Informed Health Care Consumer

As the semester is ending and I begin to reflect on this course and what I have learned I realize that a lot of Americans will go their whole lives without knowing the basics of our healthcare system. It is hard to believe that that is where I was at at the beginning of the semester. Since then I have learned and immense amount of information that I believe will forever be valuable.

Our health care system is a complex one and very different one when considered internationally. It is also in danger of collapsing our economy if regulations on spending are not put in place soon. The reason health care is so expensive is because it is treated like another commodity in the US rather than a basic human right.Now this may be because health care rose alongside the medical profession. However, there is nothing that can be done to change the past we can only learn from this mistake so that we are able to improve. No country in the world has perfected their health care  system. In Japan the cost of health care is too low and Switzerland it is too high (although not as high as it is in the US). Regardless improvement to our system is necessary.

This is only one of the issues with health care in the United States there are others like medicalization, long term care, and medical training. All of which deserve attention for the American public.  Having taken this course I am now a more informed consumer of health care but I know there is still so much to learn.

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Importance of having the conversation

After reading the New York Times article “Tip-Toeing Toward Conversations About Death” I think that is remarkable how our health care system has changed its perspective about end of life care in such a short time. Previously doctors who wanted to have end of life conversations with patients were considered to be a part of “death panels.” Now there is a law that requires physicians to foster conversations between patients and their families by way of information pamphlets.

The goal of this initiative is to have more patients die in the manner they prefer. Currently 67% percent of people would like to die at home but this is only happening for 24%. How long will it take for the majority of people to die where they want to and what further measures will need to be taken to ensures this happens?

 

Ground Breaking Treatment for Infertility: Uterine Transplant

In the New York Times article written by Denise Grady a “frontier” procedure is discussed. In the next few months it is expected that the Cleveland Clinic will perform the first uterus transplant in the United States. Eligible recipients for this transplant must have been born without a uterus, but still have their ovaries or have a uterus that is damaged or has been removed. Though the Cleveland Clinic will be the first to perform this procedure in the states it has already been successful in Sweden. Although, with one major difference, the uterus donors in Sweden were living and in most cases the donor was the recipient’s mother. The transplants that are to take place in Cleveland will use a deceased donors uterus in an effort to avoid potentially putting another woman at risk. Women who have a successful transplant have to wait one year to undergo in vitro fertilization. During pregnancy recipients could face complications including pre-eclampsia, infection, blood clots and will be subjected to cesarean section before their due date so that the transplanted uterus and the recipient are not harmed by the “strain of labor.” In addition transplants will be temporary, and will either be removed surgically or anti rejection drug treatment will be stopped and the uterus should wither away.

This surgery is going to be ground breaking, but why has uterine transplantation become an option when there are other methods of having children? Including adoption and surrogacy. According to the woman who is set to receive the first transplant, it is about the experience. Though she is married with two adopted children, she has never known what it feels like to be pregnant and wants to experience “morning sickness,” “backaches,” feet swelling,” and “feel [her] baby move.” However, this “experience” is coming at a high cost. Women who attempt transplantation risk infection and organ rejection. Compared to the possible health risks the financial risks are relatively low. Both the transplant and pregnancy costs will be covered by research money from the Cleveland Clinic and health insurance. However, the cost of living in Cleveland for the duration of the study will fall upon the recipients and their families.

The uterine transplant will be pushing boundaries not only medically but also ethically. Traditionally organ transplant has been meant to save and improve the quality of life and now it is generating life. Can this procedure be equated to in vitro fertilization? It is essentially the same thing; women are paying to enjoy the experience that is pregnancy. But where does it end? The study conducted by the Cleveland Clinic will include 10 women who will receive transplants and for whom they will foot the bill. If the study is thought to be successful the uterine transplant will become available to more women, but at their own cost. Can it be justified that those who can afford to will be the only ones to experience pregnancy and childbirth? What about the insurance companies? In vitro fertilization is covered by select insurance plans. Will uterine transplants now have to be considered an insurance benefit treatment for infertility? These concerns question the ethicality of this procedure. Dr. Tzakis who will be performing the procedure at the Cleland Clinic has decided that the uterine transplant is ethically superior to surrogacy because it does not exploit poor women; however, the expenditure of the transplant makes it unaffordable to them.

 

http://www.nytimes.com/2015/11/13/health/uterus-transplants-may-soon-help-some-infertile-women-in-the-us-become-pregnant.html?_r=0 

Has the rise of the modern hospital made us too reliant on modern medicine?

