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Jordan Giffin

Intro to Political Science

Dr. Feeney

12/3/2019

The Correlation Between Healthcare and Happiness:

Increasing Life Satisfaction Through the Health of Nations

In the Declaration of Independence it states, “We hold these truths to be self-evident, that

all men are created equal, that they are endowed by their Creator with certain unalienable Rights,

that among these are Life, Liberty and the pursuit of Happiness.”1 This embedded the notion that

happiness belongs alongside life as a guaranteed human right in the framework of the United

States government and immortalized it in the American psyche. From this point, Article 25 of the

United Nations in The Declaration of Human Rights expanded the definition of the right to life to

include: “the right to a standard of living adequate for the health and wellbeing of himself and of

his family, including food, clothing, housing and medical care and necessary social services, and

the right to security in the event of unemployment, sickness, disability, widowhood, old age or

other lack of livelihood in circumstances beyond his control.”2 As it is clear that all aspects of

wellbeing—physical, mental, and emotional—have an impact on an individual’s overall

happiness, examining whether there is a correlation between access to affordable healthcare and

life satisfaction is vital to future healthcare reform. The best way to do so is to examine the

qualities that impact happiness and the healthcare systems of countries that consistently rank

1
​Thomas Jefferson, et al, July 4, Copy of Declaration of Independence . -07-04, 1776.
2
​United Nations. 1998. The Universal Declaration of Human Rights, 1948-1998. [New York]: [United Nations
Dept. of Public Information].
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​ a​ ​survey that ranks 156 countries on the happiness of

highly on the ​World Happiness Report—

their citizens.

In David Myers’ book The Pursuit of Happiness, he investigates the variety of factors

that constitute overall happiness. Some of these factors include stability, employment, education,

personal relationships, income, personal control, self-esteem, and physical health. Myers argues

that there are four traits of happy people, “optimism, extraversion, personal control, and

self-esteem.” He argues that money does have an impact on happiness but so does a stable

economy, safety, and education. Monetarily, “happiness peaks around $100,000 and reverses

around $250,000.” While happiness may not be entirely based on possessing the superficial,

material things that money can buy, but it is impacted by whether or not an individual possesses

the means to provide for their basic needs.

This concept is illustrated in a Health Opportunity Index developed by the Department of

Health in Virginia, which states that there are “thirteen social determinants of health.”3 This

includes “everything from education, food insecurity, job participation, income, and equality.”4

Since this shows that income has an impact on overall health and wellbeing, it should come as no

surprise that employment status also has an impact. In the article, “Happiness, Economy, and

Institutions,” it argues that, “Unemployment is correlated with substantial unhappiness. As the

income level is kept constant, that influence is not due to lower revenue, but to non-pecuniary

stress.”5 This non-pecuniary stress can, at least in part, be correlated with the inability to access

or afford healthcare without a stable income.

3
“States of Despair: Understanding Declining Life Expectancy in the United States.” Alliance for Health Policy,
August 22, 2018.
4
Ibid.
5
​Frey, Bruno S., and Alois Stutzer. "Happiness, Economy and Institutions." The Economic Journal110, no. 466
(2000): 918-38. http://www.jstor.org/stable/2667858.
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In a briefing regarding the rising rates of deaths of despair in the United States, which are

defined as deaths involving suicide, drugs, and/or alcohol, several medical professionals state

that these social determinents are correlated with poverty. They argue those in poverty cannot

afford medical expenses, turn to unhealthy coping mechanisms, and are more likely to die from

despair--creating a direct link between happiness and physical wellbeing.

