Healthcare: Private Versus Public

How to provide adequate and affordable healthcare has been an argument held for millennia. From debates ranging from ideological based complaint to financial remuneration, the arguments for or against a given system are as varied as the issue’s protagonists. Regardless of the system ultimately chosen, it is necessary to have cooperation from all major policy players if the success in the implementation of a program is to be realized. This paper seeks to address the issue of how to provide adequate healthcare coverage within a society, and specifically how this plays out in the United States (U.S.) today.

Providing sufficient healthcare coverage is a problem addressed by even the newest and smallest governments. When a community consists of only a few individuals the logistics of creating an adequate and comprehensive healthcare plan are fairly uncomplicated. As a community grows and begins to connect to surrounding areas, it becomes necessary to establish a common form of governance with those areas in order to protect all concerned. With the establishment of a common government, the collection of communities coalesces into a society and creates a larger population. This results in a greater tax on government systems already in place. The larger a population becomes the more the challenges arising from trying to meet the needs of all are compounded. The U.S. is still a juvenile in terms of age relative to other major nations, but with the population increasing yearly, the need for an all-inclusive long-term healthcare system cannot be denied.

There are two basic forms of funding that can be utilized by the healthcare sector in the U.S.: private or public. Privatized insurance plays into the American ideal of independence of choice, as the government is not directly responsible for insurance policy characteristics or choice. However, this option comes with the major drawback of potentially allowing private companies to establish healthcare policy for the country as a whole, based on profit driven philosophies. Publically or state-funded insurance programs can avoid this pitfall through utilizing the law-making process to ensure coverage based on calculated need, not calculated profit.

The U.S. currently employs a healthcare system structured to operate from within the public sector. The Affordable Care Act (ACA) functions as a federally funded healthcare system that uses the power of the government to help ensure coverage for even the poorest Americans (“H.R. 3590” 18-22). With the change in administration brought on by the recent election, came a change in governmental position regarding healthcare. The American Health Care Act (AHCA) is the new administration’s answer to the healthcare debate. The AHCA removes the federally funded ACA and implements a system driven by privatized insurance (“H.R. 277 – 115th Congress” 1). Political persuasions aside, it is the responsibility of lawmakers to reach a consensus as to the best system for healthcare in the U.S.

The basic issue of how to implement healthcare coverage within a society ultimately depends on the structure of the government. In a society where free trade is permitted with minimal oversight by the governing body, a decision must be made between state-sponsored public healthcare and privatized healthcare. The outcome of this decision is often deeply influenced by the cultural traits of the predominate societal ruling class, which generally represents the wealthier strata of a society. Furthermore, in a society that values independent thought, and sees minimal government oversight as a prerequisite of this, the ability of lawmakers to construct a state sponsored healthcare system can be hampered by the desire for what is perceived as a form of individual freedom.

One way to remediate the argument of how to implement a healthcare plan with adequate coverage for all members of society, is to allow the authority already in oversight to provide and be responsible for the healthcare of its denizens. By utilizing the law-making structure already agreed upon and in place, the members of a society can more efficiently and effectively disperse the resources allocated to health coverage, while avoiding the pitfalls of a commerce-driven healthcare marketplace.

In the U.S. the economy is based on a free-market model of trade. This type of economy not only ensures competition but encourages and rewards it. A free-market economy, such as in the U.S., is operated under the assumption that minimal interference from the government will drive competition. By removing the government as a key influence on the direction of policy within a given industry, the major players within that industry are able to take more leeway when outlining and enacting new policy. This can create a situation similar to what is now being seen in the U.S. healthcare market.

In the U.S. there is a common conception among certain members of society that any form of governmental oversight is necessarily bad. Even policy put in place to protect an individual’s rights is viewed as damaging, simply by being connected to the government in the first place. This spirit of independence is a core principle of the American philosophy.

The spirit of independence in the U.S. is very much tied to the roots of the nation. What may have started as a rebuke of specific non-secular doctrine, appears to have evolved into an anti-authoritarian declaration of freedom. The issue of bucking control of the residing authority in favor of a self-established governance, with self as representing an individual or group, is central to the American way of thinking.

