Essay on "Compares Anderson's Market Minimized Market Maximized Continuum and Roemer's Model"

Essay 5 pages (1692 words) Sources: 10

[EXCERPT] . . . .

Healthcare: Cultural Influences on Provision of Healthcare

America vs. The Rest of the World

Perhaps no issue divides the industrial world more than healthcare. Nations such as the United Kingdom and the United States that share many similarities in terms of how they view individual liberties and constitutional rights of citizens manifest notable differences in terms of how medicine is viewed. In the United States, healthcare is conceptualized as a market-driven enterprise. In the United Kingdom and the rest of Europe, healthcare is seen as something that cannot be determined by the market, and is instead primarily determined by individual need and regarded as a social service. Healthcare is viewed as a right in the UK, not as a privilege only for those individuals with employer-provided coverage. "Most countries achieved universal health insurance coverage (coverage of at least 99% of the population) between 1960 and 1997" in the industrialized capitalist world, but not the United States (Anderson & Poullier 1999: 181).

In the theorist Odin Anderson's market-minimized/market-maximized continuum model of healthcare, the greater the influence and centralization of the government in economic affairs, the greater the tendency of the government to intervene in the marketplace, including the in business of healthcare. The U.S. is on one side of this continuum, the UK at the other (Sanders 25). Socioeconomic factors such as the wealth of the nation are emphasized in the model -- and demographically speaking more wealthy nations tend to have fewer members of the very poor and very unhealthy, reducing the pressure for aggressive government intervention in the healthcare system. But this does not fully explain how despite the capitalist-generated wealth of the UK and Germany relative to the developing world, citizens have far greater access to care than in the even more affluent U.S..

Milton Roemer's model, in contrast, gives far more emphasis to socio-cultural and socioeconomic issues and importance of politics in setting healthcare policy, versus the health status of citizens or the economy of the nation. Roemer classifies health-provision systems according to three basic models: that of the entrepreneurial model, as practiced in the United States, the mandated insurance model manifested in Germany and other European countries, and the National Health Service model of the United Kingdom and other countries where 'socialized' medicine is practiced. Roemer sees advantages in all three models. For example, he cites the quality of healthcare provided -- to some citizens -- in the United States, when a good healthcare plan is offered by an employer. Of course, this system results in substantial health inequities and in some cases no health insurance coverage at all for some individuals, resulting in a tremendous cost to the citizen (who may have to declare medical bankruptcy) and to society (which has to deal with an unhealthy uninsured population). Roemer cites the 'cost savings' of the U.S. model as a plus, but given the current expenses of the U.S. healthcare system per citizen, his position on this issue seems dubious (Sanders 26).

The mandated insurance model, as deployed in Germany, requires all citizens to have health insurance, thus substantially expanding the risk pool to contain costs. Because bargaining is not allowed between contractors and providers, costs in some areas can escalate, but insurance is privatized rather than taxpayer-funded and is subject to some market pressures. The final system is that of a national healthcare system, which is funded by tax revenue, and providers are employees of the government, as exists in Canada and England (Sanders 26-28). In contrast, under the German social insurance model, health insurance is directly funded by contributions of public and private insurers. And the United States system depends upon voluntary rather than mandated contributions of recipients (Sanders 29). Only 45% of U.S. expenditures on healthcare are government-funded (Sanders 37).

The decision to fund healthcare in a particular manner is thus only partially based upon the wealth of the government, given that the U.S. manifests such major differences in its system vs. The other industrialized capitalist nations of comparable wealth. In making such a comparison, Roemer's model offers a useful point of comparison because it stresses that national income alone does not determine the health care system selected. For example, the social insurance model of healthcare provision in Germany began under Bismarck, although it has obviously undergone substantial alterations since then (Sanders 29). The attitude of the electorate of the United States is a critical aspect of the choice of the U.S. To remain privatized, in Roemer's model. A pure model of market minimization and government non-intervention clearly leaves out the importance of political and national culture in determining healthcare provision.

There is also the clear difficulty of determining what constitutes 'intervention' in the economic system as a whole. This question can only be answered by prioritizing culture when evaluating the logic of choosing a particular healthcare system in the developed world. For example, conservatives in the United States present themselves as advocates of minimal government intervention in the private sector, versus Europe's more aggressive model of providing public social services. But conservatives also support the government regulation of certain procedures that they consider immoral, such as abortion, physician-assisted suicide, and providing birth controls to minors. The idea that the individual has a right to complete freedom of choice, including the right to 'choose' not to be insured is more of presentation of a cultural bias rather than an actual, purely libertarian stance. (And the question of citizens having a 'choice,' when health insurance is not affordable for many Americans seems a dubious one).

A model of a purely inverse relationship between the nationalization of healthcare and intervention in the economy is more manifest in the developing world where there has been a marked trend towards privatization in nations such as China and Chile as the governments have grown more capitalistic in their orientation (Creese 1994: 321). In these nations there has been a general trend towards privatization of formerly-provided government services and privatization of the economy. The trend towards privatization in these instances seem to be more economically-driven, rather than ideological in nature. When the United States chose not to implement a national healthcare system after World War II during a time of tremendous prosperity, even while the recovering nations of Europe and the United Kingdom were doing so, the U.S. arguments against doing so were tinged with fear of creeping socialism. In contrast, Chile engaged in its privatization campaign to minimize hyperinflation and bloated government budgets. Despite being officially communist China privatized aspects of its healthcare system to make the nation more competitive globally (Creese 1994: 321).

According to G.F. Anderson's and G.P. Poullier's analysis of the issue, American decisions regarding the healthcare system seem to defy economic logic: "two aspects of U.S. health spending warrant special attention. First, higher health spending in the United States is not a recent phenomenon. As early as 1960 the United States was spending almost 50% more per capita than any other OECD [Organization for Economic Cooperation and Development] country," almost all of which had adopted some form of nationalized healthcare (Anderson & Poullier 1999: 180). During the 1990s U.S. "health spending per capita grew more rapidly than in the median OECD country, in spite of managed care and federal and state governments' attempts to slow the rates of cost increase in Medicare and Medicaid" (Anderson & Poullier 1999: 180).

The U.S. spends a much higher proportion of its GDP on healthcare than other industrialized nations. It also has far higher hospital expenditures. The "numbers of hospital days per capita, lengths-of-stay, and admission rates were well below the OECD median, suggesting that greater use of hospital services is not primarily responsible for the higher level of hospital spending" (Anderson & Poullier 1999: 182). Despite official efforts at cost containment, the United States ranked at the… READ MORE

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