Government Ability to Manage Social Risks - Essay Example

Running Header: The Third Way: Equitable Health Care or Broken Promise? The Third Way: Equitable Health Care or Broken Promise? The New Labour Approach to Health Policy The rule of every government is based, in large part, on its ability to manage social risks. Unemployment produces unrest when it affects a sufficiently large percentage of the population, and so governments must find a balance between providing a safety net for its most vulnerable members while giving those who are able the incentive to go out and find productive employment. One crucial part of the poverty cycle, for example, is the fact that since the poor lack some of the capital and other instruments that allow the more affluent to take risks as far as education and business opportunities go, the poor are less likely to take the risky steps that could get them above the poverty line (Holzmann and Jorgensen 2001). And so governments have to decide which programs will best reward the investment of tax dollars (Merkhofer 1987). One of the most controversial areas of public policy involves health care for that part of the population least able to pay for their own care. Socioeconomic status has been identified as a powerful factor in one’s health (Bloomberg, Meyers and Braverman 1994). The more health problems that those citizens at the lower end of the socioeconomic spectrum have, the greater the tax burden will be on the rest of the citizenry. However, while the politics of money should play a significant part in the development of social policy, there is also the idea of social justice to consider. Social justice takes on many definitions, depending on the political leanings of the definer, but the general idea involves the creation of a sense of fairness or equality of opportunity to members at all socioeconomic levels of a society (Jordan 1998; Marshal, Swift, and Roberts 2002). Under the Thatcher administration, inequalities in access to quality health care began to widen in British society (Wagstaff, Paci, and van Doorslaer 1991). When Prime Minister Blair took office, one of his first moves was to establish improved access to health care as a top priority. There are at least three schools of thought as to how to engineer social change. The “laissez-faire” line of thinking – which basically involves allowing society to shake itself into the desired state – might argue that education alone would awaken the British public to the plight of the poor, particularly with regard to health care. The transition in the health habits of the Indian state of Kerala, between 1961 and 1974, could serve as a strong example for the laissez-faire viewpoint. Over that period of time, the birth rate fell from 39 to 26.5, while levels of literacy, life expectancy, female education, and age of marriage became the highest in all of India (Ratcliffe 1978). The cause of this change is not massive social expenditure for contraceptives, not an infrastructure of free clinics, but simply public education about the benefits of family planning, and about the importance of equitable distribution of opportunities (Ratcliffe 1978). Near the other end of the spectrum stand the Social Democrats, who believe that social justice can be achieved, if government planners can only find the right level of taxation to put into place sufficient programs and infrastructure. The natural sympathy that rightly extends to those who need medical treatment that goes beyond what they can afford has made social justice one of the central ethical principles of public health nursing. Programs that do not ultimately result in a change of behavior, however, are only short-term solutions that will not change societal patterns over time (Drevdahl, Kneipp, Canales, and Dorcy 2001). Also, programs that do not accurately address the factors that connect socioeconomic status and health will, ultimately, waste taxpayers’ money and will solve nothing (Marmot and Feeney, 1997). The New Labour way of thinking sits somewhere, at least in its own mind, between the miracle of Kerala and exorbitant tax rates. The “Third Way” promoted by Prime Minister Blair focuses on pragmatism rather than politics, and so a health care policy in line with this way of thinking might well agree with Jennifer Prah Ruger, who argues that “a person’s capacity to function – rather than to be happy or to have employment opportunities – should be the gauge for assessing public policy”(2004). A social policy cannot engender a work ethic, and it cannot affect one’s mood; however, it can work towards ensuring basic standards for quality of life. It may well be questioned, however, whether the policies of New Labour ensure standards that connote social justice. This focus on pragmatic solutions would echo the sentiments of the World Bank’s views on effective health policy. Perhaps armed with the knowledge that there will not ever be enough money on the planet to implement policies to change the health-related behaviors of the world’s citizens, the World Bank has defined health as a “private” responsibility and health care as a “private” good. Therefore, governments should strictly limit the number of goods and narrowly define the forms of relief available to the poor (Laurell and Arellano, 1996). While this might be seen as a violation of basic human values, by denying equal access to health care to all members of society, it can also be seen as a recognition of the limits that exist on government pocketbooks, particularly in developing nations. While England can certainly not be seen as a developing nation, those in charge of budgeting for social policy face difficult choices similar to those that face the World Bank. One area in which many perceive the Blair government as having fallen short of ensuring social justice is the problem of the unemployed. Social workers who were expecting Blair’s Labour government to embark on a widespread program of relief payments to the unemployed poor have been disappointed by the Blair government’s “fixation with waged work as the principal solution to social exclusion and poverty”(Jones 2001). The idea of work as a solution to the poverty cycle fits between a more Social-Democratic idea (relief payments) and the laissez-faire approach (let the job market provide openings as growth occurs over time). It does not take, in the opinion of the left, sufficient interest in the needs of