In the US, a rational and a logical approach to social welfare policy have been evading the country as the problem of addressing poverty has been differently perceived. There has been considerable difference on the level of support that needs to be extended to the poor. Advocates of the poor oriented programs see millions of people suffering from hunger and curable illnesses. Their demand is that the country undertake massive and immediate public welfare programs. However many others don’t perceive poverty in the country, in a similar way.
Their contention is that the poor in America today are better off than the middle class who lived fifty years back or at least considerably well off than their counterparts in most other parts of the world. They believe that excessive governmental support would do more harm than good by not helping them to assume responsibility for themselves. They should develop a need to work, save and establish their own lives. The proponents of this version of poverty policy disagree that all beneficiaries of the governmental welfare services are actually suffering from hunger and curable diseases.
Although poverty is prevalent in all races and ethnic groups, their proportions vary greatly. The dilemmas presented in public policy making is thus reflected in the field of health too, where the difference in perception continues. As health and medical care are different aspects of life, there is confusion over which the policies should be focused. Health is related to factors over which the medical fraternity has no control like lifestyle habits, environment, lifespan, living without sickness, infant and adult mortality etc.
Medical care is associated with hospitals and doctors, equipment and accessibility. Although Americans agree that access to medical care is any individual’s right and that none should be denied medical care for financial reasons, difficulties arise when strategies are developed to implement these. During the second half of the nineteenth century, professional health services were delivered only by physicians and pharmacists. These physicians and pharmacists received very little payments from the government and charged their patients.
This fee system and private practice had got embedded in the early American healthcare system, which is evident even today. One important factor with regard to policy making is that the constitutional structure of the government in US is biased against any major changes. In England, the party having a majority in the legislature would be able to implement its programs. However in the US, even if the party controls Congress, the passage of programs cannot be assured. The executive, legislative and judiciary are involved in policy making.
This does not mean that it is not possible to bring major changes into the system, but that it has to go through a complicated process and difficult circumstances. US has historically seen a pro market ideology and an anti government bias. When people want more governmental action, they have a burden to justify it and ensure political support for its implementation. The limitation of public sector’s role in healthcare in US may be attributed to the anti government bias, which has paved the way for the private sector to lead the implementation of changes in the system.
Then there are the interest groups who are affected by changes implemented in the system. These groups try to get rid of programs that affect them while defending those programs which benefit them (Patel & Rushefsky, 1999). It is to be noted here that the original legislation of the Medicare, Medicaid and programs of the 1960s included a provision that the program would not interfere with the practice of medicine. When programs are formulated and implemented, the interest groups take position to ensure that no change is made to it.