forever immortalized in Emma Lazarus’ famous poem, “…Give me your tired, your poor, Your huddled masses yearning to breathe free…” which is emblazoned on the Statue of Liberty. Is this America: land of the free and home of the brave? According to the 2008 US Census Bureau Health Insurance Data, while 250 million people have health insurance in the United States, an estimated 46.3 million have none. This amounts to over 15% of our population. Children are suffering as well. Within the same report on health insurance data it states that over 10 million children are uninsured. The National Academy of Sciences has estimated that 18,000 die each year due to a lack of health insurance. Sadly, the number of uninsured is growing. Since when did America fall on its laurels? In the following pages an attempt shall be made to compare universal healthcare systems (Canada, England, and Sweden) against the United States’s privately based one. It is an attempt to enlighten the reader, discover the positives and negatives of each, and find which would truly work for the United States.
In our age of medical modernity, many people fail to distinguish the link between the health of the economy and the health of a country’s people. There does exist, however, an inherent and unmistakable tie between the two. The current recession within the United States may be used as a prime example. A great proportion of health care within the United States is privatized via HMOs. Health coverage is provided through HMO plans which are typically supplemented though employee benefit plans in the private sector. Carol Holtz, author of Global Health Care: Issues and Policies, states that “Seventy-five percent of people in the United States who are under 65 have private health insurance, which is mainly obtained through the place of work.” As the recession took hold, many employees were laid off and as a result lost their health coverage. As Global Health Watch 2005-2006puts it, “… rapid changes in our global economy can imperil the health of millions.” Effectively overnight, an organized system designed to encompass the masses became out of touch, foreign, and ineffective. Even if one is working in the United States there is no guarantee that health insurance will be provided by an employer. In Care Without Coverage: Too Little, Too Late, it’s revealed that over 30 million working Americans aren’t provided health coverage through their employer. This same book also stated that those without health insurance are more likely than those with it to face dire situations.
The Committee finds a consistent and statistically significant relationship between health insurance coverage and the health outcomes of adults. Coverage is associated with having a regular source of care, which promotes continuity of care, and with greater use of appropriate health services. These factors, in turn, improve the likelihood of disease screening and early detection, the management of chronic illness, and the treatment of acute conditions such as traumatic injury and heart attacks. (46)
Classically, the practice of medicine has been tied to the necessity of wellbeing in relation to body, mind, and spirit. In our modern society, regardless of privatized or socialized medicine, there has been a complete breakdown of relationships between medical professionals and patients. This is noted as a ‘“crisis of alienation”’ in Health Care Reform Around The World. Historically, in the twentieth century, the practice of medicine was nowhere near as advanced as the technology today. General medical knowledge was typically known by both the medical professional and the patient as procedures and treatments were not that advanced. Twaddle states that
… the patient was in a position to make a greater contribution to the mutual understanding of his or her disease and to the selection of treatment. Indeed, several physicians wrote books intended to provide a lay public the corpus of medical knowledge so that patients could handle their own conditions. (11)
The aspect of physical locale in relation to treatment has also changed drastically. The arena of treatment was mainly in patients’s homes as doctors used to make house calls. Within the patient’s home the doctor felt the need to respect and acknowledge the fact that they were an outsider. As medicine was modernized, the shift from homes to medical treatment facilities caused the delicate balance of power to shift as well. The patient has now become an outsider in the medical world. He has become a specimen rather than a person. Helman’s text, Culture, Health and Illness also makes note that the presence of the white coat worn by a medical professional denotes training in medicine, reliability, high social status, high income, and a familiarity with illnesses and death. It can also be ascertained that this same white coat creates an environment of superiority, omniscience, and the sense of being unquestionable. With the inception of the white coat, patients now automatically assume a doctor has viable training and credentials and may no longer rely on a doctor’s actual legacy of healing. The sense of equality, mutualism, and partnership is also lost between the patient and medical professional because the white coat only effectively annunciates the clear class, professional, and economic distinction. Lastly, there are drastically contrasting economic differentiations between the past and the present. The maintenance of good health was considered so vital that healing was delivered to patients even if there was no feasible way for them to pay. Because the physician lived and worked within the community which he practiced, goods or services would typically be offered as payment for services if a patient had no money to offer. These means of bartering as payment as well as the proximal location of the physician to his patients aided in maintaining and strengthening the social fabric of a community. In modern times physicians typically practice in a community in which they do not live. Ties to the community in which they practice in are nonexistent which only echoes the modern practice of medical professionals distancing themselves from their patients. The form of bartering as payment now ceases to exist. The practice of medicine is now a commodity based on accountability, bills, and cost vs. medical need. Those who have the lucrative means to pay receive the necessary treatment. Those without means to pay must go without.
