U.S. Health Care System In our uniquely American health care system, there are two basic models for the provision of health care. The Market Justice Model, which is the primary model in American health care, is based on the American notion of free enterprise and individual responsibility. Privately funded by insurance and/or cash payments, this model involves private practices and institutions providing health care to individuals. The model assumes that health care is like any other good or service that can most rationally be purchased by an individual with his/her doctor's assistance and with little or no governmental involvement. In sharp contrast to the Market Justice Model is the Social Justice Model, which regards health care as a unique system of basic goods and services to which every member of a society is entitled. The Social Justice Model of health care assumes that equitable health care requires significant government involvement, central planning and allocation of basic health services for which the individual's ability/inability to pay is irrelevant. Existing in American society in the forms of Medicare, Medicaid and Workers Compensation, the Social Justice Model necessarily involves significant governmental involvement on the Federal and State levels. Based on severely conflicting notions, Market Justice and Social Justice Models coexist uneasily in American Society, with Market Justice being the more dominant model at this time.
U.S. Health Care System is a series of geographically-determined networks. Established according to American beliefs and values, the system provides essentially two models of health care: the Market Justice Model, based on free enterprise and individual responsibility and ability/willingness to pay; the Social Justice Model, based on the public and equitable provision of basic health care services to all members. The two models are often in conflict with each other, with the Market Justice Model currently being the primary model.
Definition of a Health Care System
A "Health Care System" is commonly defined as "the complete network of agencies, facilities, and all providers of health care in a specified geographic area" (Mosby, 2008). Given that very broad definition, the United States has health care systems spanning such geographical areas as the entire nation, states, counties, cities, towns, villages and neighborhoods.
Implications of Beliefs and Values on a Health Care System
A society's value system, comprised of its beliefs and values, conditions its members about "what is desirable for that society" (Shi & Singh, 2010, p. 33). Consequently, that value system helps form the foundations of and perpetuate all that society's systems, including its health care system. Since the value system is deep-seated, fundamentally changing any established system, including an established health care system, is very difficult and requires "a consensus among Americans on basic values and ethics" (Shi & Singh, 2010, p. 34). Add to that people's natural resistance to change and their tendency to overvalue something they already "own" (Surowiecki, 2009), and we have a deeply-ingrained health care system that is extremely difficult to reform. America's health care system, for example, is primarily private-enterprise and market-driven, based on our beliefs and values (Shi & Singh, 2010, p. 46). In 2008, only 29% of likely voters rated the country's health care system "good or excellent" but after the announcement of health care reform, 48% rated that same system "good or excellent" (Surowiecki, 2009). As Surowiecki states, "the American health-care system didn't suddenly improve over the past eleven months. People just feel it's working better because they're being asked to contemplate changing it" (Surowiecki, 2009). In sum, beliefs and values, which comprise a society's value system, are vital to its health care system and strongly resist changes to that system.
Explanations and Examples of the Various Models of Health Care Delivery used in America
Two basic models of health care delivery are used in America. As mentioned above, one primary model is private-enterprise, market-driven health care. Chiefly funded by employer-based health insurance and/or private cash payments, the private model is based on the concept of "Market Justice" (Shi & Singh, 2010, p. 37). Market Justice can most simply be deemed "free enterprise," for Market Justice is based on the ideas that "market forces in a free economy can best achieve a fair distribution of health care" (Shi & Singh, 2010, p. 37). Market Justice operates on certain basic assumptions: health care is like any other good or service, so it can be effectively governed by the economic concepts of supply and demand; each individual is responsible for his/her own achievements and society is best served when the individual pursues his/her own best interests; the decision to purchase health care products and services is rational; with his/her doctors' help, the individual knows what is best for himself/herself; the less governmental interference, the better (Shi & Singh, 2010, p. 37). Stressing individuality, Market Justice health care focuses on how much a consumer can and will pay for health care goods and services at market prices (Shi & Singh, 2010, p. 37). Examples of ways in which the American health care system applies the Market Justice Model are: private practices; private institutions; provision of health care goods and services that the government would categorize as more-than-basic (e.g., elective surgery), which are privately funded through insurance and individual cash payments (Shi & Singh, 2010, p. 41).
In contrast to Market Justice health care but also operating in the America is the Social Justice Model of health care. The Social Justice Model focuses on providing health care to all Americans, regardless of ability to pay (Shi & Singh, 2010, p. 27). Social Justice health care operates with several assumptions: health care is a basic right and a social resource that is different from other goods/services; health care requires governmental involvement and central planning because health care for all members of the society is a social responsibility; the government can allocate health care more equitably than can Market Justice; ability/inability to pay for medical care is irrelevant; due to the fact that society cannot cover all health care requirements, the government decides which health care services are basic and must be provided by society (Shi & Singh, 2010, pp. 38-40; Daniels, 2001, p. 6). Logically, the Social Justice health care model is merely one facet of total Social Justice, for there is a "surprising convergence" between the needs of social/political well-being and the needs of mental/physical health (Daniels, 2001, p. 7). Examples of ways in which the American health care system applies the Social Justice Model are: designated basic services covered by Medicare, Medicaid and Workers Compensation (Shi & Singh, 2010, p. 40) and provided/regulated by our Federal and State governments. Due to obviously different beliefs and values, Market Justice and Social Justice Models of health care are often at odds with each other.
Conclusion
Generally defined as "the complete network of agencies, facilities, and all providers of health care in a specified geographic area," the health care system exists in America on national, state, county, town, village and neighborhood bases. As health care systems are based on and sustained by a society's beliefs and values, America's health care system is uniquely structured according to American beliefs and values. In addition, reform of societal systems, including the health care system, is difficult due to the deep-seated nature of any society's beliefs and values, along with the human resistance to change and high valuation of what is "owned." Consequently, despite even an obvious need for reform, resistance to reform is a significant barrier that may be overcome by a consensus on beliefs and values.
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