This course has really informed me a lot in terms of the way how policies are carried in our capitalist economic system, not only in the States but also in other countries as we do comparative studies. Before I came to this course, I only knew as much as the social construction of illnesses and how social institutions like the pharmaceutical companies have a huge influence in the diseases and drugs that become marketed. After this course, I learnt a lot more things and question a lot more things that I used to take for granted; such as the options we may have for our end of life care, and alternative care providers such as hospices and nursing homes. If anything, this course has made me more reflexive as a potential patient of our complex healthcare system.
As discussed in lecture, nursing homes are inadequate in satisfying the needs of the elderly, and medicare is not a solution for long term care. In addition, the “daughter’s track” explains how this care responsibility is usually assumed by women. Given that long term care is both a gendered and classed issue, how can we as a well developed nation alter its institutions to provide ways that lessen the stress put upon families and especially, women, in dealing with long term care (which takes up a lot of effort, time, commitment and dedication)?
“As we contemplate its contentious present and problematic future, we remain prisoners of its past” (Rosenbergon, 1995, p. 537). From Rosenbergon’s article on The Rise of the Modern Hospitals, we can ask how can the healthcare system to deal with both the technical necessities and human necessities?
In Chapter 12, Weitz explains how limited research there is on alternative techniques apart from allopathic medicine. She associates this limited research to the barriers to obtain funding as pharmaceutical companies do not have incentives to fund research on herbs or techniques that they cannot patent. This brings us to question how the for-profit companies in our capitalist economic system has shaped our healthcare choices and how it has impact our health. Like the economics term “opportunity cost”, it is interesting to think of what our opportunity cost is by giving these social institutions (pharmaceutical companies, legal institution, government, healthcare providers) the power and authority to define and narrow our healthcare choices, and what impact it has on our body and our social positions with these clearly defined healthcare options?
The second issue that intrigues me is how our society has framed different healthcare services according to its reflection of social status. An example to illustrate this is childbirth by lay midwives or by medical assistance. By associating medical assistance as a reflection of an upper class’s childbirth choice, and lay midwives as lower class and associated with African Americans midwives, it is important to highlight the social factors – such as gender, race and class – in our healthcare system, which is not supposed to discriminate. Hence, we may ask, how has the institution of healthcare further marginalise the social positions of women, non-whites, and lower-class?
The article on “Managing Emotions in Medical School” has raised the issue around gender, whereby they hypothesised that women would find it difficult to see the patient as a mechanical system of parts, but they found out that these female students did not find it difficult, and instead, they faced the same problem as men. The article has spent a lot to talk about how students make use of the resources offered in the medical schools to create coping strategies with their emotions. However, I would like to emphasise the importance of gender and its socio-cultural expectations, norms, roles. In other words, what are the implications for both women and men given that they are practicing in an environment that expects differently of them according to socio-cultural understandings and expectations of what it means to be a man or woman? How does that translate into the pressures and challenges for these women and men, respectively? Do women and men have, as the article discovered to be, “similar experiences and find the same solutions”?
The second article on “Silent Curriculum in medical school” talks about how these medical schools can actually reinforce health inequalities along racial lines. However, I find that it is also important that we question how different it is to be a black medical student vis-a-visa a white medical student?
Oftentimes, illnesses and diseases are always associated with the biological, and these can even be framed specifically to a particular race or ethnic group; one example is the sickle cell anemia, which is known to an inherited disease in the lineage of African Americans. However, the fact is that people are more prone to sickle cell disease is not race or ethnic group, but the geographic location – and in this case, it is the tropical conditions. It is therefore, important to note that the causes of diseases and illnesses are very much linked to social and environment, and not merely the biological.
In this article “The Real Problem with America’s Inner Cities”, it reflects that these inner cities are occupied mostly with Blacks and these neighborhood are dangerous for their street or thug culture, and the residents who occupy these neighborhoods are poor and have few skills. Hence, they make a living out of underground economy of illicit trading and crime. As the article explains, these neighborhoods’ “culture is reinforced by contemporary conditions like poverty, racial discrimination, chronic unemployment, single parenting and a chemically toxic, neurologically injurious environment, like the lead paint that poisoned Freddie Gray”.