When analyzing how a culture, society, and country’s medical and health care system has come to be, it is important to take into account differences such as cultural, social, political, and economic variations. Historical impact also plays a definite role in shaping a medical and health care system. As, Twaddle states, “The cultural features are the residue of a history that is also to some degree unique.” (4) It should also be acknowledged that a two way relationship exists between poverty and illness. Poverty creates sickness due to poor living conditions. Sickness creates poverty due to expense. (Global Health Watch 17) How effectively do both privatized and socialized medicine treat this issue?
Within the past eighty years, two systems of medical treatment have become popular: socialized and privatized. It is important to conclusively follow the serpentine history of the development of these two systems within countries which they are popular. Within the United States, the first inception of a system like Health Maintenance Organization came in the form of prepaid health care plans. The first true HMO established in the United States is the Ross-Loos Medical Group. Established in 1929 by Donald E. Ross and H. Clifford Loos, the medical plans provided payment based medical care for those employed by Los Angeles County. It provided comprehensive medical care which primary visits, prenatal care, immunizations, and various other serviced for little or no copayment. The plan aimed to provide patients with expedient care without excessive financial burden to the patient. The true original goal was to provide a health system of care which was affordable to the masses without financial incentives of the company in mind. (Stevens 226) HMOs began gaining ground in the 1970’s when a small group of people started advocating them.
…led by Paul Ellwood, Alain Enthoven, and Harlod Luft, [they] began spreading the word about HMOs. Ellwood, trained as a primary care physician, had been a backer of HMOs since the 1960s and was influential in shaping President Nixon’s plan for national health insurance, a plan that would have placed most Americans in an HMO. (Dranove 66)
Thanks to President Nixon’s efforts in recording audio throughout the White House, we are able to conclusively know intimate exchanges concerning the establishment of HMOs in America. Behind the Oval Office’s closed doors on February 17, 1971 at 5:25 PM John Ehrlichman, Assistant to the President for Domestic Affairs, briefed the president on Health Maintenance Organizations which was instrumental in helping to shape the Health Maintenance Organization Act of 1973. The exchange was as follows:
John D. Ehrlichman: “On the … on the health business …”
President Nixon: “Yeah.”
Ehrlichman: “… we have now narrowed down the vice president’s problems on this thing to one issue and that is whether we should include these health maintenance organizations like Edgar Kaiser’s Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, ‘Well, I don’t think they’ll work, but if the President thinks it’s a good idea, I’ll support him a hundred percent.’”
President Nixon: “Well, what’s … what’s the judgment?”
Ehrlichman: “Well, everybody else’s judgment very strongly is that we go with it.”
President Nixon: “All right.”
Ehrlichman: “And, uh, uh, he’s the one holdout that we have in the whole office.”
President Nixon: “Say that I … I … I’d tell him I have doubts about it, but I think that it’s, uh, now let me ask you, now you give me your judgment. You know I’m not too keen on any of these damn medical programs.”
Ehrlichman: “This, uh, let me, let me tell you how I am …”
President Nixon: [Unclear.]
Ehrlichman: “This … this is a …”
President Nixon: “I don’t [unclear] …”
Ehrlichman: “… private enterprise one.”
President Nixon: “Well, that appeals to me.”
Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because …”
President Nixon: [Unclear.]
Ehrlichman: “… the less care they give them, the more money they make.”
President Nixon: “Fine.” [Unclear.]
Ehrlichman: [Unclear] “… and the incentives run the right way.”
President Nixon: “Not bad.”
