Social welfare refers to the well-being of the society or in its entirety. It is not similar to living standards because it concerns more about the value of life. This involves various factors such as quality of the environment, which includes soil, air and water. It also includes the extent of drug abuse, the level of crime, and the availability of social services that are essential: health, education, transport, and sewerage. Finally, it also includes the spiritual aspects of life and the religious practices in the society. To ensure and maintain social welfare to all members of the society, social policies come up to protect this welfare. Social policies or social responsibility usually has reference to social insurance. This is because the main intention is to insure the people and the society against crises and catastrophes in life such as disability, serious sickness, and ravages of job loss or aging.
Social welfare policies try to provide support and assistance to special groups found in the society. Most people equate the practice of social welfare by the government, exclusively for the monies they give to the poor. However, the government gives more money to those who are not poor than those who live below the poverty line. Social policy is of two kinds: entitlement programs and means-tested programs. An entitlement refers to any benefit one gets by law regardless of their need. A good example of the two biggest social welfare entitlement programs is Medicare and Social security. Means-tested programs refer to the benefits provided selectively to only those people who have specific needs: disability, disaster stricken families such as famine, floods, hunger and tsunami. These programs have a tendency of generating powerful political controversy. Therefore, people have to prove their qualifications for these programs to be eligible for them (Abramowitz & Blau, 2007).
Social policy refers to the legislation, guidelines, activities and principles affecting the living conditions that are conducive to human welfare. It is an applied and interdisciplinary subject concerned with analysis of the society’s responses to the social needs. It fosters capacity to understand theory and draw evidence from a wide range of disciplines of social science such as sociology, economics, psychology, history, geography, law, political science and philosophy. It focuses on economic, political and societal aspects that are necessary to the existence of humans, and the means by which to promote them. Basic human needs include shelter and food, a safe and sustainable environment. The treatment of the sick and promotion of health support and care, of those who are not able to live an independent life fully, forms part of necessity needs.
Moreover, training and education of individuals to levels that enable them to participate fully in the society they live in. Public policy and practice involves areas such as healthcare, criminal justice, human services, education, inequality and labor. In most cases, social policy deals with the wicked problems in the society. Therefore, social policy refers to the actions affecting the well-being of members in a society by shaping the distribution of and access to resources and goods in that society. Social policy through governments’ direct interventions in human welfare dates back to the 6th century during the reign of Caliph Umar ibn al-Khattab of Islam, the second successor. He used collections made from Zaka and others from the resources from government to establish income support, pensions, child benefits, and various stipends for people of the non-Muslim community.
These social policies aim at improving the welfare of humans and meet their needs for housing, health, education and social security. Some of the most important areas of social policy are social security, welfare state, unemployment insurance, pensions, environmental policy, healthcare, social care, social housing, social exclusion, child protection, crime, education policy and criminal justices. Some even refer to policies that govern the behaviors of human. This could be through the regulation of abortion, homosexuality, euthanasia, divorce, marriage and adoption issues. It also refers to the legal status of prostitution and recreational drugs such as alcohol in wines and beers, nicotine in tobacco, and caffeine found in coffee (Ashman, 2009).
A health system, or a health care system, refers to the organizations of institutions, where people and resources, with the goal of delivering health care services, meet the health needs of the targeted population. There exists a wide variety of health care systems around the world. Some countries distribute health care systems plans among market participants. In other countries, they concert their efforts among trade unions, governments, charities, coordinated and other religious bodies to deliver planned health care services to the targeted populations that they serve. However, health care planning is evolutionary rather than revolutionary. According to the World Health Organization, the major goals for health care systems are good health, fair financial contribution, and responsiveness to the expectations of the poor (WHO).
Progress towards achievement of social health care depends on how the health care systems carryout the four vital functions. These functions are resource generation, stewardship, health care services, and financing. Other dimensions used in evaluation of health care systems include quality, acceptability, efficiency, and equity. In the United States, this refers to the ‘Five Cs’ which are Cost, Consistency, Coverage, Chronic illness, and Complexity. Continuity of health care is also a major goal in this. A health care system consists of all the people, organizations, or actions that have a primary intention of promotion, restoration, or maintenance of health. This involves efforts done to influence determinants of health, and more direct activities to improve health. Therefore, this health system is a pyramid of publicly owned facilities that deliver personalized health services. Examples include a mother caring for a child, who is sick while at home, or the behavior change programs, private providers, vector-control campaigns, occupational health, health insurance organizations, and safety regulations. It also includes actions that are intersectoral by the health and medical staff, such as encouraging the education ministry to promote female education. This is a well-known determinant of better health.
Social health care policy targets to ensure that every member of the society has access to health care services. Its mandate and main objective is to promote good health and healthy living through proper dieting and exercises; prevention and control of the spread of infections from diseases and sickness. It also involves treatment of those already infected through providing them access to health care services, access to medical health attention, examination and treatment. Providers of health care services are individuals and institutions that are mainly based on it. These individuals providing health care services include health professionals, allied health professional working as employees in clinics and hospitals. Other health care services providers are the government, and non-governmental organizations (NGOs) that are either profitable or non-profitable. They also include outpatient medical care in government health departments or agencies, health training institutions and medical laboratories.
