Introduction
Due to the rapid changes in the demographic situation , associated with the drastically growing geographic mobility, ageing and strengthening of the so-called middle class in the developed and partly in the developing countries, healthcare system management is becoming a challenging issue (Hillman, p.28). The most disputed question, the point of global debate, is the source of healthcare system financing. Nowadays, it is possible to identify two popular models of medicine organization: socialized healthcare, which implies placing the responsibility for covering the cost of medical services provided to the citizens, and insurance-based system, which combines guaranteed governmental coverage of certain groups and shared reimbursement obligations which citizens and employers perform (Carrier, Howard and Kourany, p. 208). The United States healthcare system is organized according to the second principle and is widely criticized for low cost-effectiveness and problems with universal access to the corresponding services. The present paper is intended to research the theory and practice of social medicine, including its strengths and weaknesses, and demonstrate that publicly-funded healthcare can be used in the United States as the option, along with the public and private insurance systems.
A brief overview of the concept and history of social medicine
As Brochu writes, the term “social medicine” is used to describe a system of publicly administered national health care. This system can range from programs in which the government runs hospitals and health organizations to programs in which there is national universal health care” (Brochu, par.1). Social medicine was introduced in Europe in the late 19th-early 20th century, as governments were dissatisfied with the existing fee system. Leys identifies two factors which contributed to the healthcare reform: firstly, the standards of medical services were growing, accordingly, they became unaffordable to the majority of the population; secondly, the incomes of lower classes were growing much slower than physician fees, so there was an objective need for government’s intervention (Leys, p.243). As a result, the contemporary German administration adopted several regulations which obligated the state to pay salaries to health care specialists and provide at least partial compensations of services which socially and financially insecure groups received. In the 20th century, social medicine was spread among socialist countries including the Soviet Union and allies, France, Sweden, the United Kingdom and Canada.
A comparative analysis of healthcare systems in the United States and Sweden
In order to understand the principles of social medicine and evaluate its effectiveness, it would be useful to compare the United States and Swedish health protection systems, the latter of which is funded by the government. The United States health care is based primarily upon insurance, which provides access to medical facilities and services. There are two major types of insurance – the public and the private. Public health insurance can, in turn, be divided into two subtypes – Medicare and Medicaid, the former of which is designed for senior citizens and certain groups of people with disabilities, whereas the latter covers disadvantaged groups of population, including those with special needs (Chua, p.18; Carrier, Howard and Kourany, p. 208). Unfortunately, the program covers only the neediest groups, the poorest families and pregnant women, whereas childless adults have no access to the program. There are also smaller programs within the public health insurance like S-CHIP, designed for children, and VA, intended for veterans.
As for the insurance in the private sphere, it is also divided into two subtypes – employer-funded and private non-group-funded programs. In fact, at each workplace, employers are supposed to finance the insurance for their employees; in addition, workers also pay a small part of the premium, stopped from their wages. This insurance covers all cases of illness in employees, both professional and unrelated to the workplace. On the individual market, there also exist insurances, privately sponsored by individuals (retired or self-employed, for instance). Citizens are also entitled to purchase this insurance when they are dissatisfied with the employee-sponsored health care services or with to take additional measures to safeguard their lives against the cases of disability or trauma.
The criticism of the American healthcare system mainly addresses the fact that despite the notable diversification of insurance plans, there are still about 45 million uninsured (Stanzak, p. 32). There is also a notable discrepancy in service quality when comparing the public and private insurance plans; in particularly, the shortage of nursing staff and narrower range of diagnosing and treatment services in Medicare and Medicaid hospitals are nowadays broadly criticized (Stanzak, p.64). Another national concern is the boosting governmental investments into the system, so it appears the most expensive in the world, whereas the results of over-financing are viewed as dissatisfactory, as there are only 2.8 physicians per 1000 citizens (in Europe this parameter is 3-5, whereas per capita health spending is two times lower), 9.37 nurses (the lowest rate among the Big Eight group). Moreover, the U.S. can not be distinguished for high patient satisfaction rates, or significant results in cancer, cardiovascular disease and HIV/AIDS prevention (Stanzak, p.34). Furthermore, both employers and employees are dissatisfied with disproportionate premiums, used mainly to financially support the national research and development sector.
Due to the dominance of socialism in Swedish health care system, it appears more affordable to all groups of population. The government-sponsored healthcare serves are provides by private clinics and hospitals, the system in general has seven directions that encompass the needs of different age groups (women, children, older adults) and different types of medical care (prevention, counseling, emergency, in-patient care) (Hogberg, p.40). The government normally covers 85 percent of the original service cost, so patients’ fee are purely symbolic, moreover, they are not charged from those citizens who are exposed to poverty and have low income. In Sweden, citizens receive practically the same services in terms of range and quality, regardless of their income and residence area, but those interested in extra services, are entitled to pay full amount of physician fees in special private clinics. This means, the basic health care is guaranteed; if additional services are requested by the patient, the patients are entitled to use private health care services.