It was a system based entirely on market profit rather than care. On February 18, President Nixon announced to the world the new HMO based system which we have now stating that “I want America to have the finest health care in the world. And I want every American to be able to have that care when he needs it.” It seems the mission has failed. In 1973 Ellwood began a consulting relationship with Kaiser-Permanente. Ellwood, who is now regarded as the father of modern HMO movement, consulted President Nixon on “… ways of constraining the rise in the Medicare budget.” (Kongstvedt 6) On December 29, 1973 President Nixon signed into law P.L. 93-222 which was the Health Maintenance Organization Act of 1973. With the passage of the bill into law, it brought with it the requirement for employers of more than 25 people to provide an HMO based option of healthcare and many other requirements which were beneficial for the fostering and growth of HMOs in America. Within privatized medicine, the almighty dollar has become unequivocally omnipotent. Everything has a cost. Market profit creates an auto repair shopesque atmosphere of healing for cash. The linkage of status to healing is part of the overall modern commercialization of medicine in America. Prevention of sickness is not thoroughly encouraged as treatment is the name of the game; that is, of course, if you can pay. The swapping of organs, pushing of pills, and the stoic, sterile, disingenuous demeanor of the professional doctor only reflects the ideology that patients and their health are no longer the number one issue within many doctor’s minds. Treatment of the sick has now become optional based on financial feasibility rather than an overall moral righteousness. The sick simply do not matter as they are customers, not patients, and if they die or become too poor to pay there are always more. Let’s be honest here. Medical treatment in America is no longer about the wellbeing and good of the people. While HMOs claim that they do not deny anyone from seeing medical providers outside of their coverage, most people cannot pay for such treatment out of pocket. The corralling of patients towards specific doctors and away from others, the exclusion of people from coverage, and the lack of authorization for life-saving treatments borders on legalized murder. (Moore) We foster a system of sickness, a system wherein if you die under a doctor’s care, he is paid regardless. There is no motivation to encourage wellness. Quite the opposite, it fosters indifference. There seems to be some small headway being made with the passing of H.R. 3590, or the Patient Protection and Affordable Care Act, on March 23, 2010. However, the law enacts measures to protect Americans in an untimely fashion. Take , for instance, the moratorium for child and adult protection against discrimination regarding pre-existing conditions does not take effect until later in the 2010 year for children and 2014 for adults. The measures enacted are entirely fruitless when dealing with a system which has been collectively raping the American public for decades. It is simply too little, too late. Our lawmakers have boasted numerous times that we have the greatest healthcare system in the world, yet it’s terrifying to think that in 2000 the World Health Organization published their final ranking of the world’s health systems by country. It was ended that year due to the complexity of the evaluation process. The WHO analyzed statistics such as longevity, rates of cancer, rates of infant mortality, and a myriad of other important factors. In the ranking, France was in the top position followed by Italy, San Marino, Andorra, and Malta respectively. But where was the United States? It was 37th on the list, stuck between Costa Rica and Slovenia. Cuba, the communist thorn in our southern side, is in the 39th position. All other first world countries were ranked among the top thirty. It should also be noted that we are the only first world developed country without universal health care. (Moore) While a bill exists for the formation of a universal health care plan, H.R. 676, it has faced much opposition and is likely to fail. It is important, however, to compare our health care system against other universal health care systems of the world and see what can be learned or improved.
When comparing different health care systems it is important to note that the ideologies of peoples of countries are also fundamentally different. In countries with universal health care such as Britain, basic bare-bones medical care is provided completely. There are cost limitations as to what the government may provide. There are no luxuries within socialized medicine. Within market profit health care systems like the United States, medical care is based on the individual, not the masses. Spare no expense and almighty cutting edge technology shall save you. If we were to compare these two mindsets I think we would find that those who are under socialized medicine have a more practical and realistic view on life and death. They view the quality of years over the quantity of years which exemplifies an entirely different mindset and values system. In the United States people sometimes view socialized medicine as something which carries negative connotations. The idea of paying for those who are unemployed, poor, or elderly leaves many with a bad taste in their mouths. They claim that typically those most attracted to socialized health care are those who are the most needy. It may be a reflection of the typical mindset of the people in the United States. Within America we have a very individualist, self sufficient, and autonomous attitude. We tend to view our population as a collection of individuals rather than a collaborative people. It seems only during times of great national pride after some bloody war or terrorist attack do we all function as one and work for all together. Typically there exists a “them vs. me” attitude. This attitude could unequivocally be reflected with opinions on health care. Other similar first world countries like Canada, Sweden, and Britain, which have a universal health care system have citizens who tend to be more collective thinkers. They realize that the health of the people of their countries are their national identity. The sick; the poor; the weak; as well as the strong are the soul of that country and without such great diversity their society would cease to exist.