the disabled, and those who have entered their working lives disadvantaged as a result of racial discrimination or educational shortfalls as a result of immigration (Williams, 2001). Initially, the Blair government recognized that the NHS would need a considerable increase in funding, in order to meet the needs of the public. Otherwise, the middle class would buy its way out, and the NHS would end up serving only the poorest citizens. Tax increases began in 2003 and will continue until 2008 – a 43% increase, in real money, in British health taxes. By 2007-2008, 9.3% of the GDP will be spent on health care, which is near the upper end of the spectrum among European nations (Stevens 2004). The Blair government has taken steps in addition to increasing funding with an eye toward reforming British health policy. Legislation increasing international recruitment, authorizing flexible return-to-work provisions for doctors with young children, and creating pay incentives, has served to ease the shortfall – the number of NHS nurses has increased by 50,000 since 1997 (Stevens 2004). In addition to reducing the provider shortfall, electronic medical records for all fifty million Britons have been created, at a cost of 2.3 billion pounds. The NHS Modernisation Agency spends 220 million pounds a year in the redesign and reengineering of such services as cancer, cardiac, primary care and emergency surgery (Stevens 2004). The NHS has set many challenging goals for itself, including: reducing cancer death rates by 20 percent in people under age seventy-five by 2010; cutting heart disease death rates by 40 percent in people under age seventy-five by 2010; reducing death rates from suicide and undetermined injury by 20 percent by 2010; reducing inequalities in infant mortality and life expectancy at birth by 10% before 2010; and reducing the conception rate for those under the age of eighteen by 50 percent by 2010 (Department of Health 2000). Whether these goals are met or not will, in large part, determine how close the Blair government has come to creating an atmosphere of social justice in its health policy. The Blair government’s approach to the child obesity problem is typical of its tendency to place pragmatism ahead of other concerns. The UK school meals policy emphasis has changed from quantity of food per child to the nutritional composition of the food that children receive (Gustafsson 2002). While this may sound like solid policy in principle, the government’s emphasis has been on privatization of the meal production and distribution process, and on minimizing the costs of the program, rather than on attending to the nutritional quality of the food – in other words, as in other areas of health policy, the economics of the problem have taken precedence over the effectiveness (Gustafsson 2002). Another tenet of the Blair health policy has been to emphasize the contributions that social service departments can make to promoting health. This has consisted of three elements: streamlining organization by merging elements of the NHS and the service departments; implementing new funding mechanisms for health and social services; and fighting inequalities in health by fighting inequalities of socioeconomic status (Bywaters and McLeod 2001). Of particular concern to this third element is the introduction of the Health Action Zones, designed to infuse funds and infrastructure into those areas that need it most (Powell and Moon, 2001). The other side of the argument, however, is that certain health care services might be restricted to certain zones of the population, based on the amount of financial subsidies involved. The result is that the entire British population is guaranteed access to health care, but the British government spends about half the proportion of its national income on health care in comparison to the US (Klein, 1998). While this has not proven to create a utopian situation as far as health care goes for the entire socioeconomic spectrum, it has served as a pragmatic solution to a difficult problem (Tuohy 1999). Whether it is socially just solution, however, is another question. One tenet of the New Labour health programme that has aroused controversy has been the privatization of many of the publicly funded health services. Public-sector management have a somewhat pessimistic view of public-private partnerships, given the possible conflicts of interest between those accustomed to generating a profit and those accustomed to administering a public entitlement (Field and Peck, 2003). Because of the ongoing philosophical debate within the Labour party concerning the involvement of private companies in the health care system, the government is not giving its health care management the tools to benefit from these partnerships. A benefit of these partnerships, however, has been the modernization of medical facilities that has been undertaken by private companies, which operate the hospitals (Stevens 2004). Additionally, for the first time, doctors must renew their licenses every five years, and legislation has created a National Clinical Assessment Authority to inspect doctors who give rise to concern. NHS hospitals are subject to independent inspection, and so there is external oversight of the private concerns that have entered the healthcare industry on the Blair government’s watch (Stevens 2004). In Britain, the public philosophy embraced by New Labour contains an ideal from within the socialist tradition—that is, “citizens attaining moral personhood within and through the community” (Bevir and O’Brien, 2001). Whereas Old Labour generally sought to use a universal welfare state to create this ideal, New Labour envisions a partnership among the government, private organizations, and citizens, to create this ideal. The problem, however, with partnerships of this nature is that when the government delegates public responsibilities to private concerns, there is not as much oversight to the operation of those public responsibilities, and so social justice can suffer. While New Labour may have accomplished much in the way of controlling social costs, the government has also sacrificed much in the way of helping the poor, particularly in the health care arena. 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Williams F 2001, “In and beyond New Labour: towards a new political ethics of care”, Critical Social Policy, vol. 21, no. 4, pp. 467-493. Read More