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I Socioeconomic Dynamics Alfred Marshall opened his Principles with "political economy or economics is a study of mankind in the ordinary business of life" (32, 1). That is, any analysis of the socioeconomic situation needs to start with "what is" at the time and place in question and not necessarily according to some formulated paradigm or theory. Any valid and meaningful model must, presumably, reflect socioeconomic reality. This may imply that no socioeconomic structure is permanent; it may need to adapt itself to changing circumstances and grow through continuous experimentation (13, 116, 130-31; 8, 222). The question arises how socioeconomic policies should be evaluated. Leo Rogin suggested that theories or policies be judged according to their relevancy to socioeconomic issues and the likelihood of their enactment. Policies have "meaning" if they address problems of concern to people and enterprises. Their chances for implementation determine whether or not they possess "validity." Hence, for a socioeconomic policy to have meaning and validity, it must focus on how people and businesses perceive and conduct their "ordinary business of life" (45, 1-13). There is no question that proposals for reforming the U.S. health care system are "meaningful" in terms of Rogin's criteria. Victor Fuchs argues that although the U.S. enjoys the best medical technology, it is seriously deficient on cost control, universal financial access to medical care, i.e., universal health insurance, and scrutiny over its public health and service dimensions (17). As surveys indicate, the majority of the American people are of the opinion that the present system needs to be significantly changed. It is estimated that 39 million people (about 15 percent) have no health insurance, that "27 percent of the population . . . was uninsured at some point . . . from 1987 through 1989," (7, 19-20) and that tens of millions more are underinsured. Underinsurance arises when people are financially unable to seek preventive or necessary medical care because of insufficient funds or health insurance coverage. This may be due to specified deductibles, cost-sharing, maximum life-time benefits, and the exclusion of services, (7, 18) and the fear of losing the insurance (as 2 million persons do in any two-year period). Job mobility may be reduced by as much as 25 percent in the absence of universal insurance coverage and people may be encouraged to stay on "welfare." When indigent people do obtain care, they tend to be sicker, suffer higher mortality rates, and receive less treatment than those adequately covered by insurance (2, 2519; 12). Those with serious illnesses may have their policies cancelled, those with preexisting conditions may be denied insurance, or it may be offered at prohibitive premiums. Hence, people are becoming increasingly concerned about rising possibilities of economic insecurity (2, 2509; 28, 281; 53, 48, 131-36). It also appears that reform of the health care system has "validity" in that there exists widespread acceptance by all major parties in the socioeconomic setting that something needs to be done. However, this does not necessarily imply that every legislative proposal for health care reform possesses "validity," or all have an equal probability of being implemented. Economic growth per se is neither sufficient nor does it alone bestow strength and vitality on the economy. How societies forge and maintain the bonds which assure their material survival constitutes the basic problem of economics. Similarly, the basic problems of production and distribution are to devise institutions which will efficiently mobilize human energy and other resources in order to attain as high a level of well-being as possible with a given resource base (24). These considerations, in essence, justify universal education, universal health insurance, and other social safety net measures. Private enterprise and entrepreneurship are pan of a wider culture. … |
