A welfare state is an
ideal state model where the welfare of citizens, economic and social, is
provided for by a state that not only assumes this responsibility but defends its
exclusive right in doing so (although it may share it with other independent
institutions). The objective is social protection…a guarantee of conservation
of human dignity, fair treatment of citizens and the effort to solve their
ordeals in an efficient and effective manner. The developed world has achieved
perfection in its design and implementation of such a state, whilst the developing
world (or part of it) is improving its systems and institutions for that end. A
state where people’s needs are met, where health, education and decent living
are responsibilities that the state assumes in full accord with its citizens is
the objective. A culture of well-being is the supreme goal.
However, the
utopian scenario is, well, utopian. Perfection in a public administration is an
unrealistic (and quite arrogant) concept. Each system has its flaws and defauxs;
even those designed with the best intention and good will have their share of
cons. For instance, a country as developed and the USA where the defence of
human dignity and protection of citizens’ well-being are founding pillars has
its share of mistakes in its understanding and implementation of its welfare
state model. Let us take healthcare as an example, which failed miserably and
had to be rescued by the Patient Protection and Affordable Care Act (AKA Obamacare) with the
ambitious goal of enrolling 6 million people into private health care
plans via the Affordable Care Act. The goal was ambitious but was met as 7 million people enrolled for private coverage. The
new law, notedthe Los Angeles Times, "has spurred
the largest expansion in health coverage in America in half a century." So
this affordable health insurance should solve an important problem in the US
society, even if it means that citizens have to pay from their own pockets to
ensure receiving tis vital service. A country that spends trillions on weapons
is asking its citizens to enrol in private health schemes. Where welfare
in that is, I am not quite sure.
This Act would
have appalled and caused mass demonstrations in European countries which
frowned upon such a solution. Let’s take Spain for example, an excellent model
of supreme health services, where citizens, foreigners, tourists and illegal
immigrants all have access to free, immediate and excellent health services.
Retired European senior citizens flee to sunny Spain feeling confident that
they would be in safe hands. They know that they will be taken care of without
any discrimination or additional payments. The health system is very well
designed and transparent, where citizens are assigned to a health centre and a
set of doctors to consult when in need with zero charge. That is indeed a state
that cares about the wellbeing of its citizens, as no one would worry about
being unattended in times of need. Or is that so? The problem with a highly
organized and regulated system is that it tends to kill the human and social aspect.
As a patient you become a number…that number gets you to that only hospital, to
that only doctor and to that only appointment. You can’t choose your healthcare
practitioner, nor can you tailor your appointments to your needs, nor can you
establish a personal relation with any of the staff. You are identified by an ID
that dictates your future when it comes to health issues and how they are
addressed. You don’t exist outside that number. That sense of security suddenly
fades in a moment of emergency or illogical and inexplicable worry. The system
does not identify worry as a reason to access such services. Surprisingly, a
non-welfare state offers –sometimes- a relief dose much needed in these
advanced systems. Let us take Jordan as an example, a country that does not enjoy
an efficient healthcare service, but is one where one can feel secure
nonetheless. You do exist outside your ID number. A telephone call can solve a
problem or push a date back. Logic, compassion and common sense are not limited
by bureaucracy and systems. Your confidence stems not from the quality of the
system but the quality of the staffs’ character and morals. The social ties and
cultural background in this county, as may be in other countries I assume, are
a solid rock to many…a safe place to fall back on. Welfare, in my opinion, is a
sense of security, confidence that when in need someone will help in a
personalized manner. It is not paying little money in a private health scheme
with a fancy name, neither is it a blind treatment of ailments in a manner void
of any compassion or interest. It is indeed a prompt response, a flexible
attitude and a personalized treatment. To conclude, welfare means different
things to different people and different nations. My personal understanding of
it has been strengthened and rooted thanks to my experience with Jordanian
healthcare. Not a welfare state perhaps, but one of welfare health providers.
Great article Dina. Brilliant as you always are. Welfare wont be ideal unless you improve the role of state (authorities), place (hospitals,clinics...) & providers (medical staff). All that should interact in a flexible way with patients (medical seekers). Integrated system. My relation with my patient doesnt end once he /she closes the door saying goodbye! It is a life long relation that i'd be proud of.
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