Healthcare and Cultural Differences

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By Donna Marsh

As an American/British dual national, it is always interesting to consider the innumerable cultural differences between the two countries.

Of course, these differences extend far beyond your definition of football, when you think World War II began, or in which hand you hold a fork. The current debate concerning proposed American health care reform has provided a platform that clearly illustrates how different the two countries can be.

Individualism Versus Collectivism

Americans are taught from an early age to take care of themselves, i.e., to pull themselves up by their bootstraps if necessary. Many Americans view health insurance—supplied by many but not all employers to their employees and their families—as something they individually earn, along with their wages or salaries. Some also are of the opinion that those who do not have health insurance should be motivated to find “better” work that does include this benefit. Indeed, there are a portion of Americans who view health care as a privilege and not a human right. Some Americans’ general mistrust of government-controlled social programs further fuel this attitude.

However, America’s scepticism is not as clear cut as it initially might seem. The American government has been sponsoring two important health programs since the 1960s. America’s Medicaid system provides health benefits to certain low-income groups. The Medicare system provides comprehensive health benefits to those older than 65.

Both programs generate strong feelings in the American public. Some may feel resentment toward the Medicaid system for any number of reasons, mostly relating to a belief that these individuals have not “earned the right” to access a system paid by taxpayers’ dollars and thus “don’t deserve it.” This reluctance to help the less fortunate, especially if there also is a perception of “not pulling their weight” is a telling example of the Protestant work ethic and its belief in reward for hard work.

However, Medicare most often is seen as an entitlement to be accessed at the age most Americans retire from work, and often—not insignificantly—lose their work-related health care benefits, as well. It would take some effort to find many Americans who would argue against the availability of the Medicare system for their elderly relatives or for themselves at some point in the future. The shift from individualism to a more collectivist approach is being made, at least in this instance.

In the United Kingdom, the National Health Service is free at the point of need to all British residents, including foreign nationals with a legal right to remain in the U.K. (including expatriate Americans). The NHS is funded through the National Insurance system, paid by both employees and employers. It undoubtedly is considered a human right by the British public, expected to be provided for all by the government.

This approach also fits into the U.K.’s value system of fair play and characteristic support for the underdog. Although it is not difficult to find many British people criticizing their government, there is not an equivalent level of mistrust as found among many Americans.

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