Posted: March 24th, 2023

Healthcare Reforms in China and the United States


            Hearing appeals to personal rights in various discourses is commonplace in our contemporary world. Indeed, irrespective of their social statuses, individuals utilize their rights in their attempts to justify particular policies. Although these “right” talks can be lawful, quite often, there is no elucidation for the basis of the individual rights. For instance, a definitive example of the “rights” is the right to universal healthcare, which has characterized political debates in developed and developing nations such as China and the United States. Political philosophies are concepts that are applied in these contexts in an attempt to offer the basis of explaining these individual rights. Marxism is one of the political philosophies that help elucidate these phenomena. Marxism concept was thought to be long dead, but in the recent past, its writings have surfaced. The reemerging of this concept is called an Analytical Marxism, which is trying to fortify the Marx concept with new views derived from political philosophy and modern social science (Kymlicka, 2002, p. 2). The philosophy of healthcare is fundamental in our contemporary society since it helps create a link between democracy and health. In addition, the concept views development in society as the way of expanding liberty and freedoms of individuals.

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            The right to collective healthcare offers a unique example of the modern analytical Marxism. In our contemporary healthcare systems, individuals from the lower classes are revolting or demanding their rights to quality health care, just as individuals of the affluent social statuses. Kymlicka (2002, p. 166) states that analytic Marxism endorses equality from all arenas, which entails rights to equal opportunity, equal political, human rights, and right to material resources, including access to quality healthcare. Owing to the fact that the right to equal health care necessitates the pooling of resources, states have developed health care reforms that improve its safety and quality to provide better care for their distinct citizens. The United States of America and China are two nations that have developed health care reform, as shall be discussed.

Background of Healthcare Reform in China

            When the Chinese Communist Party took control of China in 1949, the health sector and health policies were controlled by the ministry of health. Under this administration, the country’s officials, as opposed to local government, mainly determined how healthcare was accessed. People living in the rural areas were the most affected and saw the need to reform the Chinese health care system. As such, the three-tier rural health system, referred to as the Rural Cooperative Medical System (RCMS), was established. The cooperative operated under a prepayment strategy that entailed income contributions from rural people, welfare funds from villages, and federal government grants.

            The first tier comprised on-foot medical practitioners who were skilled with basic hygiene and customary Chinese medicine. In fact, these doctors were the most easily accessible, especially in the rural settlements. The second tiers were known as township health sites. They were characterized by small outpatient hospitals with employed medical practitioners who the federal government funded. County hospitals were the third tier of RCMS for the very sick individuals (Xu et al., 2009). The government funded them, which collaborated with the local government for equipment and other resources. The RCMS significantly improved the life of the Chinese populace. In fact, life expectancy nearly doubled, and infant mortality rates lowered. The prevalence of other illnesses, such as malaria, dropped drastically. Indeed, the RCMS transformed the Chinese public health sector. However, it discriminated against the poor people who were not in a position to prepay for their medication. It was not until the 1980s when the Chinese communities witnessed great improvements in their public health after the agricultural sector transformed the original RCMS that adversely impacted the health of the poor. There was a decentralization of the Chinese administration, hence reducing the involvement of the Chinese government in the public health sector.

            Rather than making accessibility to quality healthcare available to all, including the poor people living in the rural areas, the inadequate government involvement resulting from the agricultural reform only made the situation worse. In order to curb the social menace that threatened to jeopardize the health of Chinese rural citizens, the New Rural Cooperative Medical Care system was established in 2003. The voluntary medical system has promoted quality health care to all individuals, including the poor. Individuals fund the program, and the government subsidizes the poor. Under this medical program, all the inpatient costs are covered, but most outpatient visits are not. Patients benefit from this scheme at a local level because the percentages of the county-level hospitals are covered by 60 percent compared to about 80% in local levels.

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Background of Health Care Reform in the U.S

            The topic of a comprehensive health care reform in the United States started almost a century ago when Teddy Roosevelt contested for a presidential position on a platform that comprised of a national health insurance. The support for universal universal health coverage ramped up in the ensuing years characterized by the great depression and thrived all through the Second World War. In the year 1932, the committee appointed to deal with the escalating costs of medical care released a report which indicated that huge numbers of households that were not ranked as poor by conformist measures also faced fiscal constraints when a member of their family got sick. Health care reform attained major success upon the opening of Medicare back in 1965.