Being too poor to seek for medical care in a healthcare system that does not cover everyone is one thing. Being penalized and deprived of opportunities to advance the social (and health) ladder is another issue. The social environment in which people grow up and live in has tremendous impact to their health. The social reasoning of poor health has been illustrated in the film “In Sickness and Wealth” during class.
In the article “Millions of poor are left uncovered by the State Law” by Tavernise and Gebeloff, they have brought race into the picture to understand why the states that have rejected the expansion of Medicaid are places where the demographics has a majority of Blacks, single mothers. This disproportionate numbers of Blacks who are uninsured – because they are torn between the eligibility for Medicaid and the eligibility for new health exchanges – have been justified in economic terms. But this article makes us question whether it is really more economically justifiable to choose not to expand or because of the power struggle between the different racial groups. The question we should ask is how have race affect the lived experiences of us in our daily life, and how have we perpetuate the inequality in health outcomes along racial lines, and how can we alleviate this struggle/issue?
I had virtually zero knowledge on the U.S. healthcare system because I am not from the States and it is my first time here. However, based on my personal experience in the first week I’ve arrived, I was shocked. I paid over $700 for my health insurance and I was told that the insurance did not cover the prescribed drugs. I had to go to the pharmacy and get the cough medicine which cost $24, and because it’d cost $5 back home in Singapore, I was quite shocked. Having said that, I personally think that my home country’s healthcare system is not exactly affordable too. I found the similarities between Singapore and the States – and that is they are both rooted in neoliberalism and they do not adopt the stance of a welfare state.
With the lessons from this course, I realized how the healthcare system and arrangements must be critically understood historically, politically, economically and socially. To be honest, I am still not a hundred percent sure how healthcare works here (e.g. when are you ineligible, when to follow the Federal or the State laws) for it is a huge complex system. But the interesting takeaway from this course so far was actually the consumerism mindset, how consumers’ expectations and mentality of “more is better” and how we often do not realize that sometimes more is not necessarily better, and there are a lot of side effects to consider.
The most challenging reading I have encountered was “Towards a Sociology of Disease” by Timmermans and Haas. Because I have always understood healthcare in the perspective of sociology of health and illness, instead of the perspective of sociology in disease. In fact, I have thought they were similar. I did not account for the biological or technical aspects of healthcare, and I would avoid being specific on diseases. This reading challenged my thoughts and broadened my view on healthcare. Although I still find it difficult to separate between sociology of health and illness and sociology of disease, it seems to me that the former is more general which focus holistically while the latter is more specific.
In the article “Trapped in the System: A Sick Doctor’s Story” published in the New York Times is a doctor’s anecdote about his experience in getting medication through a tedious process with the different institutions involved such as his doctor, insurance company, pharmaceutical and laboratory personnel. Given that he knows how the system works in terms on the processing, paperwork and documentation in order to ensure that the bills get subsidized by insurance companies, and to obtain the pills itself, he still finds it difficult to get medication for his illness. It is noteworthy that because he is a doctor, he knows which medication is a better option and the side effects. This knowledge is not something that can be easily learnt to the general public. If he finds it difficult as an individual patient in this system, the question is how else is the general public coping? More importantly, the question of how are the people with more urgent illnesses coping?
He argues that while much discussion has been revolving around the quality of and access to healthcare, the obstacles in which people face with dealing the healthcare system have oftentimes been neglected. Thus, the article provokes us to think further about the ways and indicators we consider when measuring the quality of and access to healthcare in a holistic way. This article has reminded me that not only are the groups of the uninsured, or the precariously insured citizens, or the poor are susceptible to fall from the cracks of our healthcare system, the educated, well-informed in terms of resources and power are also victims of a system, which has room of improvement in terms of delivering care. Besides its unaffordability and the unproductive outcomes (given how much we have spent on healthcare), this article reminds us to look into the red tape produced by our bureaucratic healthcare system, and how individuals, with varying power and social positions, negotiate with the many different institutions (insurance company, employers, pharmaceutical companies, doctors etc.). More importantly, how their outcomes vary depending on their social positions and power, which then varies along class lines, race, age, gender, profession, socio-economic statuses. I believe that we need to integrate these social factors in order to understand the healthcare system sociologically.