Nevertheless, this system also has its weaknesses. Firstly, Sweden’s social medicine lacks uniformity and centralization, as the principle of local self-regulation might create certain inequalities among the regions and thus force individuals to make a long way to another locality for more specialized services. In addition, the system is literally ruled by queues and waiting lists and the government often fails to comply with the obligation to keep the 5-day limit of serve delaying for doctor’s appointments and 3-month limit for surgery waiting lists (Hogberg, p.42).
Strength and weaknesses of social medicine in the context of the United States
Due to the fact that the U.S. has distinct social policies and unique idea of government’s role in human services provision, the introduction of social medicine can bring about a number of country-specific benefits and dangers. The strong point of socialized healthcare, as it has been noted, is universal coverage, i.e. it leaves no citizen behind (Leys, p.120; Chua, p.10). This means, the discrimination against Medicare and Medicaid citizens will be eliminated and the democratic principle of equality (Vladeck and Fishman, p.105) will dominate the system. Consequently, the population’s subjective perception of health security is likely to improve; due to the fact that patient beliefs concerning the accessibility of the service are an integral part of client satisfaction, the overall quality of medical care will grow. The expanded inclusion of the system also allows the government curbing expenses on emergency care for previously uninsured patients, who will receive timely preventative services and outpatient care under the new conditions.
It also needs to be noted that social medicine is more successful in popularizing preventive care, as compared to insurance plans, as the former does not necessarily require the appearance of certain adverse symptoms or dysfunction as a prerequisite for doctor’s appointment, so public health level will be positively influenced by government-sponsored healthcare in the long-term perspective (Chua, p.11).
Furthermore, the implementation of the single-player model will release American businesses from the burden of employer-sponsored insurance plans which threaten the survival of smaller enterprises. The national economy, in turn, benefits from the increased revenue of corporate citizens and proportionately growing amounts of income taxes companies will pay. In addition, working citizens will become less dependent upon their employers have greater freedom in workplace and career selection , which will also stimulate businesses to abide to employment laws and ethical principles of employer-employee relations in order to avoid the decline of personnel retention.
At the same time, in the United States social medicine is likely to be introduced with substantial limitations. Firstly, equal and universal coverage is likely to appear even more costly than the existing insurance programs, especially in the short-term perspective, as patient compensating 15-20 percent of the service fee will bring much less money to the state or local budget (Hillmann, p.629). In addition, it is not clear whether the outcomes of the transition to socialized healthcare justify the cost of the reform, as Americans have predominantly critical attitudes towards this system. It is possible to state that the ideological platform of socialized healthcare is not acceptable for Americans, whose inherent value is self-reliance and control over one’s own life. Due to the fact that social medicine implies high trust for the government, and taking into consideration citizens’ views on public services (Hillmann, p.627), measured by nationwide polls, it is possible to anticipate critical reception of the innovation. Most groups of the population are not interested in switching to the state of dependence upon the government, as the direct relationship between the timely financing of healthcare institutions and the quality and range of medical services the patient can receive seems to certain extent dangerous.
It also needs to be noted that the cases of delayed health care are quite frequent even under the insurance system, so the problem with long queues and waiting lists is likely to intensify following the introduction of social medicine. As Hillman observes, the European experience suggests that “attempts to contain costs of socialized medicine in general result in either low-quality health care or long waiting times for treatment […] Long waiting times for consultations and treatment, and impersonal medical attention can lead people to forgo free publicly financed socialized medicine in favor of the private market” (Hillman, p.626).
As one can conclude, social medicine can be useful for its universal coverage and affordability of services to everyone regardless of financial and social status, but it is not consistent with such American values as independence and individual choice and has an underlying threat of the worsening of the situation with delayed medical services and long waiting times. Thus, it needs to be admitted that the existing U.S. healthcare system needs adaptations rather than radical transformations and it is possible to adopt social medicine as a healthcare option and a guarantee of basic healthcare services for everyone. If socialized medicine is introduced as one of the alternatives to choose from, privately-insured citizens are likely to remain loyal to their insurance plans and thus will continue to pay for healthcare with their premiums, whereas the disadvantaged and marginalized groups who were not insured before, will finally access medical services.
Works cited
Brochu, M. “The Question of Socialized Medicine”. 2009, Web.
Carrier, M., Howard, D. and Kourany, J. The Challenge of the Social and the Pressure of Practice: Science and Values Revisited. University of Pittsburgh Press, 2008.
Chua, K.-P. Overview of the U.S. Health Care System. AMSA Jack Rutledge Press, 2006.
Hillman, A. Public Finance and Public Policy: Responsibilities and Limitations of Government. Cambridge University Press, 2003.
Hogberg, D. “Sweden’s Single-Player Health System Provides a Warning to Other Nations”. National Policy Analysis, May 2007, pp. 38-52.
Leys, W. Ethics and Social Policy. Read Books, 2007.
Stanzak, R. Bottom Line Medicine: a Layman’s Guide to Evidence-Based Medicine. Algora Publishing, 2006
Vladeck, B. and Fishman, E. “Unequal by Design: Health Care, Distributive Justice, and the American Political System”. In Medicine and Social Justice: Essays on the Distribution of Health Care, edited by Rosamond Rhodes, M. Pabst Battin and Anita Silvers. Oxford University Press, 2002, pp.102-120.