The health workers involved in provision of health care services are doctors, midwives, nurses, dieticians, dentists, paramedics, therapists, medical laboratory technologists, pharmacists, psychologists, chiropractors, community health workers, optometrists and traditional medicine practitioners. The five main primary methods used for funding health care systems and social Medicare policies include donations through charity, payment out of the pocket, voluntary or private health insurance, social health insurance, and general taxation from the state, the county, or the local/municipal governments. There are several payment models for payment of medical health services. In many countries, the wage cost for practitioners of health care reach to estimates of between 65-80 percent of renewable health system expenditures.
There are three major ways through which to pay medical practitioners. However, there is growing interest to blend the elements of these systems. They are capitution, salary and fee-for-service arrangement. Fee-for-service arrangements paid to general practitioners base on their service. The setting of this fee levels bases on individual practitioners and central negotiations. General practitioners under central negotiation are free to charge extra fees above the standardized patient reimbursement rates. Capitution payment systems pay general health practitioners for each patient attended on their lists. However, it involves adjustments for factors like age and gender. A salary arrangement for general practitioners pays salaries for employed health workers by the government. This arrangement allows funder to control primary costs of health care directly. The main problem with it is that it leads to under provision of services, lack of proper attention to the preferences of the patients, and excessive referrals to secondary health care providers. Most countries and governments are moving away from this system of payment (Segal, 2010).
The history of Medicare in the United States dates back to the year of 1965 when the U.S. Congress enacted a social insurance program. The Federal Government of the United States administered this National Social Insurance Program. Medicare guaranteed access to health insurance for all Americans who were of 65 years and above, and to the younger generation who had disabilities. It also guaranteed people renal disease that was at the end stage access to the crucial health care insurance. Medicare, being a social insurance program, spreads all the financial risks associated with illnesses across the society to protect every one. This gives it a different social role compared to private health insurers who provide health insurance for profits. They manage the risk portfolio by adjusting prices in accordance to perceived risks.
Medicare provides defined services to all those enrolled to it. Part A covers hospital care while Part B covers medical services. It offers a choice between a single player health care plan that is Traditional Medicare and of an open-network system, or a network plan that is Medicare advantage of Part C of Medicare, where the federal government stands in for private health coverage. Most of Medicare enrollees have the Traditional Medicare option, standing at 76 percent unlike the Medicare Advantage Plan, which stands at 24 percent. Part D of Medicare covers drugs prescriptions of outpatients exclusively, either through private plans or through Medicare Advantage plans, which offer prescription of drugs. Statistics show that in 2010 Medicare provided health insurance to forty eight million Americans. Of this, forty million were of older age: from 65 years and above. The remainder of eight million consisted of the younger generation who had disabilities.
Medicare also covers almost half of the health care costs that the enrollees incur. This is about forty-eight percent. The enrollees cover the remaining health care costs. These costs, made from out-of-pocket, vary according to the amount of health care services that a Medicare enrollee requires. They may include supplemental insurance and uncovered services like dental care, vision care, and hearing care that are of long term servicing. The United States Congress created Medicare in 1965 under the Social Security Act Title XVIII to provide health insurance to their citizens aged 65 or older regardless of their medical history or income.
Only half of the older adults had access to health insurance before Medicare came into place. This coverage was mostly unaffordable and unavailable to the remaining half of the old age population. This is because the older generations had almost half the income that their younger generation counterparts earned, but still paid three times for their health insurance. Medicare spurred integration of thousands of hospital floors, waiting rooms, and physician practices. This was through making all payments modes to health care providers conditional on desegregation. Therefore, Medicare operated in the United States for over forty years, and has had several amendments and changes over time. For example, by 1972, Medicare provisions expanded to provide benefits for physical, speech and chiropractic therapy (Elrod & Ryder, 2011).
There have been many economic and political contexts to the formation and use of Medicare in the United States. The development of this policy by the Congress of the United States had both political interest and goodwill of politicians. There were many times when politicians and, most especially presidential candidates, use medicate campaigns for them to woe voters to elect them into office. Every prospective candidate for the congress or senate comes up with a convincing health care plan and uses it to sell themselves to the voters for election into office. Most common are the contenders for the White House who design health care plans in their manifestos, where the voters hold them accountable after their election into office. The most recent presidential Medicare plan is the ‘Obama Care’ health policy. This policy spirited the effort of president Barrack Hussein Obama back into office as the president of the United States of America in 2012 for a second term in office.
The Obama Care, a brand name of the proposed health bill named after president Barrack Obama, was a health insurance bill that was comprehensive and greatly improved on the Medicare plan already in place. It guaranteed health insurance to more people, and expanded the range of services offered under it. It also improved on the mode of financing to enable every American to afford it. This plan showed his political goodwill and concern for the American Nation that they elected him back to office for a second term in the White House (Yanoov, 1997). Even the predecessors of Obama used the health care tag to get the support of voters. The presidential candidate even went on presidential debate over the issues concerned with medical health of their citizens.
