When societies come together to form governing organizations the goal is to provide a means to deal with public goods. The most basic of these being stability and security for it’s masses, but as a nation grows it’s governing body’s obligation does as well. As the nation’s responsibilities grow the problem of collective action a rises. In this paper health care will be the public good in focus, and how the United States, Canada, and Germany each deal with the disbursement of this public good. A critique of each will be done with three approaches to the collective action problem as the guide. These three outlooks are Thomas Hobbes’ Leviathan, the anarchistic solution, and the entrepreneurial solution. These will help us review each of the three chosen nations’ methods of distributing health care to its citizens and which one works the best.
The first country that we will look at is Germany. Germany has a strong tradition of state funded health care for it’s citizens. The health care system of Germany was established 115 years ago on the heels of the industrial revolution of the 19th century. Having the oldest state run health care program, the German system has changed through out the years, yet has been able to adapt to the times. The German system covers 90% of the population, with the other 10% choosing private forms of health care (Tutuncu p.1). This system covers unlimited ambulatory physician care including home visits, unlimited hospital care with minor copayments, maternity care, prescription of drugs with unlimited copayments, medical supplies and devices, preventive care, family planning, rehabilitative services, and periodic “rest cures” at certified health spas. The German plan also includes dental care including routine preventive care, restorative care, periodontal services, dentures and other prostheses and orthodontia, optical services (including glasses), and ambulance transport (Tutuncu p.2). With this type of coverage the German health system has been labeled one of the best in the world.
The German approach to the need of health care for its’ citizens is a form of the entrepreneurial solution. The German health care program has grown and improved over time because of political entrepreneurs that understand the importance of health care. Without the political entrepreneur catering to the public’s need, public good would not be served. This method of dealing with the need for health care has proven to be very successful and has greatly improved the living standards of the German people.
The next country that we will look at is Canada. Our neighbors to the north have an interesting system in that is a mixture of private and public distribution to form its’ health care program. Private hospitals, physicians, and other institutions mainly carry out the services provided in Canadian health care. There are a few health services that are state operated, but the trend in Canada has been to privatize these as well. The state plays a bigger role in funding of these services rather than providing them. State funding for these private health care services comes from income taxes, sales taxes, “sin” taxes, employer levies, health premiums, and property taxes (CNFH p.1). The Canadian government traditionally funds 75% of all health care expenditures yet recently this number has began to decline due to the increase in private payments (CNFH p.1).
Canada’s health care programs and funding fall under the entrepreneurial solution format. The Canadian system is in a transition between two types of entrepreneurs, political and private. This transition from the political entrepreneur to the private one could result in a potential disparity in quality of health care for citizens of Canada. The reason for this would be that political entrepreneurs court the public for support, there for improvements in the care and coverage would benefit them, but private entrepreneurs are in pursuit of profits, and improvements in care would be sold at a higher cost to increase those profits. In this system and in the path it is going down, health care could improve if you can afford it, but for those who can’t care will become less of an option.
The final country that we will look at is the United States. The United States operates health care with a different perspective. The United States government is all most completely uninvolved in providing health care compared to the prior to nations in this essay. The health care system in the United States is privatized and for all intensive purposes unfunded by the government. United States health care is formed of private health services funded by private funds. Health insurance is also a privately operated system, where the public must purchase there own coverage to have any.
The United States health care program can be filed under the anarchistic solution to a collective action problem. The United States’ lack of involvement in health care shows its’ preference towards finding a solution to this collective action problem without relying on the government. This system seems to fit the United States well because of its’ strong sense of individualism and self reliance. Yet this system does cause inequalities in health care that would not occur in a state controlled system.
Now comparing the three Germany, Canada, and the United States and their means of health care distribution, Germany is clearly the best. The German system allows for virtually complete health coverage for every citizen, without compromising quality. Health care in Germany is seen less as a commodity and more as a right, and it shows in their political entrepreneurial solution to it. Having health care as a right and not a commodity allows for all to benefit from advances in treatments and medicines without having to pay extra for it. This allows for a greater equality in the care that is provided. The Canadian system follows in second, because of its’ slow turn towards privatization. By having the government fund private health care services the drive for all care to be equals is diminished because of a lack of conformity. Plus the rise in private funding for health care which will cause greater disparity in quality. In last place is the United States. With large numbers of citizen unable to afford health insurance and medical cost that far exceed the other two countries, the United States shows the perils of the anarchistic solution. The quality of care in the United States is very good, but it’s availability is suspect. This is due to the fact that health care is seen as a commodity and sold like one. This is why the United States finishes in last.
Tutuncu, Dr. Rengin: The World Health Organization, Health Care and Services Profile, 1999; www.whocollab.od.mah.se/index.html
Unnamed: Canadian National Forum on Health, Canada’s Health Care and Financing, 1999; www.nfh.hc-sc.gc.ca/public/canada.html