This conception of personal independence is based on the idea of the motive power of the individual. The idea that authority originates from within the individual, or at least from the philosophies/religion of the individual, and that according to their own beliefs the individual has the right, and perhaps the duty, to throw off an existing authority in favor of a self-realized one, is directly responsible for the creation of the U.S. This conception has flaws, however, for when a new authority is established, it immediately falls prey to the same conditions that led to its establishment, namely the self-authorization of the individual.

Since each individual has the capacity to find justification within themselves, the need for cooperation in choosing to abide by a particular set of rules, or system, is ever-present. Democracy offers perhaps the most inclusive model of government, in that it allows for input from most members of society. Although the particulars of the implementation create more or less input according to how lines are drawn, this model of government provides perceived authority to a larger portion of society than many of the models in.

The health of a nation is dependent upon its economy, which is ultimately driven by the health and wellbeing of the members of society constituting the workforce. Policy is influenced by all voting members of a democratic society, however, voting members are determined based on policy implemented by the current power holders. This necessarily results in interest driven policy, as no individual is completely free of self-interest. Additionally, due to our representational democratic system, the power of any one individual is the only representative of the power held by the collection of members within a voting district. Tallying of collective public opinion ultimately results in representative’s casting votes accordingly, and thus ensuring the smooth continuation of a democratic system. The feeling of inclusion and power afforded through a democratic system is one of its most outwardly attractive qualities, but may not provide these things at the same level for all members.

As was previously touched on, the laws of any nation are created by and for the individuals seizing, or already seated in, power. With power comes financial backing, which can serve to elevate a country’s leaders to a pecuniary position far above the average member of society. When this happens a sense of connection with constituents, and an understanding of the hardships of life brought on by financial lack can become lost. In some cases this display of alienation does not have the expected effect, for lines of obedience might be drawn according to other more powerful similarities. If a constituent identifies with a lawmaker based on ideological or ethnocentric issues, this self-identification can serve to cloud and override perception of equally important differences. An example of this led to the resulting Republican victory in the last election, namely the instance of poor, working-class, white voters identifying with the idea of reestablishing the authoritative power of the perceived American majority, over the realization of the actuality of the economic situation in the U.S.

When members of a democratic society vote against their own best interest, or the best interest of the society as a whole, it is the responsibility of the government to ensure the basic needs of the underprivileged members of a society. If the basic needs of the poor-majority are not met, in this case, due to freedom of private insurance companies from government oversight and regulation, the health of a nation’s workforce will deteriorate. If the nation’s workers deteriorate so too will the economy, and ultimately the security of the state. Furthermore, the ability of corporate entities to dictate policy and law, especially in terms of health and welfare, is a dangerous thing. It allows the negation of the inherent paternal connection between country and citizen and abolishes the checks on business extant in a society. Without the oversight of a larger authority, privatized insurance companies are able to determine their own prices, and set their own regulations, regardless of the cost to society. Therefore, a publically funded approach to healthcare is the best option for the continued health of a nation-state.

The main question this paper seeks to address is the issue of how to provide adequate healthcare coverage for all members of society. Without a clear idea of the obstacles and forces at play within a society it is impossible to formulate a comprehensive plan along these lines. Secondarily, this paper addresses the issue of the self-realization of the individual as an authority figure, and the potentialities of this realization. Thirdly, the question of a publically funded versus privatized insurance marketplace is addressed. Which form of insurance offers the most comprehensive coverage for all eligible Americans? Finally, does the ACA or AHCA best fulfill the healthcare needs of the majority of U.S. citizens?

As previously stated, it is the state’s responsibility to ensure its own growth, safety, and prosperity, but it is the members of a given society that provide the work necessary to achieve these goals. Therefore, it is the state’s responsibility to take care of all of its members. Allowing a privatized marketplace for healthcare coverage that can result in the exclusion of poor or sick individuals is antithetical to the wellbeing of the state. It is necessary to retain a publically funded approach to healthcare in the U.S., in order to help ensure the continual health of the country as a whole.

In order to help ensure the safety and security of any nation, it is necessary to take into account the general health and wellbeing of its members. The U.S. Constitution states in the opening lines, “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America” (Preamble). The founding fathers recognized the importance of the idea of the general welfare of the members of society and by extension the country as a whole.

