In this article I will try to give some answers to the phenomenon that difference in social standard and living conditions have such great impact on peoples lives and possibilities to take advantage of a modern society and get service from the society in a whole life period. Although such service like healthcare and education is governed by laws and regulations. This is the situation all over the world, but the countries use different ways to regulate for instance the relations between services given from private companies and institutions and public services.
The article is also about how the authorities deal with this matters in a Crosspoint between politics and laws and regulations. I will also give some comments to how authorities and federal governments in United States deal with this compared to authorities and governments in the Nordic countries. The governments way to handle human rights compared to paragraphs I have picked out from the United Nations human rights declaration will also have an impact on peoples access to all kinds of public service.
I will try to edit this topics in the same way you and I would like to get answers of the questions I have mentioned above.
Different ways to organize services in the society. Consequences for the inhabitants.
Like an illustration to what I am going to talk about I will start with article 25 and 26 in the United Nations declaration of human rights:
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
(1) Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit.
(2) Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace.
(3) Parents have a prior right to choose the kind of education that shall be given to their children.
In the Nordic countries most of public service is organized by the state or by counties and municipalities. This was the picture for many years. In later years private companies and institutions have started to offer public services. Specially healthcare and education, but also other services.
This services offered by public institutions have still so high standard in the Nordic countries that most of the inhabitants use them paid by the authorities. The state and the counties and municipalities finance public service by the tax people pay to them.
This model give equal service to all inhabitants in spite of different personal income and social status. In later years use of private services have increased even in the Nordic countries. Such a development can give a social gap between people that afford to buy private services and people that cannot afford to do so.
Education on all levels are organized by the authorities. They make laws and regulations for organizing of education and it is free for the inhabitants in all the Nordic countries. This service is organized a bit different in these countries, but the main thing is that it is free for the population and keep a high standard. The inhabitants pay of course for education by the tax bill, but this is regulated due to every ones economical capacity. The main thing is that the standard of education is equal for everyone and keep a high quality.
The education starts when a child is 6 years and are free of costs until you finish university or other higher education. When you reach a higher level of your education you will get some costs related to books and other education tools. This way to organize public education is much the same in all the Nordic countries.
This way to organize education for all gives you a society where people get the same possibility for education. Social status and money will not divide people as much as it does in a society where education not are equal for all.
That picture have unfortunately changed a bit in all the Nordic countries because influence from private education have grown bigger lately and it will give a more divided society if it expands. This is a result of the policy in a country and if we take a look to Norway that I know best, private paid education have increased in the last 8 years when Norway have had a so called non-socialist government. They have opened up for private education and the municipalities and counties are obligated to give economical support to such a education. This gives less money to the public education offers and can give a higher level of private education than the counties and municipalities can offer for public education. This is of course politics, but it seems to give a more equal society for all when you have a social democratic government. This picture can change from county to county and municipality to municipality because every county and municipality have different political governments.
Healthcare is organized in a very similar way like education. All the Nordic countries have a strong public healthcare from healthcare in the municipalities to hospitals owned and organized by the state. It is organized different between political and governmental levels in the Nordic countries, but the main picture is a strong public healthcare. Private healthcare offers have lately increased in the Nordic countries too.
In Norway it is the municipalities that organize a general practitioner doctor for all inhabitants. The municipality organize and runs nursing homes for older people and several other healthcare offers for the inhabitants.
The state organize and runs hospitals and other specialized healthcare offers for the inhabitants. The most of this is free, but you have to pay a small fare yourself for the treatment. In the nursing homes it is rules for payment that are equal for all and is taken directly from the pension.
Nearly all the offers of healthcare I have talked about have private alternatives that compares with the public offers. The big difference is that all those offers have to be paid for and are not affordable for most people. Even in the Nordic countries many people are signing up and pays for private health insurances or get such insurances as a part of their job agreements. It is the same with pension agreements. In Norway we have the social security that pays for most healthcare treatments and pension funds paid for by both private companies, public authorities and the inhabitants themselves by the tax bill.
