Entitlement+Society+or+Working+Society?



Student Number: N8282226 Ryan Kemp-McCormack Tutor: Katie Page Submitted: 4/11/2011

Public Health From A Liberal Perspective: Objectivism and Individuals

The cultural artefact I selected depicts the phrase “Entitlement” along with a caption criticising the entitlement mentality that, arguably, today’s generation displays. The author of the blog post uses this image to highlight how people in this day and age are not earning their keep and that society just expects everything to be done for them with little effort. From this artefact, a larger area of debate and controversy can be drawn upon. Currently in Australia all citizens enjoy the luxury of a single-payer universal health care system, but at what cost? Should people not pay for services that another person performs? This luxury has become increasingly hard to maintain and without urgent reforms, the costs are likely to spiral upwards and end up decreasing the standard of care and outcomes from a public health perspective. Specifically this paper will use peer-reviewed research to outline the possible benefits of adopting a more economically liberal approach to the Australian healthcare system such as demonstrating how a ‘user-pay’ system in the long run will help individuals and the already strained public Medicare system and increase good public health goals and results. From Robinson’s (1989) paper, Ayn Rand’s theory of Objectivism along with Milton Freidman’s theory of economic rationalism, makes the argument against the collectivist approach to health and rather focusing on personalised outcomes in terms of health and the health of a society.

From the previous research of Wright & Wilcox (2002) the distinct advantages of drawing upon a new model of where the user pays, were analysed from the reforms of the Liberal Howard Government, which were put into place in the late 1990’s. These reforms such as the thirty percent private health care rebate for individuals were studied from the period of 1998-2001 with results showing a greater increase in the number of people utilising private health care showing an increase of 27 percent of the population to an increase of 42 percent. In addition to these findings it was also determined using data from the Australian Buerau of Statistics in conjunction with the research of Wilcox (2001), the increase in private health care consumption had lead to more market based efficiencies, such as freeing up waiting lists in the public and private sectors, freeing up hospital beds in that same period and increasing the number of GP’s operating in Australia. These studies only applied to Australian hospitals and used statistical data from the Australian Bureau of Statistics to make a personal judgement about the benefits of private care. The primary limitation to these studies was that the selected period studied was too brief and thus to draw major policy conclusions would be premature although strong data exists for the existence of a user pay health system (Wilcox, 2001).

The debate whether or not private health care being more efficient in terms of public health was studied in depth by Brekke&Sorgard (2007). They analysed the effect that a government has on the operating of a health system, in specifically the NHS was analysed. It found that the more government health expenditures had increased, a increase was in rates such as infant mortality, lower life expectancy, cancer death rates and chronic health conditions. It concluded that government control mechanisms had severely reduced the possibility of individuals obtaining quick affordable health care and had in fact caused a decrease in the number of doctors operating and longer waiting times per capita. It laid out recommendations to the NHS to introduce more market based solutions to allow more doctors to come back into the system. Limitations to the research were the fact that it studied the NHS not Australia’s system of Medicare, however slight the comparisons may be. The study used surveys of patients and physicians while analysing government health data from 2001-2006 a relatively short time frame and future research will be more long term orientated. This research also drew the same conclusions as Wright etal. (2002) in that more money was needed to fund the health systems long term either through large tax increases or more user paying mechanisms.

The fact that a publically funded Medicare exists in Australia presents a challenge to right wing reformers of the system. The capacity of individuals to pay for more of their health care services was examined in a study by Ryan, Scott & Donaldson (2004), which surveyed the data of Australian several types of income brackets and determined that as a percentage of their income around 80percent of Australians could actually pay for and had paid for medical services at some point. It found that tax incentives and subsidies implemented by the Howard government had been a success in terms of addressing the needs of shoring up funding of both the public and private systems (Ryan et al. 2004) and improving public waiting list times and increasing the number of GP’s into the system. Methodologies in the study may have been flawed as it used a small representation and might have only focused on middle of high income earners as a bearing of the results. The research by Ryan et al. did also fall into line with the research of Brau, Bruni& Pinna (2010) regarding the fact that the idea that a public funded system could be sustained long term was not accepted due to economic modelling for future growth and that injecting more user pay ability was necessary from an economic and political viewpoint.