Central to the issue of public welfare is the issue of adequate healthcare coverage. The ACA seeks to provide coverage to all members of society, regardless of economic or employment status (“H.R. 3590 – 111th Congress” 18-22). For an individual who is hovering near the poverty line, access to affordable healthcare is a make or break scenario. Suppose a working-poor father of two, a contributing member of society, falls ill as a result of non-work related causes, or experiences a flair-up of a pre-existing condition and requires medical attention. If this individual is not provided insurance through their job and does not have access to government-sponsored healthcare, then their medical expenses are likely to come out of pocket. Because of the way privatized insurance is allowed to structure itself, if overarching government regulation is prohibited, the ability of the underprivileged and working-poor to buy insurance becomes greatly diminished. The situation should not exist in America today where a father is forced to choose between medicine for himself and food for his children, but without publically funded healthcare this is not an uncommon occurrence.

The AHCA, by supporting a privately funded system with minimal government oversight, presents a model of the healthcare market place that is driven by profit margin and allows the wealthiest companies to advance private policy. One example of this plays out in the abolishment of funding for certain abortion services. Abortion is federally legal, but the AHCA denies federal funding for any abortion, except those necessary to save the mother’s life and those resulting from rape or incest (“H.R. 277 – 115th Congress” 3-4). A huge contributor to poverty in this country is unplanned pregnancy; therefore it is in the best economic interest of the state to allow those mothers that choose to exercise their constitutional right to their own bodies to receive abortions under public funding.

The AHCA takes the issue of denial of federal funds involving abortion a step further than what is mentioned in the previous paragraph. The AHCA denies funding, not only for abortions the act defines as not necessary, but also for all affiliated services providing abortion-related services, or that are, “primarily engaged in family planning services, reproductive health, and related medical care” (“H.R. 277 – 115th Congress” 3). The idea that defunding prenatal and early care will improve society through the reduction of abortion is directly opposed to the idea of improving overall state health. This is another example of how individual ideology can dictate policy that runs counter to national interests in matters even so basic as freedom.

By allowing private insurance companies to dictate the coverage provided to the individual, and to deny funding towards remediation of a major contributing factor to poverty and health costs in this country, the government is not acting in its own best interest. The issue of legality has already been laid to rest on the matter, and to favor individual doctrine over the general law is irresponsible. The state has spoken, and although the law is continually in flux, it is necessary to operate along the best possible course of action for the health of the society, based on the agreed upon structure of the rule of law currently in place.

All things considered, the ACA appears to be more effective at providing coverage for the large majority of Americans than the AHCA. It ensures coverage for services beneficial to the health of the state, such as coverage for voluntary abortion, and allows the underprivileged a financially realistic means of attaining healthcare (“H.R. 3590 – 111th Congress” 118-126). Without access to affordable healthcare, the individual is denied the basic ability to ensure the concept of general welfare as set forth by the founding fathers (US Const. Preamble).

In conclusion, a publically funded healthcare marketplace is the most responsible approach to providing adequate healthcare coverage to all members of society. Although privatized healthcare can seem to allow greater choice, it is not an affordable option to all members of society. The purpose of establishing a state is to ensure the welfare of a collection of people. Since it is the members of a given society that build and maintain the structure they reside within, adequate healthcare coverage is a prerequisite for the continued health of the state.

By allowing private companies oversight of the healthcare marketplace, the authority of the state in particular implementation of policy is relinquished, allowing individuals in control of corporate entities more power than the collection of voters within a society. When policy on healthcare is allowed to be determined by the desires of the few, rather than the needs of the whole, the motive power of the individual threatens to undermine the agreement of the majority. The failure to establish majority interest over individual interest can lead to the weakening of the workforce and thus the state itself. In the interest of national security and societal welfare it is prudent to undertake a state-sponsored approach to healthcare, with the ACA currently being the most effective model for the U.S.

Works Cited

“H.R. 277 — 115th Congress: American Health Care Reform Act of 2017.” GovTrack, 2017, www.govtrack.us/congress/bills/115/hr277

“H.R. 3590 — 111th Congress: Patient Protection and Affordable Care Act.” GovTrack, 2009, www.govtrack.us/congress/bills/111/hr3590

U.S. Constitution. Preamble. 1787.