Wednesday, November 25, 2009

Culture Differences in the news 3

In the International Herald Tribune today (Nov. 25), David Brooks writes that the debate in the US over healthcare is actually a debate about values... Indeed! Perhaps the coin is dropping at last.
The people inbedded in a culture are the last ones to realize the underlying values that shape it, so it is no wonder that Brooks says that the values in question are "vitality" and "security". Actually, he is not that far off the mark. Research shows that the dilemma in the American culture is between "performance" (and the status assigned to it) versus "caring for others & quality of life". It is what Hofstede labeled as "Masculinity" versus "Femininity", two terms that most Americans have issues with, because they immediately link them to "macho" behaviour and "feminist" issues.
Research shows (not my opinion, nor anybody's opinion, this is simply research data) that the US culture scores higher on "performance" over "caring". No wonder it has taken them so long to adopt universal health care (and the discussion is not over)... In the American culture, performing and being a "winner" is much more important than caring for others or than leading a life of quality rather than quantity. It's all about competing to win.
By contrast, the Dutch and Scandinavian cultures (according to research) favor "caring" over "performance", and they've had universal health care for many decades.
Brooks urges Americans to "make a choice" about what kind of country does the US want to become, and he puts it bluntly about choosing between becoming more "vibrant" as an economy or providing more healthcare. He talks about having to decide between allocating funds either to stimulate the economy or to care for "the elderly" and "the vulnerable".
If you look a bit deeper, however, you can see that the US has actually managed to have the worst of all worlds: its healthcare system is the most expensive in the world AND it does not provide full coverage. How come? How is it possible that The Netherlands, the Scandinavian countries, and even England (an Anglo-Saxon culture like the US) are all able to provide universal healthcare, yet at a lower cost?
Perhaps because America has unwillingly combined the worst bits of "savage capitalism" into its current healthcare model. By allowing a lot of freedom to private enterprises, which in the US culture (more than anywhere else) means "making the most money at the expense of all else" because "performance" and "the bottom line" is all that matters, America has created a "monster" in which healthcare PRICES are artificially high. Prices are not exactly the same as costs.
Yes, in theory it is possible to extend healthcare to everyone in the US AND to lower the overall cost. However, this would require to rein the healthcare companies who are making too much money in the current situation. There lies the hard part of this dilemma, because it goes against the cherished value of freedom of competition in a free marketplace. Many people in the US fail to realize that "freedom to compete" should not be equal to "freedom to rip off" the population who have a health concern. "Ripping off" means overcharging, but it also means over-prescribing, over-testing, prescribing testing and treatment beyond what is really needed.
The right-wing shouts "rationing", but there should be a way to reconcile this dilemma.
The American culture will not change. OK, maybe in a hundred years, when there are more immigrants living in the US coming from other cultures and they have influenced the way children are being brought up. So we can discuss it again at the beginning of the 22nd Century.
In the meantime, the US has to find a way to reconcile its moral preference for "performance" with the need to provide at least minimum health care for the masses. You don't have to go very far. In South America, most countries provide low-cost, low-standard universal health care. And the wealthy are free to be ripped off by the providers of their choice when they want high-standard medical services. It is socialism for the poor majority and market capitalism for the rich minority.
However, this collides with the American value of "equality". In the US it is not morally acceptable to have a "privileged minority" entitled to better medical care, co-existing with an "underprivileged majority" that has no access to that. This makes it more difficult to reconcile the dilemma between "performance" and "caring".
The paradox is that, over time (in the past 30 years), income distribution in the US is becoming more concentrated, while in Brazil (for instance) it is becoming less concentrated (see "The Economist" of last week). Perhaps in the 22nd Century the situation will be reversed... The US will have a "de facto" unequal society, while in South America people will enjoy the economic equality that was a 20th Century ideal.
Actually, that is not very likely. Culture changes much more slowly than in a century. What IS likely is that the US will eventually adopt a healthcare system that will continue to combine the worst of "savage capitalism" with the emphasis on "performance", thereby increasing prices and overall costs, leading to a slow deterioration of the American competitiveness and "market share" in the global economy. The US will still be one of the large economies on the planet, (second to Europe) but less dominant than in 1970 (when Europe was still fractioned) and more interdependent with the BRIC countries.
Like in the rental car ads of the seventies, the motto will shift from Hertz ("We're Number One, we're the best!") to Avis ("We're Number Two, we try harder!").

No comments:

Post a Comment