Applying this Class to Real Life

This class has been enlightening and has inspired me to think of health care, doctors, hospitals and our systems in the United States in new ways. One interesting thing I want to share relates to the topic of discussing end of life care with family members. My mom is an elderly care lawyer so she is around people in this type of situation every day at work. I haven’t ever really talked to her about end of life care before.

Over this thanksgiving break my grandparents and my stepfather’s parents both were visiting and staying in our house. One morning, I walked into the kitchen to get breakfast and I overheard my mom talking to my step dad telling him that he needed to have this conversation with his parents while they were visiting. She had printed out forms that my step dad and his parents needed to sign, which would give him authority over making decisions about their care, if and when the time came. I stopped what I was doing to listen and watch. My step dad seemed anxious and acted as if he was trying to avoid the conversation. However, my mom eventually convinced him that it was the necessary thing to do.

Later that day I talked to my mom about what she did that morning and I told her how we had just talked about that material in this class. She told me that it was part of her every day duties to inform people about end of life care decisions and she always encourages people to have these discussions with their families, especially on holidays such as Thanksgiving! I thought it was interesting how timing worked out and I wanted to share this story. To rap up my final post I would like to say thank you for a great class, I’ve learned a lot and would recommend this class to any premedical student.

Live Long and Pay for it: What Can we Do?

Americans over age 65 are projected to increase from 13 percent in 2010 to more than 20 percent in 2050. Americans over age 85 will increase from 1.8 percent in 2010 to 4.3 percent in 2050, and these are the Americans that are most likely to need long-term care. With the cost of long-term medical care at the end of life averaging at about $78,000 a year, how can Americans revise our system to better suite the aging population of America?

Galston’s article talks about multiple solutions to this aging problem. He defines the German solution to their aging population. Germany instituted a mandatory long-term care system in 1995. This system creates a tax that is equally split between workers and employers which funds a mandatory care system. Germans are required to either participate in this federal elderly care or opt out and pay for private care. This type of system is similar to universal healthcare but applies directly to the elderly. Since we are facing an aging population, would implicating a similar system to the German system be beneficial to our country? Would it be possible to establish a federal health care system to provide across the board care to the elderly population even though we already have medicare?

Debating ACA, Republicans versus Democrats

Since the creation of the Affordable Care Act, republicans have been opposed to the ‘socialist’ health care law. Since this law was enacted in 2010, both republicans and democrats have discussed the outcomes of the law. It’s interesting to compare and contrast these opposing view points because we are at a point in time when our government is soon to be subject to change (upcoming presidential election).

This article brings up many stats that highlight the outcomes of the Affordable Care Act. For example, private insurance provider UnitedHealth Group reported that it was losing money in the insurance exchanges, and it saw no expected improvements in 2016 and might pull out in 2017. Similar concerns have also led to the collapse 12 of the 23 non-profit private insurance companies established by ACA through federal loans. Continue reading “Debating ACA, Republicans versus Democrats”

Social Value Versus Equivalent Care for All

In Timmermans’ text about Social Death, he cites many sources including past researchers, physicians and nurses in order to piece together the idea of social value as a determinate of received care. Throughout his segment, sources are cited claiming that a person’s social worth has and should determine the care they receive which in turn leads the outcome of their situation. For example, there seems to be a trend that old people are determined as less important and less urgent to deal with as opposed to younger people or people of high social status.

Is this idea of social status as a limiting factor in determination of care a real component of our medical system today? If so, is this fair it certain patients receive a lower degree of care due to their social situation even if they have to pay the same amount of money?

Parsons’ Sick Role and Society

Parsons defines the sick role to be ‘the social expectations regarding how society should view sick people and how sick should behave’. Parsons was also one of the first people to recognize illness as a deviance. He talks about how people may consciously or unconsciously use illness as a means of evading their social responsibilities. He also contemplates how society would function if people weren’t allowed to take sick days.

I decided it would be interesting to look up average numbers of hours worked annually for the average American worker and compare this number to other countries. For example the average American worked 1789 hours in 2014. Compare this to Germany, 1371, France, 1473, and United Kingdom, 1677. Would it be effective to shorten the work day in an effort to improve health for workers? if this was the case then sick days could be reduced, which would discourage people from taking “personal days”, would this increase overall health and work efficiency in our country?

Statistics from: https://stats.oecd.org/Index.aspx?DataSetCode=ANHRS

Does the Way a Doctor Phrases a Question Affect the Response from a Patient?

In Groopman’s book How Doctors Think, he harps on an important concept that I though was similar to a main point in the ted talk. In his description of the case for the patient Anne Dodge, Groopman quotes the doctor who solved her case, Dr. Falchuk. Dr. Falchuk explains how even though he received a patient who has seen many other doctors, he started from scratch and let her talk freely. The doctor allowed her to begin from the start of her condition, even though it was something that had been going on for 15 years. Dr. Falchuk asked an open ended question, which influenced his patient to answer more openly, which in turn, helped lead to a correct diagnosis.