In the article written by Charles Rosenburg “The Rise of the Modern Hospital” it is discussed how the public’s perception of medicine allowed for the establishment of moderns hospitals because people began to see hospitals as a central location for both medical and surgical care. Is it possible that now our perception of hospitals and medicine in general has shifted to point we are too reliant on them to explain everything; thus leading to medicalization of previous non medical conditions and the spending of trillions of dollars on health care?

Are insurance companies contributing to the de-professionalization of nurses?

The standardization of the doctor’s role in the medical profession in the twentieth century has led to the the decline of autonomy among nurses and in turn the de-professionalization of nursing. Nurses with previous niches such as midwifes and AIDS nurses have been taken over by medical specialties like OB/GYNS and Infectious Disease. Nurses previously had significant control over hospital conditions and are now subject to hostile work environments at the hands of doctors. Weitz mentions that in a effort keep the autonomy of nurses low hospitals hire fewer and for more hours so they have less say over their schedules and niches.

What about insurance companies, are they contributing to the de-professionalization of nurses?

Lack of standardization among insurance companies and insurance forms leaves nurses doing more administrative work reduces the amount of time that can be spent with patients. In addition to this insurance companies value the time of a doctor over that of a nurse. This is attributed to the extra knowledge that doctors have. What about Nurse practitioners? They poses masters and doctorates, are able to diagnose and prescribe with limited supervision from doctors. This is a similar to residents being over seen by and attending. So why is there such a large gap in pay and recognition?

The Breast Cancer Racial Gap

In the New York Times article “A Grim Breast Cancer Milestone for Black Women” Tara Parker discusses the “dubious milestone” African American women have recently reached. According to the American Cancer Society the incidence of breast cancer among black women is now equal to that of their white counterparts. This is troublesome for the women of the African American community because statistically they are more likely to die from breast cancer. Now that the incidence rate in African American women has gone up it is expected to broaden the mortality gap between black and white women.

What changes have occurred in recent years that have led to more black women being diagnosed with breast cancer? Could it just be that early diagnosis is allowing doctors to recognize more cases?

While, early diagnosis is discussed as a contributing factor it is not enough to explain this great of a raise in the trends. It is rather obesity and a change in reproductive patterns that is increasing the risk of breast cancer in black women. So this explains why black women are being diagnosed, but does not explain the higher mortality rate. Parker attributes this to several factors including the lack of availability of that black women have to quality health care compared to white women. In addition to the fact that black women are more likely to be diagnosed with triple negative breast cancer, a form of the disease which has a worse prognosis than estrogen-receptor positive disease, the most treatable form of breast cancer; more commonly found in white women.

This disturbing statistic that projects that African American women are 70 percent more likely to die from breast cancer than white women speaks to on going inequalities in our health care system. Why is it than in 2015 race still plays a role in the quality of care that a person receives? I believe that these disparities date back to policies and the lack there of in previous decades and gives us reason to modify our health care system so that it benefits everyone equally. Because the perpetuation of the current United States health care system will continue to indirectly kill black women.

Just because black women lack the insurance coverage and access that their white counterparts have to seek and pay for quality treatment does not mean that they should continue to suffer more. This also speaks to the lack of standardization of care in the United States. The only way to fix the system so that race does not continue to be a determining factor in the quality of treatment is equalization of our hospitals, medical schools, insurance policies, pharmaceutical research studies and medical facilities across the board.

The inequalities in our health care system stem from social and economic policies that have failed to equalize the social and economic statuses of communities, neighborhoods, and cities across the nation. To start enacting change we need to start on a small scale and then work our way up from there. At the community level African American women need to be more informed about breast cancer, how it could potentially affect them and ways to seek preventative care. At state and possibly federal levels universal coverage plans need to be enacted so that lack of insurance is not a death sentence. People who lack insurance turn life saving treatments and even preventative care down everyday and this should not be the case. Until the health care system is equalized, the mortality gap between black in white women will continue to widen; because the system we have now is not operating in favor of black women, but against them.

http://well.blogs.nytimes.com/2015/10/29/a-grim-breast-cancer-milestone-for-black-women/?_r=0

Medicalization of Deviations From the Norm

The article tilted “Tall Girls: The Social Shaping of a Medical Therapy” discusses a medical therapy of the 60’s and 70’s in which hormones were given to girl who were predicted to be tall later in life. With the permission of their parents of these girls doctors administered hormones to induce puberty and growth plate closure in order to prevent any further growth. This practice was prevalent at the time because it was considered undesirable for girls to be taller than their male counterparts. This is an example of how social norms or practices have the power to medicalize characteristics which society perceives as deviations from the norm. Are social standards of what woman’s appearance should be still shaping medical therapies today?  And are they the reason for the continuous increase in cosmetic procedures?

