How much control should a doctor truly have over a dying patient?

In the New York Times article “Fighting to Honor a Father’s Last Wish: To Die at Home”, we are introduced Ms. Stefanides and her dying father, Mr. Andrey, and their battle with the healthcare system. Unfortunately, Ms. Stefanides could not afford out-of-pocket home care, and though her father qualified for both Medicaid and Medicare, “the flow of money seemed to bypass what he actually wanted at the end of life”. In addition to emphasizing that Mr. Andrey couldn’t even be granted his basic wish to die at home, the article further talked about all the abuse that occurs at rehabilitation homes that care for the elderly. Ms. Stefanides recalled her own mother’s month-long abuse and eventual death in the hospice, and refused to subject her father to that kind of tragedy. Unfortunately her options were incredibly slim, and she felt that the doctors were “bullying her to disregard her father’s wishes”, and they basically wanted him sent somewhere else to die.

This incredibly touching and sad article sheds light on the difficult position many are faced with due to a failing healthcare and abusive system. One must wonder if all of this heartache for Ms. Stefanides and her father were worth it, and if his dying wish should’ve been granted in the first place. This brings up the issue of the doctor-patient relationship, and how invested a doctor should truly during a patient’s final years. And so I ask – Where do we draw the line to how much say a doctor has during a patient’s time for his/her death? Should the patient have full ownership over their body and where they will rest during their final time, or does the doctor know what is best?

Video: Medicaid Gap

Link: https://www.youtube.com/watch?v=5d3nASKtGas

I found this video on YouTube of John Oliver on his show Last Week Tonight. He discussed the current elections and how this effects the Medicaid gap in the country. These upcoming elections may determine whether many Americans will receive health insurance or not. He talks about Obama’s initial “ObamaCare” plan with the focus on providing everyone with healthcare. But, after the Supreme Court didn’t approve of the entire health care bill, which then gave states the option to choose whether or not they want to expand Medicaid. States that did expand Medicaid showed a decrease of uninsured Americans in their state. I thought this was an interesting video and adds a lot of humor with this current situation.

Government Healthcare Insurance Better than Private Insurance?

According to various statistics taken, preventative health visits were higher in children who had Medicaid and CHIP insurance plans as opposed to those with private insurance (private: 83%; Medicaid: 88%). Those with private insurance also reported having to pay more out of pocket expenses than those with Medicaid and CHIP (private: 77%; Mediaid: 26%).

Money, Money, Money… Must Be Funny.

Medicaid Costs Rise, but Some States Are Spared

By Abby Goodnough

http://www.nytimes.com/2015/10/16/us/medicaid-costs-rise-report-says-but-not-more-than-most-states-expected.html

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).

First Native American Birth Center

https://www.colorlines.com/articles/navajo-midwives-new-mexico-plan-first-ever-native-american-birth-center

This year, thanks to the combined efforts of Nicolle Gonzales, Brittany Simplicio, and the nonprofit “Changing Woman Initiative,” a plan has been put into place to create the first ever Native American birth center. Gonzales and Simplicio are two of only fourteen certified nurse midwives who are Native American. The pair have a firsthand understanding of how frequently Native American women suffer the consequences of being minorities with a low socioeconomic status when it comes to health, and, more specifically, pregnancy, birth, and neonatal care.

On this topic, I have mixed feelings.

On one hand, Native American women will have better access to pregnancy and birth care, but I also wonder, how in the world is this first ever birth center for this already largely underserved group of people? How much has this group had suffer as the result their inability to access a birth center?

There is no greater illustration of how institutional racism and mishandled bureaucracy directly harm health outcomes for Native American people than what we see with Indian Health Services (IHS), particularly at the Santa Fe location where Gonzales used to work. Due to underfunding, native women only have access to prenatal care because the labor and delivery ward was shut down in 2008. When I see that, I immediately wonder and worry: when a native woman does go into labor, how far does she have to travel to safely give birth? Does she have access to a safe, clean place if she gives labor at home? How far is the nearest hospital if something goes wrong? The answer all of these to these questions are provided nowhere other than the disproportionately high rates of infant mortality among Native American people.
To add insult to injury, at the Santa Fe location, women are provided neonatal care through IHS, which is funded by the federal government, but for delivery at a hospital, they must apply for Medicaid. The interaction between IHS and Medicaid—for all medical procedures, not just birth—has created a confusing mess for native American people who don’t realize they’re eligible for both.

Gonzales and Simplicio explain that “poverty, discrimination, geography, and racism” have created cultural disparities that leave Native American people less healthy than they should be. These disparities manifest as “higher rates of gestational diabetes, increased rates of postpartum depression, and higher rates of preterm birth and low birth weights.”

It’s just amazing to me that it could take this long to finally give Native American people access to a service that might have saved an unknown number of lives had it been provided earlier.

Medicaid Costs Rise, but Some States Are Spared

Medicaid is jointly financed by state and federal funds. Although the federal government covers vast majority of the cost state officials complain that they spend most of their budget on Medicaid. Based on a recent report Medicaid spending has increased by 14%. This is a result of newly eligible enrollees. However, federal funds covered all additional spending. National Medicaid enrollment climbed 13.8% resulting in an increase in spending on the program.

Income Inequalities With Old Age

On the very first day of lecture, we learned in class that there is a difference between sociology in medicine and sociology of medicine. The former means that we accept the basic principles of medicine, but the latter means that we are analyzing medicine from outside the medical system and challenging accepted beliefs and ideas claimed in this complex field. In this article titled “Income Inequality Grows With Age and Shapes Later Years,” the writer tells a story of two senior women who both grew up in frugal households but lived very different lives throughout their adult and elderly years.