“My friends, watch out for the little fellow with the big idea.” These witty words were spoken by Tommy Douglas and entirely embody his essence, being, and passion in working for the betterment of humanity. Tommy Douglas is a name not many Americans know. He is the father of Medicare, in Canada at least. Douglas also served as the Premier of Saskatchewan and was a great social reformer who worked tirelessly on issues such as pensions, welfare, mothers’ allowances, and Medicare.
I felt that no boy should have to depend either for his leg or his life upon the ability of his parents to raise enough money to bring a first-class surgeon to his bedside. And I think it was out of this experience, not at the moment consciously, but through the years, I came to believe that health services ought not to have a price tag on them, and that people should be able to get whatever health services they require irrespective of their individual capacity to pay. (Thomas 7)
Before Tommy Douglas’s plan ever came into effect, there was a realization that the Canadian healthcare system needed reform. A multitude of private plans and non-profit organizations existed to provide patients with healthcare. The large problem with these plans was that while hospital visits and physician care may be covered, drugs and treatment were not. The sick and needy also were collectively left out of the loop and only taken in as charity cases at hospitals and doctors’ offices. Douglas launched his campaign in 1961 for a universal health care system for Saskatchewan. He succeeded in his mission in 1962. In 1966 the Saskatchewan model was implemented on a national scale providing full health care for all Canadian citizens. For his efforts he is regarded as the greatest Canadian in all of Canadian history.
Medicare is considered to be the most valued social programme in Canada today. Canadians have rated it as their most important concern, ahead of programmes in employment and social welfare… medicare is an essential part of Canada’s national identity and part... of what it means to be Canadian. (Houston 3)
When exchanging ideas with those in the United States about the Canadian healthcare system one comes across the constant rhetoric that the Canadians dislike their healthcare system or are unhappy with it and might prefer one like our own. The following provides interesting insight.
The Canadian universal health care system, although expensive, remains an important national 'right' or principle of this country. As stated in the Canada Health Act, the federal government is committed to maintaining Canada's world-renowned health insurance system. This system is universally available to permanent residents, comprehensive in the services it covers, accessible without income barriers, portable within the country, and publicly funded. Each province and territory administers its own health care plan with respect for these five basic principles of the Canada Health Act. Studying the Canadian model, our neighbour to the south has been unsuccessful in its attempt to launch a similar public health-insurance system. (“Canadian Medicine:”)
The Canadians obviously view the people of the United States on the shallow end of healthcare intellect pool.
To provide another example of universal healthcare we must journey a little further back in the annals of time to when our brothers across the pond formed theirs. The end of World War II brought with it new problems for Britain. The country was in shambles both physically and fiscally. As waves of wounded men came back from the war, what awaited them was a bombed out country teetering on the edge of financial ruin. For quite some time within the country reformers had been pushing the issue of universal healthcare. It was then on July 5, 1948 that the creation of their National Health Service was born. According to Tony Benn, a former member of Parliament, when asked “When did this whole idea that every British citizen should have a right to health care?’ He responded as follows:
Well if you go back it all began with democracy. Before we had the vote all the powers were in the hands of rich people. If you had money you could get health care, education, look after yourself when you were old, and what democracy did was to give the poor the vote and it moved power from the marketplace to the polling station, from the wallet to the ballot. And what people said was very simple, they said ‘In the 1930’s we had mass unemployment but we don’t have any unemployment during the war. If you could have full employment by killing Germans, why can’t you have full employment by building hospitals, building schools, recruiting nurses, recruiting teachers.’ If you can find money to kill people, you can find money to help people. (Moore)
To further illustrate the importance and staying power of the National Health Service in Britain, Moore and Benn had the following exchange:
Benn: “Even Mrs. Thatcher said ‘The National Health Service is safe in our hands.’ It’s as non-controversial as votes for women. Nobody could come along now and say ‘Why should women have the right to vote now?’ because people wouldn’t have it, and they wouldn’t have it in Britain. They wouldn’t accept the deterioration or destruction of the National Health system.”
Moore: “Even if Thatcher or Blair had said “I’m going to dismantle the National Healthcare?”