            Although President Lyndon political skills played a fundamental role in the passage of Medicare, so did the political climate of the time. President Lyndon Johnson had received 61% of the popular vote and 2/3 majority, which offered him a unique chance to trail his jurisdictive agenda. The next momentum for reform was built following the election of President Bill Clinton, though the political atmosphere did not present him with an opportunity to garner the heights of support President Lyndon had.

            The essential historical difference amid today’s health care reform and that of the past is that in today setting, health care reforms pass through more complex and multifaceted legislative setting. Before the congressional rule passed in 1975 indicating that any bill should be referred to multiple committees before its enactment, the president, such as Lyndon, could concentrate on one committee chairperson (Jacobs & Skocpol, 2012). In fact, this is unlike our modern United States, where the president supporting a health reform has to pass through five or six chairpersons with divergent priorities and agendas. Indeed, President Obama’s recent passage of the American healthcare reform represented a very important achievement due to the complexities that involve today’s legislative processes (Obama, 2016).

Health Insurance

            No single person plans to get ill or hurt, but at some point, individuals require medical attention. Health insurance is a type of coverage that insures individuals against the peril of medical costs. The estimation of the entire healthcare risk and the expenses incurred in the health care system are among a targeted group. In fact, an insurance company is facilitated to develop a health policy that includes a routine monetary structure; for instance, the payroll taxes and month premiums, which ascertains that funds are available to cater for insured persons’ medication as depicted in a coverage agreement. The United States’ health insurance association defines insurance as a coverage that settles payments that arise from illnesses or injury, including losses incurred from accidents, disabilities, death, and dismemberment, as well as medical expenses. Having an insurance cover is important to individuals irrespective of their status. Not only does it protect individuals from heavy financial responsibilities or losses due to an emergency or illness, but it also ensures that they get adequate medical attention timely, thus increasing the quality of their health outcomes.    

Health Insurance in America

            In the United States, most health insurance companies are private. The public programs offer the basic insurance cover for adults and low income earning households’ children and households meeting a certain admissibility requirement. The main public insurance programs are the federal social coverage and Medicare or Medicaid. The State and Federal governments mutually subsidize Medicaid, but it is controlled nationally (Arbuckle, 2013). Other public insurance programs include TRICARE for military, the veteran health administration, and the Indian health service. Important to note is that states have supplementary insurance programs for low-income earning households and persons with disabilities.

Health Insurance in China

            Just like the United States, China has both private and public health insurance programs, though the rise in private coverage programs occurred in the past few decades. The reforms include the new rural cooperative medical system, the World Bank health project, and the 2020 healthy China project (Wagstaff et al., 2009). One of the challenges that the China healthcare insurance sector experiences is based on the minimal accessibility to all individuals, especially those in the rural sector. It is not mandatory for individuals to acquire health coverage in China. Therefore, some people fail to buy insurance policies and instead cover their medical expenses when incurred.   

How Marxism Influenced China’s healthcare policy

            China is in the midst of major structural alterations and the universal health care reform that seems to be impelled by slower economic development and mounting international competition, which is just an example of the systemic reforms. For China to achieve successful transformation in all policies, including health, the country must refine its economic, judicial, and institutional systems, as well as its mastery of trade-based development, while at the same time take real steps towards addressing the overarching issue of inequality. Indeed, Marxism has influenced all arenas of China reform, including the healthcare policy. In his political philosophy writings, Marx was convinced that socialism would replace capitalism (Kymlicka, 2002, p. 169). Although long dead, his concept still thrives on. Like others in the world, China’s healthcare systems emphasize political power and dominance based on economic statuses in a capitalist society. From the era of Mao Zedong to the times of Deng Xiaoping, there has been divergence and unequal distribution of healthcare services and policies, especially to individuals living in the rural China.

