Final Process Reflection

Coming into this class, I had a very negative view of the healthcare system. I found it to be inefficient and ineffective. However, I had a very naive way at looking at ways to fix the problem: I thought merely an economic fix would change things: make the health care field into a proper market economy, and the market will take care of the system, will make it both cost effective and provide optimal care for patients. What I didn’t realize is that health isn’t your average commodity, and you can’t treat it that way, without leading to over treatment and poorer care for the patient.  Along with that, there are so many other factors that lead to ineffective care, the most important of which includes socioeconomic status. While I was right in assuming the system is decrepit and self defeating, I did not give law makers any slack: it’s a complicated system and there are many variables to consider. Washington being in the pocket of lobbyist doesn’t make the situation any better. A giant overhaul of the system is necessary in order to make the American healthcare system both sustainable and effective.

Where is all the money going?

Bernstein’s article suggests that despite elderly Americans’ desires to have end of life care at home, most do not. The primary reason for this seems to be the fact that it is far more profitable for elderly patients to live in nursing homes rather than at home. Where does all the money hospice/home care go? It it’s clearly not enough to sustain the patients. And even in nursing homes, proper care isn’t given to patients– the homes are often understaffed and inadequate care is given to patients. Despite this, nursing homes manage to make a profit. Where is the money going to allow this to happen? Is there a way to curb nursing home expenditures to ensure that elderly patients are given the care they need? And if not, is there a way to make it so that home care expenditures are sustainable, thus allowing elderly patients to die at home as many of them wish to?

The ethics of end of life care

In reading Bebinger’s article about of end of life care, I was besieged with a variety of conflicting emotions. I realize death is a part of life, and mandating doctors to give information to “appropriate patients” is a vital step to beginning necessary conversations. However, isn’t the duty of the doctor to save lives, as is specified by the Hippocratic Oath? When does saving lives merge into a hopeless preservation of life that leads the patient to have a lower quality of life and thus lead them to rather embrace death than continue living? Does the doctor’s ethics have nothing to do with this decision, but only the patient’s?  If it’s the patient’s decision, is that in itself an ethical decision?

Why should the aging population be an issue?

While I understand Galston’s issue with the rising cost of long term care and its pinching the system, I’m wondering if it really is as big of an issue as he’s making it out to be? The way our medical finances are going are clearly unsustainable. But, hypothetically, if we were to curb that, wouldn’t the US be better off than most countries? Unlike other western countries, the US doesn’t experience negative population growth due to its influx of immigrants. That being said, there seems to be a sustainably large working population available to fund Medicaid and Medicare. I don’t understand why there has to be a struggle of which organization gets what funding. (All of this is under the assumption that we somehow get the cost of long term care under control that is).

How to better treat the elderly?

Harringson’s article was quite enlightening in regards to the sub par care nursing home patients receive when admitted to Investor owned nursing homes. My question is, where is the disconnect? Why is it that quality of care and cost efficiency don’t coincide, and how can we better analyze businesses to make sure the elderly is getting the best care possible?

The Hispanic Paradox and the Rosetto Effect

Last week, we began discussing how socioeconomic backgrounds of patients affect patient healthcare and drive health inequalities across the US. We mentioned a strange phenomenon in regards to immigrant Hispanics mortality rates and that of white Americans: immigrants, initially, have a lower mortality rates than that of white Americans. However, immigrants tend to lose this edge the longer they stay in America. The reason for this has been attributed to the social connectedness Hispanic immigrants had when they first move to the US.

A slightly related phenomenon is the Roseto effect, of Roseto, Pennsylvania in the 1960’s. This town was composed of long settled Italian immigrants, who had significantly low mortality rates due to cardiovascular disease than the rest of America at the time. Studies were conducted of the town, and a similar finding to the Hispanic paradox was developed: social connectedness was what kept this town healthier than the rest of the country. However, a key difference between the Hispanic paradox and the Roseto effect is that the Roseto effect was seen in American citizens, who happen to be of the same ethnicity/town in Roseto, Italy. The Effect was seen to have wear off in the 1970’s, when social unrest and the lost of the tradition family unit permeated the lives of the people of Roseto.

My question is this: what is it about modern America that is so toxic to health? America clearly never had issues in the past, but the fact that the Roseto effect wore off, and that Hispanic Americans begin to lose their health the longer they stay in America seems indicative of the fact that there is something fundamentally wrong with the social structure of the US.

Income Inequality and Health Disparity

In the video we watched last Thursday, there was a mention of food deserts. This is essentially the idea that low income neighborhoods don’t have as much access to fresh, healthy foods than do higher income areas. My question is, why? Why isn’t it economically feasible for food to be healthy and cheap? Why isn’t it possible for nonprofit grocery stores like the Daily Table to exist and be viable and sustainable options, both for low income households and for suppliers of these stores? Why is preventative medicine currently transfixed on medical ways of solving problem (vaccinations, CT scans, etc), and not on baseline methods of prevention, like healthy eating and exercise? I feel like if it were, grocery stores like the Daily Table would be the norm, and not the outlier.