United States have a strong decentralized education system based on the Supreme law of the United States. The states in the United States have a big influence of the education system and it have differences from stat to state. The federal government and the Congress have a minor role in the system.
Education in the lower part of the education system are free and for college and university education you have to pay for education and housing. A system like this with education you have to pay for will create big gaps for peoples possibilities to get a proper education. A good education will depend on your economic capacity and your parents income and status in the society.
The United States have of course many excellent schools and universities, but they are not available for everyone. You need economic strength to take advantage of the American education system.
American healthcare is built up very similar to the education system. You have a ground based healthcare that is public own and driven. This care cannot give you all you need from a healthcare treatment. You have to buy a health insurance that pays for the treatment in both general or specialist healthcare and hospital stays. A health insurance is very expensive and many people cannot afford it. Some people are lucky to get the insurance as part of their job agreement.
When the congress dealed with the question about a public health insurance in 2010, 32 million Americans was without health insurance. This mean that every treatment in hospitals and other health institutions have to be paid for of the persons without health insurance.
The law that was called Obamacare allowed people to sign up for health insurances subsidized from the federal government. It was a lot of political struggle about this law, but the supreme court of the United States found in 2012 that the law was not in conflict with the supreme law of the United States.
This law has lead to a decrease in number of Americans without health insurance. The percentage have gone down from 16% in 2010 to 8,9% in 2016.
There is a public health insurance or health care in the United States called Medicaid. Unfortunately it is only for disabled and poor people. The states practice this healthcare in many different ways. It depends often if a state is governed by democrats or republicans. States with republican government have often a more strong practice of the law than states with government from the democratic party.
The Obamacare health law have also different practice in the states of the same reasons that I have mentioned in the former section of my article.
This means that a lot of people in the Untied States falls into a so called Coverage Gap between the Medicare and Obamacare systems if they do not have their own health insurance. It was earlier a penalty fee if you did not sign up for a health insurance in the Obamacare system. The republican majority in the congress removed in 2017 this fee. The result of this was that number of Americans without a health insurance increased from 28,6 million people to 30,4 million people.
The result of the American healthcare system is a huge gap between people that can afford to sign up for a health insurance and people that not have financial possibility to do so. Such a system divides people and gives a different healthcare to people depending of financial strength to sign up for a good health insurance. Some people with chronic diseases cannot get health insurances at all because the insurance companies do not allow them to do it.
I will conclude this section about American health care and say that the United States probably has one of the best healthcare in the world, but the problem is that use of it depends of the inhabitants possibility to pay for it.
Last week brought a very negative episode into relations towards healthcare in the United States. President Trump have sent a letter to the United Nations with the message that United States will not be a member of WHO, World Health Organization from the 6. of July 2021. He has done this because he disagree with the way WHO have handled the corona pandemic situation and WHO’s relationship to China. United States is WHO’s largest economical contributor. Now the US economical accessions are frozen. A very irresponsible act from a nation that should be reliable in international collaboration.
In this article I have compared Nordic models for education and healthcare with the same service in the United States. It is probably nothing to be said of the quality of the services. The big difference is the cost for the service and how it is financed.
It has to be said that the tax system is different in the countries and can explain some of the differences, but not all of them. The main thing is that people with a very good financial situation seems to get a far more better education and healthcare in the United States than people that do not have that economic capacity. Such a system is probably not inside the United nations human rights articles about healthcare and education that I have mentioned earlier in my article.
The Nordic model for education and healthcare creates more equality between people in a country, but seems to be under pressure from private companies and a bigger difference in income between people, also for the Nordic countries. The government policy will always play an important role here.
I will recommend you to read the book: Public service and Good Governance for the Twenty-First Century. Written by several authors. This book gives you a very good illustration for the present situation regarding public service in the United States.