            After the health care policy reform that occurred during the times of Deng Xiaoping, the healthcare system and policy mirrored society’s class structure characterized by control over health facilities and limited affordability of health policy for the poor. Rather than having a universal and collective health policy that ensured equal provision of healthcare for all, including the low income earning populations, Deng supported a capitalized form of health care policy that reflected the economic and political goals. Indeed, this adversely impacted the poor when the administration reduced its financing and the healthcare policies instituted during the Maoist era. As a result, life expectancy reduced and infant mortality increased. This medical scenario would be altered by the change of healthcare reforms in 1998 and early 2000s. Just as Marx would have predicted, the Chinese society is moving from capitalism to communism. Individuals are increasingly demanding a healthcare policy that suits their common class interests. The only way to attain this socialist wonderland regarding health care policy is through removing the existing social conditions. As such, the Chinese government has tried to expand the health coverage with the aim of attaining universality and by augmenting the government funding, particularly to the low-income earners and people living in the rural areas, which is intended to homogenize health care spending in different regions (In He & In Meng, 2016). The government involvement and proposal in health care policy represents Marxism influence in that the initiatives are meant to advance the populations’ access to health care through increasing financial sustainability.

Advantages and Disadvantages of Healthcare Reforms in US

            The United States healthcare reform has had various advantages. First, it has increased the efficiency of healthcare. The provisions of the healthcare reform encourage health institutions to find new methods of increasing the efficiency of their facilities. Not only can hospitals cut down their operating costs in order to renovate their facilities, but they can also implement new programs such as nurse call centers that limit the number of visits to the facilities. Secondly, more people are being covered, indicating that finances will be available to healthcare providers. Healthcare reform has also enabled individuals to reap the best of insurance coverage, as they must provide at least ten essential health benefits (Patel & Mark, 2014; Kongstvedt, 2016).

            The major drawbacks of health care reform are anchored on the premise that the reforms have not decreased the costs for everyone. Most people, such as those who were insured under private insurance plans, had to buy new since many policies were canceled. Employers are also finding it cheaper to pay taxes as opposed to insuring workers, which has caused employees to lose company-sponsored health plans. Tax penalties are other disadvantages of the current healthcare reform.

Advantages and Disadvantages of Healthcare Reform in China

            One of the advantages of the healthcare reform is that many people, including the poor and underprivileged, can now obtain medical procedures at affordable costs. Although this is an advantage to the members of the public, it is viewed as a major disadvantage to health institutions, especially the public hospitals that are forced to sell drugs at the cost they bought to avoid overcharging patients. The effect of the increase in health care among China’s populations is the reduction of infant mortality and increased life expectancy, as was in the Maoism era (Wong et al., 2006). On the one hand, more people will get access to healthcare services, which is a factor that promotes their quality of life. In addition, this will be a disadvantage to the medical practitioners. Therefore, the initiative will not only bring a shortage of physicians but also increase their workload, thus cause fatigue, which leads to medical errors and poor treatment outcomes. Most importantly, China’s healthcare reform will increase parity among rural dwellers and the Chinese urban residents.


            Political philosophy has indeed influenced healthcare between developed and developing nations such as China and the United States of America. Not only has philosophical concepts helped the United States’ populations to understand and shape their health destiny, it has also greatly influenced their ability to acquire egalitarianism, though the process is in progress. Indeed, citizens of these two nations have been active agents for change and reformation in their distinct health care sectors. Chinese and American citizens have actively participated in political decisions regarding their health and wellbeing, thanks to the influence of political philosophy.



Arbuckle, G. A. (2013). Humanizing healthcare reforms. London: Jessica Kingsley Publishers. In He, J. A., & In Meng, Q. (2016). Chinese national health care reform: On the mend?

Jacobs, L. R., & Skocpol, T. (2012). Health Care Reform and American Politics: What Everyone Needs to Know (2nd Edition). Oxford University Press, USA.

Kongstvedt, P. R. (2016). Health insurance and managed care: What they are and how they work.

Kymlicka, W. (2002). Contemporary political philosophy: An introduction. Oxford [u.a.: Oxford Univ. Press.

Obama, Barack. “United States Health Care reform: Progress to date and next steps.” Jama 316, no. 5 (2016): 525-532.

Patel, Kant, and Mark E. Rushefsky. 2014.  Healthcare Politics and Policy in America: Routledge.

Wagstaff, A., Lindelow, M., Wang, S. and Zhang, S. 2009. “Reforming China’s Rural Health System”. World Bank, Human Development.

Wong, C., Lo, V. I., & Tang, K. (2006). China’s urban health care reform: From state protection to individual responsibility. Lanham, Md: Lexington Books.

Xu, K., Saksena, P., Huang Fu, X. & Lei, H. 2009. “Health Care Financing in Rural China: New Rural Cooperative Medical Scheme”, WHO.                      


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