Who’s responsible for correcting the conditions that make the poor more susceptible to disease?

There is a link between environmental conditions, diet, and access to health care that foster illness. Environmental conditions such as pollution can encourage illnesses such as high blood pressure and emotional stress. Inadequate or unsafe housing increases the risk of infection, while diets high in fat can lead to heart disease, diabetes and other illnesses. These conditions are prominent in low income areas and stem from social policies or lack there of that have resulted in the poor becoming sicker simply because they lack the power and the money to change their situation.

Knowing this is it the responsibility of the government to enact policies that set a standard for adequate housing or is it the moral responsibility of the landlord to provide the best living situation possible for their tenants. In addition who’s responsibility is to ensure that the poor have access to healthier food options so they can avoid high fat diets?

The current conditions experienced by those who are poor make them more susceptible to disease so in a effort to prevent this disease and in turn lower health care spending. What should be done and who should be doing it?

Health Care as a Right

Having been born and raised in this country my entire life it is hard to imagine that before this class I had virtually no idea how our health care system worked. Being in this class I have a much better understanding of how our health system was developed and why it is so fragmented. Although, I can’t help but think why despite our status as a developed country we have one of the least cost effective systems and are not more concerned about fixing it. Having been in this class only a few weeks and already learned so much about the U.S. health care system and how it stands in comparison to peer countries it seems as though the answer is simple. Some sort of change in how our health system is run is necessary to prevent an economic crisis in the near future. Why haven’t we looked toward our peer countries for ideas? In Germany they offer a system of social insurance plans to its citizens and in Great Britain almost all health costs are payed for by the government through their National Health Service. And both of these countries have better healthcare outcomes and longer life expectancies than the U.S.

The lack of change in our system can be partially attributed to the AMA, big pharma, and for profit insurance companies that have a bigger steak in health care than the patients receiving the care. However, when did it become okay to care more about making money off of people suffering from sickness and disease than it did to prevent their diseases in the first place through more cost effective care like prevention and education. The United States has been slow to implement reforms like the ACA, which barley scratch the surface in reforming heath care policy. To take real strides in providing health care nationally the United States needs to first acknowledge health care as a basic right that every citizen of this country is entitled to.

Government Intervention in Our Health Care “System”

In Atual Gawande’s article “Testing Testing” he highlights what he believes to be the two main problems of America’s fragmented health care system, cost and coverage. Not all Americans have access health insurance and even with coverage out of pocket medical costs continue to soar. With the passage of the Affordable Health Care Act more Americans have insurance coverage but the bill has done little to make “significant long-term cost reductions.” According to Gawande, if costs continue to rise at the current rate more than a fifth of every dollar Americans earn will go to health care costs.

Gawande goes on in the article to give a brief history of the United States agricultural system, essentially comparing it to the current state of our health care system. In the 1900’s there was an agricultural crisis in America, there were limited crop options at high prices with differing qualities. However, through government intervention the USDA was able to implement pilot programs that improved the quality of farms county by county by providing technical assistance to local framers. This system was effective in that it standardized quality of crops, lowered prices and increased availability. The government was able to be involved in improving the country’s agricultural system without taking control away from the farmers. Additionally, this process did not happen over night, it took years to standardized the US agricultural system. It also required trial and error as far determining which farming techniques were better than others and which techniques produced the highest quality products at the lowest prices.

The history of America’s agricultural system tells us that government intervention may be the logical next step in response to the health care crisis. Because at this point we are in crisis and continuing to let big pharma, hospitals, insurance companies, and the AMA control our health care system is not a logical option. Answering to the government may not be physicians, pharmaceutical, and insurance companies want because it threatens their autonomy, but if they are not willing to come up with a standardized system the government will need to do so. There is no reason for the United States to continue to be an outlier when it comes to the amount we spend on health care. The cost of health care in other parts of the developed world like Switzerland and Norway pale in comparison to what Americans are paying. There are other less fractured and more organized systems that are working in other countries around the world. The United States needs to find another system that works without the high costs and low coverage that we are currently experiencing. Our current system is not going to get any better unless something is done because as of now it is not matter of whether or not our existing health care system will bankrupt our country but when.

http://www.newyorker.com/magazine/2009/12/14/testing-testing-2