The success of any society is ultimately determined by how well its population lives and dies. Within this paradigm of “successful population” are two fundamental elements – individual and collective wellness. A successful society therefore embodies the notion that both individuals and the overall population are well, and these two measures are reasonable assessments of the wellness, and hence the success of any given society.
In other words, the success of a society can be assessed, characterized, and understood through these two main measures. To break it down, individual wellness consists of answering the question: does the society reasonably allow and encourage individuals to be well? Secondly, does the society allow and encourage wellness for the entire population from birth to death? To the latter question, the most important component of population wellness and hence, societal success, is the degree to which the sum of individual wellness creates collective wellness. The single-most important component of population wellness is a high level of population health, measured by the numbers of individuals who are well or have reasonable access to being well.
The four scenarios below represent a summary snapshot of healthcare systems currently in existence in the Western Hemisphere. The scenarios are predicated on the reality that the cost of healthcare is (next to purchasing a home) the most expensive cost one will experience during his or her lifetime and that these costs are expected to continue to escalate over time as new technology, treatments, and pharmaceuticals continue to drive costs. These four main approaches to healthcare are:
1. No healthcare programs (other than free market)
2. Universally funded programs
3. Insurance company funded programs
4. Combinations of the above
These four healthcare approaches are summarized below with respect to how well they represent the ability to create a successful society. Remember, a successful society is one that encourages, promotes, and allows for both individual and collective wellness, as measured by population health.
1. No Healthcare Programs: Countries which have no healthcare programs generally have lower than average population health. While some members of the population in these societies (namely the very rich) who are able to afford healthcare may be healthy indeed, the overall population health is often quite low. It is important to note that socioeconomic status is generally a good predictor of population health. In countries where no healthcare programs exist, and the reason for these lack of programs is lack of finances, then population health is usually comparatively low. Using our definitions of societal success, the success of these societies would be low, or unsuccessful.
2. Government Sponsored Programs: Countries with government sponsored and funded universal healthcare programs generally have a collectively higher level of healthcare than other countries. Again, if the one applies the definition of success of the entire population as the sum total of the wellness of all individuals within that system, then countries which offer healthcare programs that collectively confer benefits on the highest number of individuals are, by definition, successful. Since one cannot be more than well, there is no incentive for individuals to access more services than are required in order to be well. Leaving aside preventative programs and social marketing costs as key aspects of overall population health, health and wellness can be accessed within government sponsored programs up to a certain level depending on the aggregate overall need of the population. Therefore, by definition, and in spite of incentives and disincentives within the system, the societies that employ these systems are successful.
3. Insurance Company: Healthcare programs sponsored by insurance corporations can work well, provided that the insurance coverage provides all members of society with at least basic coverage and coverage through catastrophic illness. Nobody plans on getting leukemia, or ALS, or meningitis, or lupus, for instance. If you are well-educated and have a position with health benefits with a corporation or you have been successful in your career or business, then it is likely you will be able to afford the costs of healthcare. However, since healthcare and profit-motive are mixed within the same crucible, there is a strong incentive to cheat or to create environments where profit supersedes care if the two vie for supremacy – much as suggested in Michael Moore’s movie, Sicko. The active removal or denial of healthcare is a logical and inevitable outcome of a for-profit, insurance corporation controlled system of care delivery – particularly where the population is aging. Also, there is no compelling motive for insurance corporations to cover individuals susceptible to high healthcare costs (i.e., those with catastrophic physical illness; mental illness; the frail elderly; new mothers and infants), period. The outcome of such a system would be to spiral into category 1 – No healthcare programs – (mediated by a very few insurance companies) wherein the richest segments of society would be able to access services. The irony is, the richest citizenry often require much less healthcare than others. The upshot is this: there is an increasing disparity in the number of people who are able to access healthcare in the face of age and cost escalations. One needs to question the current and future success of these social systems.
4. Combinations of Above: Combinations of the above become extremely complex and difficult to assess. There are certainly advantages and disadvantages, as well as incentives and disincentives for a hybrid of the above systems. Each of these advantages and incentives (or lack of) are inextricably connected to the socioeconomic class you and your family belong to or are transitioning into as well as a host of external and internal factors. A government funded universal system provides healthcare to everyone, including those who are disadvantaged and could not possibly access care without subsidization. It also provides care to those who are charged by some who would abuse care (though unclear who this group might be as people do not consume unlimited healthcare once they are well). Alternatively, the system dominated by large insurance companies provides very high quality, responsive care to individuals who can pay or who are insured by corporations who in turn can pay. This system works well where individuals insured are reasonably healthy and young. A problem occurs when the population of employees becomes older and insurance premiums are either hiked to cover extraordinarily high costs (insurers will only cover healthcare costs where the profits of covering healthcare costs actuarially calculated costs) or removed entirely. Countries in which no healthcare programs exist (presuming healthcare is available) results in costly but accessible services for the very few. There is no need to get into the obvious personal suffering and strife in this latter healthcare system.
To summarize the four systems discussed:
1. The richest members of society will continue to receive care regardless of the system in place.
2. The poor will suffer the most in instances where there is either no system in place or where insurance corporations are the primary arbiters of healthcare delivery.
3. The government funded universal system provides care to the greatest number of individuals in society, despite any shortcomings.
4. Profit motive and linkages to incentive to constrain services and limit accessibility becomes increasingly prevalent as the workforce ages (and healthcare benefits supplied by employers become accessed more frequently).
5. Societal Success = providing the opportunity for wellness for the greatest number of people that make up the society.
In conclusion, the success of a society is correlated with the individual and collective wellness of that society. Wellness of the society is inextricably linked to the overall health of the population within that society.
Societies that provide healthcare to the highest number of individuals to an established floor (as opposed to ceiling) level of care (inclusive of the most downtrodden and indigent) are successful. A ceiling level of care is redundant when referring to healthcare, since, with the exception of only an extremely rare and unusual incidence, people only access healthcare up to the amount which will result in wellness. For instance, unlike other goods or services (e.g., Ferraris, Rolex watches, massages, Gucci handbags), obtaining healthcare in excess amounts is both redundant and ridiculous and counterintuitive to human nature.
It is therefore reasonable to suggest that a system of care which provides for the greatest number in society (e.g., everyone), the most vulnerable in society; as well as those at the highest rungs of the socioeconomic ladder and everyone in between could reasonably be argued as the most effective. To those who would charge or decry a system that would benefit everyone as inefficient or unaccountable and therefore untenable, it is important to ask where they, themselves, fit into the healthcare-socioeconomic landscape. Secondly, are they interested in the societal success, will their approach move the society toward success, or are their own parochial interests – however they are justified – masquerading as societal success. You be the judge.