In the United States, in particular, there is a wealth barrier in terms of accessing and

affording basic care. For example, Americans have been known to call an Uber to take them to

the hospital so as to not be placed in thousands of dollars of debt by an ambulance ride or avoid

going to the doctor entirely so as to not have to pay the deductible. According to the article,

“Medicare Extra for All”, the “Costs and deductibles remain much too high: 28 percent of

nonelderly adults, or 41 million Americans, remain underinsured, which means that

out-of-pocket costs exceed 10 percent of income.3 In the wealthiest nation on earth, 28.8 million

individuals remain uninsured.”6

Over time, the American government has attempted to remedy this problem. In 2010, the

Obama administration implemented the Affordable Care Act which was intended to “extend

coverage to millions of uninsured Americans, to implement measures that will lower health care

costs and improve system efficiency, and to eliminate industry practices that include rescission

and denial of coverage due to pre-existing conditions.7 However, throughout the Trump

administration has since attempted to undo the Affordable Care Act. While this has not yet

succeeded, the cuts that have been passed make it so that “23 million Americans will lose their

6
CAP Health Policy Team. “Medicare Extra for All.” Center for American Progress, February 22,
2018.https://www.americanprogress.org/issues/healthcare/reports/2018/02/22/447095/medicare-extra-for-all/.
7
​ ource: https://www.healthinsurance.org/glossary/affordable-care-act/
S
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health care by 2026 as Medicaid is slashed, households’ premium costs skyrocket, and

protections for people with preexisting conditions are eliminated.”8

As the current American healthcare system doesn’t work, it is important to examine the

aspects of successful, and other unsuccessful, international healthcare systems to find what

combination of a single-payer, public system and a market-driven, private system, which is

shown by current research to do the most for overall wellbeing, is the most effective. A

single-payer, public system is mandated by the government and paid for by citizens’ tax dollars

while a private, market-driven system is paid for directly by the system.

The qualities of these systems and some of their nuances are outlined in the Annual

Review of Sociology’s article, Healthcare System in Comparative Perspective: Classification,

Convergence, Institutions, Inequalities, and Five Missed Turns” as:

“Austria, Belgium, France, Germany, and Luxembourg belong to the health service

provision-oriented type. These countries put a high importance on service provision,

especially in the outpatient sector. There are a high number of providers and a

free choice of medical doctors. Patients are expected to pay only a modest out-of

pocket copayment. Importantly, and in contrast to the United States, autonomy of patients

and equal access are greatly valued and matter more than the autonomy of the

medical profession. Denmark, Great Britain, Sweden, Italy, and Ireland belong to

the universal coverage-controlled access type. Here, all citizens are covered through

universal plans, but access to care is strictly regulated by the state.”9

8
​Bivens, Josh. “Millions of People Have a Lot to Lose under the AHCA.” Economic Policy Institute, June 21, 2017.
https://www.epi.org/publication/millions-of-people-have-a-lot-to-lose-under-the-ahca/.
9
​Beckfield, Jason, Sigrun Olafsdottir, and Benjamin Sosnaud. "Healthcare Systems in Comparative Perspective:
Classification, Convergence, Institutions, Inequalities, and Five Missed Turns." ​Annual Review of Sociology​ 39
(2013): 127-46.
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One system that is also in need of repair is that of the Czech Republic, where the fall of

communism caused a movement from a faulty public system to market-driven healthcare. This is

because: “By the fall of communism, both doctors and patients expressed dissatisfaction with the

system. While patients received free care, they had no choice of doctor, waited in long queues

for care, and often had to pay bribes to receive better service. Doctors in turn despaired of their

lack of freedom to earn additional income and control their practices. Their salaries were

sometimes lower than less-skilled laborers though they could earn significant income from

gratuity payments or bribes for better service.”10 While it makes sense that the Czech Republic

would move away from this system,, an entirely market-based healthcare system is expensive for

Czech citizens, which creates the same wealth barrier as can be seen in the United States.

The Netherlands, in particular, has been successfully reworking their healthcare system

for the last forty years. They are currently ranked fifth on the 2019 World Happiness Report11

and operate under a combination of a single-payer public system and market-driven private

system. By the 1970s, the Netherlands began to regulate healthcare by recognizing that “First,

rising health care spending could jeopardize the goal of universal access to basic care. Second,

the government feared that rising health care costs would result in higher labor costs, which

would raise unemployment and harm the Dutch open economy, which relies heavily on exports.”

