The U.S. health care system exists within a framework bounded by two ideological opposites: health care is a public good and health care is a private good. These two concepts—private good and public good—are defined as follows.
Public good, in economics, (is) a product or service that is non-excludable and nondepletable (or “non-rivalrous”). A good is non-excludable if one cannot exclude individuals from enjoying its benefits when the good is provided. A good is nondepletable if one individual’s enjoyment of the good does not diminish the amount of the good available to others. For example, clean air is (for all practical purposes) a public good, because its use by one individual does not (for all practical purposes) deplete the stock available to other individuals, and there is no way to exclude an individual from consuming it, if it exists. (Ingham, 2019, para 1). Acceptance of this view identifies health care as a public good—a product or service that is nonexcludable. When the good or service is provided, individuals cannot be excluded from enjoying or using it. It is a right of all citizens to receive health care at all levels. Health care should not be hidden behind a paywall that prohibits health care being received by consumers.
Private good (is) a product or service produced by a privately owned business and purchased to increase the utility, or satisfaction, of the buyer. Most of the goods and services consumed in a market economy are private goods, and their prices are determined to some degree by the market forces of supply and demand. Pure private goods are both excludable and rivalrous, where excludability means that producers can prevent some people from consuming the good or service based on their ability or willingness to pay and rivalrous indicates that one person’s consumption of a product reduces the amount available for consumption by another. In practice, private goods exist along a continuum of excludability and rivalry and can even exhibit only one of these characteristics. (Summary & Henry, 2019, para 1) Those who view health care as a private good tend to favor a private health care system. The United States was founded on the principle of a constitutionally limited government, and this remains a strong value in the United States today. America’s founders believed that governmental power should be limited and constrained by our Constitution. For those on this side of the spectrum, health care delivery belongs to the free-market economy, which made America an economic superpower and provided generations of Americans with opportunities and higher standards of living. The markets and private enterprise are best suited to deliver the health care that people want. A lot of people who value this side of believe that it is a good thing that many different health care practices are hidden behind paywalls and many people can’t afford the care is okay. I personally do not agree with this sentiment. I believe that regardless of economic status people should have access to health care.
Many different problems with the health care and ways to solve it have shaped the foundation of the American health care system to this date. I also believe that there will be many more pieces of legislation and problems that will occur in the future that will continue to shape the American health care system for years to come.
Hi Holly, Good Afternoon
Firstly, I’d like to say great blog entry! I am so sorry to hear about your son’s broken leg. It sounds so painful and heartbreaking! Kids will be kids and sometimes that ends in expensive injuries in the country we live in. I do agree with you that most of the hospital’s service is certainly for-profit and since healthcare is not seen as a “necessity” per se in the United States, your son’s injury is, unfortunately, one way they make all the money.
Do we have an efficient system that creates an efficient market for healthcare? Absolutely not, I believe that since our healthcare system is built on political views and financial gain, it is nearly impossible to have an efficient system with those two factors involved. Healthcare should be a basic human right and it should be provided whether a person can pay for it or not. Does one’s health need to suffer simply because that official is unable to afford care? In a sense, that is inhumane. The average cost of a hospital visit in the United States does not surprise me. I have a son as well. I stayed in the hospital the normal 4 days after I gave birth to him and upon our exit, I was baffled to see a financial associate enter my room to ask how I’d like to receive my bill. I have private insurance through my employer that I pay monthly and AFTER that coverage, my balance was $9000. There were no tools or instruments used during delivery. Simply medicines and tests were done on my newborn. I could not believe that it cost that much to deliver a human AFTER my insurance kicked in.
I think that it is INSANE that health coverage premiums can cost more than a mortgage or rent on a home. The U.S. has options to make this necessity more affordable but some factors interfere and would make it too difficult to see eye to eye with larger sectors (hospitals, private insurance). The uncomfortable topic needs to be talked about. There need to be more options on the table for more affordable healthcare and not the battle between affording care or not. Health coverage and good health should be a societal goal among citizens and lawmakers.
I am hoping for the best for this country but preparing for the worst in terms of healthcare affordability.
Good Morning Eboni,
I had a similar experience after the birth of my son! $9,000 is crazy AFTER insurance. So in NY where I had my daughter, we did not have the same time of experience. I had to pay my co pay, and that was IT. When I came here and had my son it was an eye opener for sure!
I asked for the breakdown bill after my son. They had a charge in there for $2,000 for a nursery. I am not sure if you had your son at ECU health – aka Vidant but they do not have a nursery. I inquired about that.. it is the warming light/box they have in the room. My son wasn’t even in there. They charged me for the use of it in my room! I know it is standard practice, but I think it is a shame what they can get away with and we as patients have no say.
-Holly
Hi Gavin! I enjoyed reading your post and think you did a very thorough job at describing both the public and private sectors of healthcare and how the U.S. healthcare system is considered both a public and private good. On the outside, I feel like a system that is both public and private in nature sounds like a good idea, as it implies a collaborative or middle-ground approach because is encompasses aspects from both ends of the spectrum. However, I agree with your post in that the view of health care as a private good is detrimental to the way healthcare operates in the United States. This is because it leads to disproportionate healthcare accessibility and equity issues, such as how you mentioned how certain healthcare services are hidden behind paywalls.
As I was doing some of my own research to best respond to your post, I keep coming across the word “capitalism” in reference to American healthcare. I have even come across the term “disease of capitalism” in reference to healthcare multiple times. This intrigued me and seemed to relate a bit to this chapter so wanted to share some of my findings. One article I came across, Health, Health Care, and Capitalism (2009), notes how capitalism is seen as an engine of growth and responsible for major health improvements. This article argues in opposition to that notion, and states that the U.S. is a world leader in healthcare market failure, backed up by expenditure and health outcomes of other smaller and often poorer countries. Additionally, the article 21st-Century Capitalism: Structural Challenges for Universal Health Care (2019) discusses (1) financialized capitalism, (2) trades, intangibles, and global value chains, and (3) inequality as the main issues for the U.S. in achieving universal health care. The article’s main idea is that capitalism has cultivated a climate of economic volatility, that which is in power by controllers of global value chains rather than traditional commodity producers and traders. This climate has affected not just the traditional economy, but also that of healthcare.
References
– Health, Health Care, and Capitalism (2009): https://socialistregister.com/index.php/srv/article/view/6761/3914
– 21st-Century Capitalism: Structural Challenges for Universal Health Care (2019): https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0517-3