Also crucial to understanding the need to reform the publically funded health system is to consider the benefits from a social and economic standpoint. From the research of Olsen, Kidholm, Donaldson & Shackley (2004) a US study was conducted to determine in a given population sample the factors, barriers and the ability of people to pay for private health care. Two methods of affordability were analysed; subsidising health care and using tax credits for people to pay for their health care. Results found that across the board people when offered subsidised health coverage compared to tax credits there was an increase in US private health cover in the period of 1999-2003 resulting in large part by the subsidy to private health care enacted in 2002 by the Bush Administration, according to a 2004 HHS report. The research also confirmed other findings by Hancock, Comas-Herrera, Wittemberg & Pickard (2003) which analysed new market based reforms enacted by the Blair government which also after a few years of implementation had decreased public waiting lists and increased access to vital specialists and as a result saw improvements in public health metics such as cancer survival and a reduction in chronic illnesses (Hancock et al.). The studies above did analyse US and British health services but recommendations and conclusions can be made to adapt for Australia’s Medicare system.

To understand why society and culture will benefit from the capitalistic reforms to the health care system, two key schools of philosophies and social theories must be explored; Ayn Rand’s theory of Objectivism and economist Milton Freidman’s theories of economic rationalism. Objectivism holds that selfishness and the pursuit of an individual’s own goals is moral good (Branden, 1984) and consequently the virtues of altruism and the need to belong to a group display a weak capacity to make strides in life. In the latter part of the 20th century with the fall of the Soviet Union and the rise in free market capitalism in Western societies, Robinson (2002) notes that the notion that something was for free began to fall under heavy scrutiny by many capitalists and other free market thinkers like Milton Friedman and Ayn Rand. They argued that the services that a person required was built upon from technological innovation and labour from another person and the idea that the service the other person provides should be free or heavily subsidised by the State amounted to a loss of liberty and a system that would inevitably try and control itself through rationing and central economic planning, which had shown to be failed policies according to Robinson (2002). She stressed that anything that an individual needs or wants must be bought by them alone or family or friends and not the State picking up the tab for an individual’s needs. She along with Freidman (1992) suggests that this was the basis for human growth since the industrial revolution in the 1800’s a market place of ideas with minimal interference from the governing state.

Adopting a system in which the user pays more for their own health care needs is fundamental to reducing the exploding debt the most Western nations are incurring as a result of having a quasi-socialised medicine system as explained by Wilcox (2001). Certain groups in society may benefit from these changes mainly middle to upper class families as they can afford these services however other people who cannot afford services can rely on private charity and small government subsidies to afford basic care. Also evident from the research of Branden (1989), Rand said we as a society should not focus on broad notions of a ‘public’ but rather that individuals should have more freedom to consult with private GP’s and clinics for ensuring their own health (Wilcox, 2001) and that if individuals were healthy that would free up more productivity into our economy and thus more private charity. Along with Rand’s theory of Objectivism, the economic ideas of Milton Freidman gained prominence with the explosion of the welfare state across Western nations and increasing hardships at delivering health care to its citizens (Branden, 1989). Many countries including Australia began to implement private reforms to health services. These reforms accompanied bythe economic rationalist theories of Friedman (1992), held that a publically funded medical system will always fail in the long run because it seeks to control the system that must serve a population whose demographics are always changing, thereby creating a system of command and control that will be used to deliver basic services until the doctors and other service providers cannot afford to do so as the government cannot collect enough taxes to fund services (Friedman, 1992). The user pay system according to Friedman (1992) is the model that will succeed because it delivers a system whereby all labour and services are paid for by consumers meaning more choice and shorter waiting times and access to services that can be built to accommodate expanding health services that individuals need within a market based framework.