This caused them to implement a system that created an allowance that “is independent of the

choice of insurers, consumers are fully price-sensitive at the margin. No premium is required for

coverage of children (under age eighteen); government compensates the REF for their health

10
​Roberts, Andrew. "The Politics of Healthcare Reform in Postcommunist Europe: The Importance of Access."
Journal of Public Policy​ 29, no. 3 (2009): 305-25.
11
“World Happiness Report 2019.” 2019 | The World Happiness Report, March 20, 2019.
https://worldhappiness.report/ed/2019/.
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care costs.” All of which was defined by the Health Insurance Act, the most updated version of

which went into effect in 2006.

In the article, “Universal Mandatory Health Insurance In The Netherlands: A Model For

The United States?”, this is defined as combining “mandatory universal health insurance with

competition among private health insurers. It is not a single-payer system.” Their government

prohibits insurers from denying coverage to those with preexisting conditions and still provides

choice and autonomy in terms of coverage. The value of this system and the reason it works, not

perfectly, but better than that of the United States, is that it provides affordable basic care while

also allowing citizens to choose their primary care physician and supplementary options for

specific procedures that are not absolutely necessary for survival and would be considered

premium services.

Overall, the idea that happiness belongs alongside life as a guaranteed human right was

built into the Declaration of Independence and this right to life was expanded upon by Article 25

of the United Nations in The Declaration of Human Rights to include medical care. Current

happiness research shows that health, stability, and personal control are important to life

satisfaction and that the inability to provide for one’s basic needs leads to what is referred to as

deaths of despair—those caused by suicide, drugs, or alcohol. This shows a direct correlation

between access to affordable healthcare and happiness. The wealth barrier in nations around the

world, particularly the United States, prevents the citizens of nations with a mostly market-based

healthcare system from being able to afford basic care. This shows that, to promote happiness,

the most effective healthcare systems must strike a balance between a public system that

maintains affordability and supplementary private insurance that allows citizens the autonomy to
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choose things such as their primary care physician. The country that shows the most promise in

creating a system that functions to provide the coverage necessary to sustain life as well as

maintains the autonomy of its citizens is The Netherlands, which ranks fifth out of 156 countries

on The 2019 World Happiness Index.

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Works Cited

Beckfield, Jason, Sigrun Olafsdottir, and Benjamin Sosnaud. "Healthcare Systems in

Comparative Perspective: Classification, Convergence, Institutions, Inequalities, and Five

Missed Turns." Annual Review of Sociology 39 (2013): 127-46.

“States of Despair: Understanding Declining Life Expectancy in the United States.” Alliance for

Health Policy, August 22, 2018.

Frey, Bruno S., and Alois Stutzer. "Happiness, Economy and Institutions." The Economic

Journal110, no. 466 (2000): 918-38.

United Nations. 1998. The Universal Declaration of Human Rights, 1948-1998. [New York]:

[United Nations Dept. of Public Information].

Ven, Wynand P.M.M. van de, Frederik T. Schut, Katherine Baicker, Rosemarie Day, Pamela

Nadash, Dinny H. de Bakker, Donald M. Berwick, et al. “Universal Mandatory Health Insurance

In The Netherlands: A Model For The United States?” Health Affairs, 2008.

“World Happiness Report 2019.” 2019 | The World Happiness Report, March 20, 2019.

https://worldhappiness.report/ed/2019/.

Roberts, Andrew. "The Politics of Healthcare Reform in Postcommunist Europe: The Importance

of Access." Journal of Public Policy 29, no. 3 (2009): 305-25.

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Thomas Jefferson, et al, July 4, Copy of Declaration of Independence . -07-04, 1776.

Myers, David G., and Ed Diener. “The Scientific Pursuit of Happiness.” Perspectives on

Psychological Science 2018, 2018.

CAP Health Policy Team. “Medicare Extra for All.” Center for American Progress, February 22,

2018.https://www.americanprogress.org/issues/healthcare/reports/2018/02/22/447095/medicare-

extra-for-all/.

Healthinsurance.org. “Affordable Care Act (ACA) Definition.” healthinsurance.org.

healthinsurance.org, July 27, 2018.

Bivens, Josh. “Millions of People Have a Lot to Lose under the AHCA.” Economic Policy

Institute, June 21, 2017. https://www.epi.org/publication/millions-of-people-have-a-lot-to-

lose-under-the-ahca/.