Presidents Bill Clinton, George Bush and Richard Nixon are some of the United States’ presidents who used the Medicare bait for their campaigns for election or re-election back to the White House. Once in office, they were to fulfill their promises made during elections. Failure to do so damages the image of the candidate in office, and drops the support his party to enjoy in the senate and congress. Thus, they fail to marshal enough support to pass other crucial bill that are necessary for the smooth running of the state, even though not affiliated to health care. The party with the president then gets a lot of opposition from the main opposition team and from within its own folds among those junior representatives who are not comfortable with the actions of the executive, or their party policies.
Economically, Medicare face numerous significant financial challenges arising from the ever increasing costs of health care, the reducing ratio of enrollees to workers and the increasing enrollment prompted by the aging population. Projections of the total spending on Medicare show a massive increase from the $523 billion in 2010 to the $932 billion by 2020, while projections on enrollment for the years 2010 to 2030 show an increase from $47 million recorded in 2010 to the $79 million expected in 2030. Furthermore, projections for the ratio of workers to enrollees show a decline from 3.7 to 2.4. Nonetheless, the ratios of retires to workers shows a steady decline over the decades while systems of social insurance remained sustainable through the rise in productivity of workers. Statistics show that there will be continued gains in productivity that will constantly offset demographic trends in future days.
Overall, health care costs will increase by 5.8 percent per year as expected from 2010 to 2020. This is because of the increased use of medical services, new technologies, and higher prices for services. Health care costs record a rise across the board. However, the insurance cost also rises dramatically for employers, families, and the federal government. Furthermore, since 1970 the per-capita cost for private coverage grew roughly a one-percentage point quicker in each year than the per-capita cost for Medicare. Medicare performed since the late 1990s especially well as compared to the private insurers. Over the following decade, the per capita of Medicare spending projects to grow at a rate of 2.5 percent annually, relative to private insurer’s growth of 4.8 percent. However, policy makers and the majority of experts agree that containing health care costs is very essential to the fiscal outlook of the nation.
Many of the debates over the future of Medicare revolve around whether per capita costs should reduce through limiting payments made to providers, or by shifting some more costs to the Medicare enrollees. Several measures provide the service of indications of the long term financial status expected of Medicare. These include the totals of Medicare spending as a part of the gross domestic product (GDP), Medicare per-capita spending growth relative to per-capita GDP growth and inflation, the solvency of the Medicare HI trust fund, and the general fund revenue as a share of total Medicare spending. This shows that with time Medicare will be sustainable over the years and be able to support the elderly and disabled, thereby fulfilling their mandate of providing social health insurance to these specialized groups.
There are several proposals advocating for the reform of Medicare as legislators seek new ways of controlling its cost. Some of the reforms introduced in the recent years include premium support. This proposal seeks to change the Medicare to a program that offers enrollees premium support from a publicly managed social insurance program, which has a defined benefit. The second option is to rise the age of eligibility for Medicare to 67 years from 65 years. The third option is to negotiate the prices of prescription drugs offered through a Medicare Advantage plan. The fourth option is to reform the care offered to dual eligible. These are the roughly nine million Americans, most of whom are low income earning older adults, and thus are eligible for both Medicaid and Medicare. The fifth option is to relate Medicare premiums with incomes, thus enabling many citizens to contribute to the insurance program. Finally, introduction of Medigap restrictions plan, especially for those Medicare supplemental insurance plans that cover all of the cost sharing of an enrollee. This insulates them from all out-of-pocket costs and guarantees financial security to individuals who have significant health care needs.
Manifest and latent functions are the social scientific concepts clarified for sociology. Manifest functions are deliberate and conscious, while the latent ones are unintended and unconscious. They usually have a positive effect on the society. The functions of the Medicare policy that the people observe and expect are that it provides social insurance to all the American citizens under the prescribed statutes regardless of their incomes. The unintended function of the Medicare plan is the financial constrain or burden that the enrollee have to bear for them to be eligible for this program, because Medicare only foots up to half of the bill of the health services the patient receives.
Politicians and interest groups carry out debate on the issue of Medicare and each group manipulates their ideas for their own interest. As seen above, presidential candidate use this as a hook for fishing votes from their electorate. From the recently completed presidential election where president barrack Obama went head-to-head with Mitt Romney on the race to White House, they two proposed radical changes to the Medicare Act. For example, Mitt Romney and Ryan proposed reduction of Medicare’s funding because of the massive strain it puts on the federal budget. However, the two refused to be committal about the specific provisions in the Medicare Act, except for President Obama.
The idea to cut the budget for Medicare was preposterous since this is a fundamental issue in the lives of Americans. In addition, the leaders’ choice of taking a ‘hanging position’ over the whole Medicare plan was a sign of non-commitment and lack of goodwill to their perceived electorate. They should focus on how to improve the services provided by Medicare to their citizens, and look for ways to expand its activities and funding so that its programs do not stall now or in the future. This will ensure a healthy nation, and this means they can all participate in nation-building activities, hence a more developed country.