A Nurse’s Perspective on the U.S. Healthcare System

• The Difference Between Market and Social Justice philosophies in healthcare
• The Characteristics of the U.S. Healthcare System and how it compares to other countries
• Challenges in Changing the U.S. Healthcare System from a Nurse’s point of view

Whether your are a community health nurse, a school nurse, or a hospital nurse, the U.S. healthcare system impacts how nurses deliver care as well as patient outcomes.  As nurses progress as leaders, researchers and, innovators to advance the nursing profession, it is important that nurses understand how the system works.

Understanding the Differences between Market Justice and Social Justice

Market Justice:

According to the principle of market justice, market forces can best achieve a fair distribution of healthcare services in a free economy.  In such a system, medical care and benefits are distributed on the basis of people’s willingness and ability to pay.

Social Justice

The idea of social justice is at odds with the principles of capitalism and market justice.  According to the principle of social justice, the equitable distribution of healthcare is a societal, rather than an individual, responsibility.

Characteristics of the U.S. Healthcare System

The United States has a unique care delivery system.  Nearly all developed countries offer universal health insurance programs, and the government plays a central role in them.

The main characteristics of the U.S. Health Care System:

• No central governing agency and little integration and coordination
• Technology-driven delivery system focusing on acute care
• High cost, unequal access, and average outcomes
• Fusion of market justice and social justice
• Multiple players and balance of power
• Access to healthcare services selectively based on insurance coverage
• Legal risk influencing practice behaviors

Challenges in Changing the U.S. Healthcare System

One is aware that the U.S. Healthcare System is chaotic and challenging when a person is in nursing school, learning about and participating in patient care, but has no ability to access the same care for themselves.  According to Shi and Singh, 176.6 million Americans younger than age 65 have private health insurance coverage, with most covered through their employers.

Typically, this is an option for full-time working employees.  When a person has to switch to part-time or quit working for various reasons, they often lose their health insurance, and with less pay, he/she cannot afford healthcare.  In the U.S., the ability to seek and receive healthcare services is based on affordability and not necessity.

Why is the U.S. Healthcare System challenging to change?  There are multiple players, who have different levels of power that have their own economic interests to protect, and problems arise when their interests are at odds.

Historically, the U.S. Healthcare System leans toward market justice, but during the Covid-19 pandemic, there was a shift toward social justice.  This was a needed change when the world witnessed various layers of inequality during the time of the pandemic.

Some people in the U.S. value the market justice system which allows choices, individual accountability, and with adequate income access to multiple tiers of healthcare services. Independence is also a quality that people in the U.S. value and serves as a reason why the U.S Healthcare System is not centrally controlled but is financed publicly and privately.

The Market justice system in the U.S. is distributed on the basis of people’s willingness and ability to pay. The question is asked – what happens to the individuals who simply do not have the ability to pay?

We learned what happens during the pandemic.  COVID‐19 has disproportionately impacted certain individuals and groups — identified particularly by factors, such as race, class, gender, disability, age, displacement and homelessness, and migration status, among others — reflecting longstanding disparities and inequalities not only in healthcare but in society overall .

The pandemic brought worldwide attention to market and social justice. Even further it brought social justice to the forefront of the conversation.

Healthy People 2030 is an organization that sets data-driven national objectives to improve health and well-being in the united states over the next decade. They also aim to increase the proportion of adults who get evidence-based preventive healthcare by reducing copays and helping people get recommended preventive care services.

The Bottom Line

Within the U.S., the ability to seek and receive healthcare services is based on affordability and not necessity.  One cannot talk about healthcare services without talking about the cost, or even more, the overall financial burden in this country. 

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