Benn: “There’d have been a revolution.”
To those of the United Kingdom, the National Health Service gives its citizens all medical, dental and nursing care that is needed and is entirely publically funded. The British consider that “…the state of [their] nation’s health [has become] a political ideal.” (BBC)
The health standards of the Swedish population is considered to be one the highest in the world. They have low infant mortality rates, declining diabetes and obesity rates, and a very high average life expectancy. Sweden, who has a national health care system, provides one of the most comprehensive systems for elderly care in the world. The elder care in Sweden is entirely a reflection of their values. There, the elderly are encouraged to maintain active lifestyles and their ways of life. Living with relatives or maintaining their independence is entirely commonplace. Sweden invests more of its gross domestic product in its elderly citizens than any other country in the world. The Swedes also have a more realistic outlook on old age and view it as a natural process. In the United States there has been an extreme medicalization of old age. (Helman 11) Again, the quality of life may be put aside in favor for the quantity of life. Pills and surgeries are now prescribed as treatment for symptoms and effects of old age. Aging is seen now as a chronic disease of which there is no cure. It has also become entirely commonplace to warehouse seniors in nursing homes until they die. It is becoming less and less common for elders to live out the rest of their days in the comfort with their loved ones around them. The focus of the United States is on the young, the new, and the productive, not the has-beens. The extreme consumerism, which is a marker of the United States, can be reflected in the treatment of seniors when they have out grown their usefulness in the workplace.
Admittedly, most universal health care systems may have problems concerning issues such as cost. Taxes also tend to be exceedingly high in countries with universal health care. With the implementation of a universal healthcare system it is to be expected that government may become highly bureaucratic. Different branches, councils, and ways of oversight are created to regulate cost, patient care, and doctors. An example of a country with a government with many different sectors and facing the high costs of healthcare is Sweden.
Health care is administered by 21 different county councils throughout the country. Eighty-nine percent of the council’s budgets are used for health and dental care. Municipalities are responsible for care of the elderly and psychiatric care. For those needing psychiatric care the municipalities also take care of their housing, employment, and financial support. Healthcare agencies within Sweden consist of 9 regional hospitals, 70 county and provincial hospitals, and 1000 health centers. The costs consist of 9.1% of the GDP, which is equal to $196.8 billion dollars. (Holtz 22)
It is also worth noting, however, that Sweden has a hybrid system in terms of paying for their national healthcare. Patients typically will face paying for charges (co pays, pharmaceutical, dental, inpatient care) out of pocket until a cap is reached. This cap is menial and typically less than $250 US. After this cap is reached the patients care is provided free of charge. In actually evaluating the pros and cons of each country’s medical system, it is entirely dependent upon that country’s values. In the United States, we value autonomy, independence, and the ability to make ones way rather than having certain things provided for us. In European countries with universal healthcare they see it as vital. They view health as a necessity which would be among food, water, clothing, and housing all of which have corresponding social welfare programs.
The creator of the polio vaccine, Dr. Jonas Salk, was asked who owned the patent on his polio vaccine and responded “Well, the people, I would say there is no patent. Could you patent the sun?” As Tommy Douglas once said at the Dominion-Provincial Conference in 1946,
It has been said that a country’s greatness can be measured by what it does for its unfortunates. By that criterion Canada certainly does not stand in the forefront of the nations of the world although there are signs that we are becoming conscious of our deficiencies and are determined to atone for lost time.
These quotes are from two men who had in part some of the greatest impact on medicine and medical care in history. I believe these quotes illustrate the point that healthcare should be based on morality, not profit. There is a battle over what is right and what is profitable. Many in the United States who oppose the new healthcare bill which passed in March simply complain of cost. My question to them is how much is a life worth? How much is a mother, father, brother, sister worth to them in dollars and cents? In the United States we search out quick, easy, and simple fixes. If a universal healthcare plan was enacted it would mean a long and messy process to establish the new plan while closing down companies worth billions of dollars. It is not something many Americans are inclined to do. Sadly, we are not a nation of morals and righteousness. We don’t feel the plight of our neighbor and respond to him with a weeping heart and open arms. While a universal healthcare system may be the best option in providing comprehensive care to millions of Americans, it is unlikely to happen because of how we are socially constructed and because of our values or lack of them.
