The Future of a Social Contract in Healthcare

The social contract between society and the healthcare industry is crucial for the overall health of the country population. Its features define not only particular processes of obtaining and providing medical treatment but determine relationships between patients and healthcare professionals. The level of trust and satisfaction of patients’ needs depends on those relationships and directly influences individual health. Therefore, the existing social contract should be viewed as an essential concept that must be largely considered when speaking about healthcare system reform.

The notion of the social contract in the contemporary context refers to the idea of an agreement between two parties – the citizen and the government. It helps to view the relations between them on a contractual basis which allows the discussion of the nature of existing and potential obligations (Institute of Medicine, 2014). Public health appears to be a significant concern for both sides. The implication of the social contract in healthcare is that “it will reduce illness and preventable death and improve quality of life” (Carter et al., 2015, p. 1). Nonetheless, both the citizenry and the government have their interests and goals that could be managed through a negotiation.

There are different types of responsibilities and expectations on every level of the healthcare system: between physicians and patients, between physicians and the government, and between the general public and the government. Patients need accessible and efficient medical care; health professionals require a safe and sufficient work environment; the government must find ways to maintain an adequate balance between healthcare expenditures and the quality of public health. The notion of “old social contract” puts the government at the central place as a system regulator. Such a structure was successfully implemented in many countries including Canada and the United Kingdom. However, the development of the healthcare industry displays a unique path in the United States.

One of the conflicts in the current healthcare system involves the problem of cost shifting. As Jacobs and Skocpol (2015) state in their book, from the start of the Obama reform in 2009, “employers offering family health coverage to their employees had to cover a remarkable 131% increase in premiums” (p. 28). This gap emerged from the inability of public funds to cover expenditures in healthcare that were rising rapidly.

Therefore, the costs were shifted to the one party in the system that could pay negatively affecting private plans. The employers, in their turn, put these expenses on their employees contributing to the conflict within the general public. Such conflict aggravates the level of disparity between different social classes undermining the possibility of a sustainable social contract in the future.

The individuals who can afford a private plan for their healthcare could not be considered fortunate. Since the growth of health care costs in the United States is astronomical, “many Americans are preoccupied with affording higher fees or contributions, not to mention covering extra health care costs that might pop up with serious or chronic illness” (Jacobs & Skocpol, 2015, p. 28). Employees are unable to pursue career opportunities because they are afraid of losing their health insurance packages.

More and more people from working and middle class are expelled from the access to health care by extremely high prices. The number of insured people across the country is decreasing. According to the Congressional Budget Office, 27 million people will be uninsured in 2024 (Hellander, 2015). The need for a fundamental change in the healthcare system is apparent to almost every American.

The future reform of the healthcare industry must begin from the conceptual level. A new structure of a social contract should be developed and implemented. An efficient social contract should include some version of basic security which will allow employees to feel more comfortable when seeking new job prospects. Also, a basic insurance plan will support those who struggle providing them with an opportunity to improve their lives. Moreover, a new social contract should encourage a certain level of personal responsibility for individual health and private savings.

The social contract between the people and the state must provide conditions for creating a fair system without a possibility for improper cost shifting. It should also foresee long-term expenses and represent a ground for developing sufficient strategies for the future. The contract between the medical workers and the healthcare system should ensure that physicians will not be victims of existing disparity while fulfilling their main purpose of helping a patient. At the same time, there should be measures developed to prevent overdiagnosis, overpricing, and unnecessary treatment within the industry.

The concept of the social contract appears to be central to the future of the healthcare system because it defines the rights of the individual and the responsibilities of the state. The government should be able to secure funds for healthcare expenditures and innovations; every citizen is entitled to timely access to healthcare and appropriate medical help. To accomplish this, the idea of a social contract should be considered as a priority not only for health care reform but for the better of the whole country. The situation in the United States is unique and can be resolved with a historically significant breakthrough.


Carter, S. M., Rogers, W., Heath, I., Degeling, C., Doust, J., & Barratt, A. (2015). The challenge of overdiagnosis begins with its definition. British Medical Journal, 350, 1-5. Web.

Hellander, I. (2015). The U.S. Health care crisis five years after passage of the Affordable Care Act: A data snapshot. International Journal of Health Services, 45(4), 706-728. Web.

Institute of Medicine. (2014). Establishing transdisciplinary professionalism for improving health outcomes: Workshop summary. Washington, DC: The National Academies Press.

Jacobs, L., & Skocpol, T. (2015). Health care reform and American politics: What everyone needs to know (3rd ed.). New York, NY: Oxford University Press.