Concerning the existing framework of the healthcare system in the United States, it has become a deep-rooted and growing conflict between the principles of market efficiency and social equity, in other words, the simplest and most fundamental agreement that a government should make sure that the basic survival and health of its people is achieved in exchange of their cooperation in an operating society. In places where hourly service work is predominant, healthcare is not something that people experience as a public right; it is a commodity that is treated as a private right, which is strongly tied to the employment status. The policy is forming a new reality in which medical care is no longer a simple issue but a financial calculation that is under constant stress. In the case of working cashiers or other food service jobs that may require a deductible, co-pay, and/or the loss of shifts, the onset of a continuous cough or minor physical injury does not prompt a recovery plan, but instead, a sequence of high stakes questions on deductibles, co-pays, and the possible loss of shifts. When insurance is pegged to a definite job, family members are usually compelled to think twice before they proceed to the professional care in fear that a visit by a single doctor may put the entire stability of the entire household at risk. The government arguably does not meet its constitutional obligation to safeguard the so-called General Welfare of the community because it treats healthcare as a product, which is earned through a certain type of labor, rather than a minimum of human dignity. This institutional tie-in rewards the very individuals, who help keep the economy running, making their physical safety a lesser consideration to corporate efficiency. Criminologically and governmentally speaking, in the event that the government is not able to offer the basic necessities of survival, the Social Contract then starts to wear out. When the security part of the bargain of the government is to provide security, there has to be security of protection against preventable physical destruction. But in the present model, this security is supposed to be provided by the “market” and this necessarily excludes low-margin, hourly jobs. I have observed in my own community, how this impacts the dynamics of the household; how much of a medical crisis it is, to the economic viability of every member of that household. When a worker is not able to afford to treat a minor ailment, this ailment tends to become a chronic condition or an emergency room visit which is much more expensive to the individual and state as well. This shows that actually the so-called market efficiency model is inefficient in the long run as it will drain the human capital of the country and will overload the emergency social services. The government should be much more central in uncoupling insurance and employment in order to pay tribute to the real spirit of the Social Contract and the social equity themes that our course covered. This would mean that when a career change, reduction in hours or the decision to seek a new opportunity occurs, a total loss of physical security is not achieved. The decoupling of healthcare and work would give the opportunity to increase labor mobility and implement a safety net, which would not be dependent on the employer. It relocates the needle between seeing health as a work benefit and as a precondition towards a functioning and a democratic society. Finally, healthcare policy cannot be quantified by economic measures only, such as GDP expenditures, or market dynamics. Rather it should be quantified by the minimum level of security, physical health and dignity that a government is ensuring all its citizens. It is only through the provision of healthcare as a communal right that the disparity between the classes can be bridged and the promise made by the government that it is there to support the welfare of the people it is meant to represent can be fulfilled, regardless of how the person would fit into the working environment or how much he would earn per hour. The encouragement of this degree of equity is not a policy choice, but a necessity to ensure the social cohesion and stability, which the Social Contract was initially designed to provide.
By Raisha
