terça-feira, 17 de novembro de 2020

Version 2.197

In the Western world, there are two schools of thought when it comes to healthcare: one is what people denote as socialized medicine, in which the healthcare system is mostly financed by taxes and there is universal healthcare; the other one is a for-profit healthcare system in which not everyone chooses to have access to routine healthcare. The healthcare system of each country usually stands within a spectrum of these two extremes, but there are hardly any pure systems, although many European countries fall closer to socialized medicine and the U.S. is closer to the for-profit system.

The U.S. is often criticized for being one of the richest countries that does not provide universal healthcare to its citizens. One should note that in the U.S., there are groups of people with access to socialized medicine type healthcare, for example, the elderly have access to Medicare which is funded with a federal tax on the working labor force, and veterans receive healthcare through a federal funded system. Medicaid is another system that is a joint effort of the federal and the state governments, which cares for children, pregnant women, parents, elderly, persons with disabilities, etc., who qualify (meet a low-income threshold).

After the Affordable Care Act was passed, health insurance became accessible to anyone in the U.S., as people with low income could have the federal government pay for part or most of their health insurance premiums. However, when the ACA individual mandate was repealed, people did not have to get health insurance, whereas when it was in place, those who chose to not get it had to pay a penalty, so there was an incentive to get health insurance.

Do not assume that some people are completely shut out of healthcare in the U.S. because federal law requires that hospitals provide emergency care to anyone, regardless of ability to pay, so you could say that in the U.S. there is universal access to catastrophic healthcare, but not universal acess to preventive healthcare. But even that is not valid everywhere. For example, San Francisco, in California, has offered universal healthcare access to their residents since 2007 and, more recently, states like California and New York have started to move in that direction as well. The main point to keep in mind is that independently of what people's views are, there is likely some place in America where they can live accordingly.

Perhaps the greatest critics of the American healthcare system are Americans themselves, but there are also many Americans who defend it because they feel that depending on the government for healthcare leads to being complacent. Furthermore, the U.S. federal government does invest in healthcare in the form of research, public health threat monitoring, etc.

One can succumb to the temptation of trashing the way Americans manage healthcare, but it is wise to remember that of the Western countries, the U.S. was best positioned to prevent the pandemic. Since the Bush Administration, there had been a multi-administration effort to try to mitigate pandemic risk. And the Obama Administration had negotiated with China to keep American observers there so as to keep track of the risk of a new virus making the jump from animals to humans.

Despite the animosity between the Democratic and Republican parties, there are many policies that continue from one administration to the next regardless of party. For example, over the last 50 years, we saw the development of biofuels and reduction of the dependence on oil, the development of the Internet, creation of the information economy with the collection of massive amounts of data and satellite imagery, etc. All of these were the work of multiple Republic and Democratic administrations.

Even in international relations, for several administrations, the United States pursued a policy that promoted the development of China because the sheer size of the country make it very attractive as a market for American products. When I first came to the United States, in 1995, I worked at the Office of International Programs at the University where I studied. Most of the students that were managed by the OIP were sponsored by foreign governments or non-profits, many from China and other Asian countries. I remember one of the first meetings I attended in which Dr. Art Klatt, the director of the OIP, spoke about how interesting China was for American companies: think about what it would mean if each Chinese person consumed a Coca-Cola a day, he would say.

The Trump Administration is the first that has interrupted the flow of inter-administration policy and the current policy has the United States navigating with a short term focus, which is completely uncharacteristic of American policy. The size of the pandemic is a faillure of American policy, but then again, all other countries are failing, which brings me to my point: all countries were dealt the same challenge, but the social contract that citizens have with their governments is different.

In European countries, the focus is on providing access to healthcare care to everyone. In the United States, the focus was to prevent the situation from hapenning in the first place. Both systems have failed and few, if any, can claim to be better than the other.

1 comentário:

  1. Muito Bom.
    Nas empresas farmacêuticas, as despesas com promoção e publicidade já ultrapassam as de investigação e desenvolvimento, tanto na Europa como nos EUA?


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