Does the way a doctor phrases a question (open ended/ closed ended) affect the response that the doctor gets from the patient? Do open ended questions take up too much of a doctors time? Do open ended questions lead to an over diagnosis of a patient?

Affordable Care Act and Low Socio-Economic Status

http://www.nytimes.com/2015/10/30/us/politics/obama-administration-campaign-will-publicize-health-care-subsidies.html?ref=health

On Thursday the Obama administration stated that it would wage a national advertising campaign to help people with low incomes get the affordable insurance that they were promised via the Affordable Care Act. People from a low socio-economic status claim that even under the Affordable Care Act, health care is still not affordable for low-income workers.

The goal of this campaign is to advertise a three-month open enrollment period, which will allow people to compare and select health plans. The enrollment period starts this Sunday. Another goal of the campaign is to spread awareness Continue reading “Affordable Care Act and Low Socio-Economic Status”

Social Economic Status and Race Leading to Unfairness in the Justice System

This discussion post doesn’t come directly from the readings for the week, but the general ideas from the readings apply well. Last night I watched a Vice documentary about President Obama’s visit to jail in his quest to reform the criminal justice system. One part of the documentary really stood out to me. A police officer being interviewed said that he was instructed to go to neighborhoods where young african americans lived, in search for people age 18-24 in possession of drugs. He was instructed to make arrests for any amount of drug, whether recreational or intent to sell. The cop then said if he went to a white neighborhood instead, with the same strategy, he would make just as many arrests as he did in the african american neighborhoods.

It seems as if cops are preying on easy targets. These cops travel to lower social economic status regions in search of arresting targets who may not have enough money to hire a lawyer or pay fines to get out of going to prison. The documentary continues to talk about how people end up getting trapped in a system where after they get out of jail, it’s impossible to get a job to pay fines to prevent getting sent back to jail.

How does someones SES effect their discrimination in the face of the law? Can our generalizations about the disadvantage of race also be extended to the justice system? Do flaws in our justice system promote these endless cycles of low SES? If so, these cycles can lead to less healthy lives for people involved and their families.

How Health Care Relates to You

I’m a premed major and I currently have an observership where I shadow a doctor at Mass General Hospital. I’ve also worked at BU medical campus in the past. Through these medically based experiences, I feel like I’ve always had a biased view on how life at a hospital works.

This class has been enlightening and I’ve already learned so much more about our health care system. Since I want to become a doctor, it is important to understand what a patient deals with when they try to obtain medical services. I had no idea how difficult it is for less fortunate people to get even the most simplest of health care procedures. And this category doesn’t even scratch the surface of people who need extensive care.

I did know that we have somewhat of a “private” health care system that is subject to the free market. I didn’t know that our country outspends every other country in health care expenses on such a high level. We spend about 17% of our GDP on health care, while the next highest percentage of GDP spent is 12%, and the majority of developed countries spend much less. The worst part about this spending is our healthcare isn’t even rated higher than these other developed countries, in some cases ours may be worse. I feel like I’ve learned a lot of statistics about our health care system so far in this class, but my goal for the next month of the class is to get a better understanding of how we can fix these problems within our own system.

One of the most valuable things I’ve learned so far relates to me as a consumer of health care. My family has always been under my father’s health care plan. I’ve never thought much about what goes into this system. I’ve always had health care and whenever I’ve needed a doctor I’ve just went. It is good to know I can stay on my family plan until I’m 26 (Affordable Care Act). However, this class has been a valuable resource in learning what steps I will have to take once it’s time for me to get my own insurance.

Why do Non-Profit Hospital Organizations make Extremely Lucrative Profits?

In the article “Bitter Pill: Why Medical Bills are Killing Us”, the author Steven Brill compiles research and data on bills from hospitals all over the country. There is a trend where non-profit hospitals are turning around huge profits.

To quote Brill, “Its nearly half­billion dollars in revenue also makes Stamford Hospital (non-profit) by far the city’s largest business serving only local residents. In fact, the hospital’s revenue exceeded all money paid to the city of Stamford in taxes and fees. The hospital is a bigger business than its host city.” …. “There is nothing special about the hospital’s fortunes. Its operating profit margin is about the same as the average for all nonprofit hospitals, 11.7%, even when those that lose money are included. And Stamford’s 12.7% was tallied after the hospital paid a slew of high salaries to its management, including $744,000 to its chief financial officer and $1,860,000 to CEO Grissler.”

Meanwhile, taking a definition from google for a non-profit organization, “A nonprofit organization (NPO, also known as a non-business entity) is an organization that uses its surplus revenues to further achieve its purpose or mission, rather than distributing its surplus income to the organization’s directors (or equivalents) as profit or dividends.”

-https://en.wikipedia.org/wiki/Nonprofit_organization

Is there some loophole in this system where these non-profit hospitals get around this stringent definition?