Concluding this research, the cultural artefact selected depicts the growing frustration that people in society today, want everything for free and the picture expresses the underlying notion that people need to earn their keep so that other people are not just subsiding their lifestyle. This point of area was expressed in terms of Australia’s current health policy and the case was made that we as individuals had to start paying more for our own health care and not burden the rest of society with higher taxes and more costs. Once people start paying more for their health care money can be utilised to ensure that they can gain some access to basic health care through Medicare. Ayn Rand’s theories of ‘Objectivism’ showed that society does not benefit when everyone is made to pay for someone elses need and that true freedom allows people to use their money as they see fit, and that Friedman’s economic theories illustrate the point that nothing in life is free and that people pay ultimately for all services they use in their lifetime. As a result of undertaking this cultural artefact analysis the way in which I see the world has changed. I have realised that society today expects everything now and that they shouldn’t have to work hard for it and that this is a problem for the future given gloomy economic times. In my learning capacity I hope to learn the appreciation of working for my keep and that feeling of being able to determine my own outcomes on my terms and not on others.

References

Branden. N. (1984) .The Benefits and Hazards of the Philosophy of Ayn Rand.//Journal of Humanistic Psychology, 24//(4), pp. 39-64. Brau. R., Bruni. M. L.,&Pinna. A.M. (2010).Public versus Private Demand for covering Long-Term Care Expenditures.//Applied Economics, 42//(28),pp. 3651-3668. doi: 10.1080/00036840802167343. Brekke. K, R., Sorgard. L. (2007). Public Versus Private Healthcare In a National Health Service. //Health Economics, 16//(2007), pg 579-601.doi: 10.1002/hec.1185. Freidman.M. (1992).Economics in Theory and Practice.//De Economist, 140//(2), pp. 271-271. Hancock.R., Comas-Herrera. A., Wittemberg. R. & Pickard.L. (2003). Who will pay for long-term care in the UK?Projections linking macro and micro-simulations models.//Fiscal Studies, 24//(2003), pp. 387–426. Olsen, J. A., Kidholm, K., Donaldson, C. and Shackley, P. (2004). Willingness to pay for public health care: A comparison of two approaches. //Health Policy, 70//(2), pp 217-228. doi:10.1016/j.healthpol.2004.03.005. Robinson. K. (1989).Ayn Rand's Objectivism: A Humanistic Interpretation. //The Humanist, 49//(1), pg. 29. Ryan, M., Scott, D. A., & Donaldson, C. (2004). Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods, //Journal of Health Economics, 23//(2), pp. 237–58.doi:10.1016/j.jhealeco.2003.09.003. Wilcox. S. (2001).Promoting Private Health Insurance In Australia. //Health Affairs, 20//(3), pg 152-161.doi: 10.1377/hlthaff.20.3.152. Wright. G, Willcox. S. (2002).Private Health Care in Australia.//Health Affairs, 21//(1), pp. 277-278.

Reflections:

That was a very interesting read Yarnzie. There are alot of aspects to take into consideration in researching gender bias in sport and you covered it from a good angle. I suppose that my input would be a slight critique in were I may diverge from you...
 * || [|n8282226] Nov 7, 2011 2:13 pm

I think that by an large society works and functions in part by a market mechanism. What people want and do is largely influenced by what is available and by how interesting it may benefit their lives.

I think in terms of sport, I believe actually that the role and coverage of womens sport is increasing dramatically I dont have the statistics to back it up but I remember reading that last years netball final had like a million viewers which was unheard of before. I think it comes down to the historical angle in that men have just traditionally played sport on the high level and it has attracted the most money and entertainment by the free market. I think that trying to make womens sport equal in some way either by government dictations on making it the same won't really reflect the mindset of consumers in the market. I think it is wonderful that women have made strides in getting the praise and success from their sporting achievements.

Good Read.

Ryan n8282226

Reflection 2

[|n8282226] Nov 7, 2011 2:33 pm Very good read.

I am not completely sure what side of the political spectrum you came to conclude had a better record but it was a great read...

I would like to add my two cents by saying that, while good public health outcomes occur in countries in Scandinavia, Canada and western Europe, you can also see that maintaining this huge bureaucracy costs so much money to maintain you can see this in the US which has the largest single payer healthcare system in the world, Medicare. As a percentage of GDP health expenditures from government spending are increasing everywhere in part by the command and control methods of left wing states. a universal health care system operates the same way as the USSR use to work until it realised that it cant manage every aspect to the system and it inevitablely collapsed on itself.

Without more users paying into the system their will ultimately be no health care for anyone as doctors wont be able to practice and nurses will have to work for next to nothing.

Thats just my opinion though and i enjoyed your essay

Ryan

N8282226 ||