I really enjoyed being in SO215 this semester. I can definitely say that I have learned so many things about our health care system that I was completely unaware of before. I think it was really important for me to take this course because my goal is to one day become a doctor. I believe it’s important to know the origins of the modern health care system and what the current state of affairs is in order for future doctors to be able to bring about effective change. This course has opened my eyes to the imperfections of our health care system but has also shown me that there is hope. There are activists and nations out there who have already begun the next step in our health care system’s evolution and I hope that by the time I enter the medical field, I will be able to do so with pride. I think one of the things I learned about our health care system is that, with the right conditions, reform is possible. I have to say that my least favorite part about this class was learning about the negative aspects of our health care system, simply because I was so unaware of many of these facts before (for example, the existence of the chargemaster). Perhaps one day I will have the chance to be a part of the change that minimizes/eradicates the profit-seeking, corrupt, and unjust aspects of our health care system, and takes it back to its initial beneficent and altruistic roots.
In Does Investor Ownership of Nursing Homes Compromise the Quality of Care?, Charlene Harrington et al. reveal that investor-owned nursing homes deliver lower quality care than do nonprofit or public facilities and explores the factors behind this marked decrease in quality of care.
Many Doctors Unaware of Truvada, Drug for Preventing H.I.V.
By Donald G. McNeil Jr.
Kudos to you if you actually got the reference I was making in the title.
But in all seriousness, this article frustrates me a lot. One of my good friends from high school is a campus advocate for Truvada (a.k.a. “PrEP”, or Pre-Exposure Prophylaxis) at NYU and I can already imagine how upset the information in this article would make him.
In The Rise of the Modern Hospital, Charles Rosenberg discusses the “contentious present and problematic future” of the hospital and explores the factors that led to the evolution of this institution from the subpar ragtag collection of inpatient beds in 1800 to the profit-maximizing monolith of the 21st century. This reading made me reflect on the things we’ve learned throughout the course of this semester. Before this class, I knew that our health care system was flawed but I had no idea of the extent of these imperfections.
In Managing Emotions in Medical School: Students’ Contacts with the Living and the Dead, Allen C. Smith and Sherryl Kleinman explore the stance our Western culture takes regarding the question of how medical students ought to express emotions and how big of a role these emotions ought to play in the care they offer. I think one point we all have to take away from this reading is that modern culture emphasizes an apparent need to desensitize ourselves in order to provide better medical care but that this carries an immense risk of dehumanizing patients. This seems like a valid and fairly obvious point, in my opinion.
Medicaid Costs Rise, but Some States Are Spared
By Abby Goodnough
In this article, Abby Goodnough discusses how the average costs of Medicaid in the United States have increased in the past fiscal year. She attributes this increase in costs primarily to the large amount of newly eligible enrollees in states that have recently significantly expanded their Medicaid programs to allow for greater amounts of low-income adults to join. In many of these states, the per-member, per-month cost for new enrollees was not higher than expected; instead, in some cases, it was much lower. Almost all of the additional spending associated with this expansion is covered by federal funds. Goodnough notes a dramatic difference between the increase in enrollment and in costs between the states that have expanded their Medicaid programs and those that have not. The article then explores the concerns that many people have regarding the financial projections for the United States given the current system of Medicaid funding and the financial policies associated with this program. At the state level, people predict that though there may be some budget strains initially, there will be net savings in the long term as things like provider taxes will offset the additional costs. At the federal level, some people question whether or not it is financially viable for the government to continue pouring as much money into Medicaid as it is currently and will continue to do in the future (at least 90% of the costs are to be taken on by the federal government after 2016).
In The Social Construction of Illness: Key Insights and Policy Implications, Peter Conrad and Kristin K. Barker explore the origins of the belief that illness is a socially constructed phenomenon. Near the end of this publication, they discuss policy implications related to this phenomenon and future directions it may take us in. Something I found extremely interesting in this section was the mention of the Internet and how it has radically changed the social construct of illness.
In “Understanding Racial-ethnic Disparities in Health : Sociological Contributions”, David Williams and Michelle Sternthal explore racial and ethnic inequalities in health in the United States. Personally, I am a proponent of color-blindness, but I question if it is a possibility in America’s future. The section of this publication titled “Racism and Health” opened my eyes to the concrete data and evidence that shows that our nation is still inherently racist, both intentionally and unintentionally. Williams and Sternthal reveal the very real presence of racial segregation that remains in this nation to this day, and this concerns me greatly.
Is institutional and wide-spread color-blindness a possibility in the future here in the United States? What, if anything, can/must be done to bring this change about? Is segregation and racism an unavoidable and everlasting aspect of our cultural fabric now?
I was lying down in my bed last night having a throwback musical jam session with my suitemate, and Where is the Love by The Black Eyed Peas started playing (I have a pretty sweet playlist, I know). On top of the cringe-worthy middle school memories that popped into my mind, I started really considering the lyrics of the song. At one point, apl.de.ap asks, “Whatever happened to the values of humanity? Whatever happened to the fairness and equality?” Based on what I have learned in SO215 thus far, I find myself asking the same questions about the world of medicine here in the United States. In my opinion, the medical profession in this country has corrupted its pure and beneficent purpose and what stands in its place is a dark world of shady backdoor dealings run by the ruthless private sector of health care.
As infuriating as the very existence of the chargemaster is, I believe we ought to focus on the bigger picture. That is, we ought to be questioning why medical bills are so high now rather than who should be paying them. What does it say about our health care system and our nation’s economic and social philosophy when we allow lobbyists and private groups with financial resources to single out those who are least able to pay and burden them with the highest rates? Our anger ought to be directed at addressing the issue of why there is a blatant and glaring lack of transparency in the world of medicine in America. At this very moment, hospitals are pulling the wool over our eyes and charging patients far more than what their care actually costs. Brill establishes that the gap between what hospitals charge for certain things (procedures, tests, etc.) and what Medicare would pay for the same things is mindbogglingly immense. How can we, as American citizens, feel comfortable about whatever care we are being given when we fear the associated costs and we are unaware of where these ridiculous bills are coming from? I posit that if the medical profession had more transparency, the public outrage alone would force radical reform to occur. This begs the following key questions: is total transparency in the medical field in America possible? Is this an attainable goal in the future or is our nation condemned to a future of rising arbitrary costs and exploitation of the less fortunate subset of our population? What, if anything, must FIRST happen/change in order for us to potentially achieve such radical reform?