Health Care Through the Social Problem Lense

The lack of health insurance has serious consequences for the uninsured and under insured, far beyond its impact on their physical health alone. A study, using the World Health Organization's measure for the quality of life, shows uninsured have:

• higher depression scores;
  
• lower physical quality of life scores;
  
• lower psychological quality of life scores;
  
• lower social quality of life scores;
  
• Lower environmental quality of life measures.
  

As one would expect, the uninsured are also less satisfied with their health and their access to health care services. (W.H.O., 2009)

The phenomemon of lack of health insurance not only hinders the quality of life and general overall health of those living without it, but also adversely affects those who do have access to insurance. When people who are uninsured are seen in an Emergency Room and are unable to pay their bill, the hospital may write off that charge, however, the hospital's insurance in turn eventually increases the cost of care in order to recover the monies lost from such write-offs. This increase is passed down the line to the consumers of individual and group health benefits, causing them to pay higher premiums and deductibles, leaving less money in their pockets for life's necessities.

Many politicians and health care companies have proclaimed for years that the US has the best health care system in the world. Still, there are many people who do not agree with this assertion, especially the 42.6 million people in the US without health insurance. The rising costs of health care and the lack of access to health care creates a myriad of social problems, and many health care professionals have begun to voice their concerns about a potential future crisis in the US health care system (Massachusetts Medical Society House of Delegates Report 207, A-99).

How does a society know when a health care system is "good"? The World Health Organization (WHO) released a report in 2000, in which it outlined three goals for a "good" health care system:

1. It should make the health status of the entire population as good as possible across the whole country.
   
2. It should respond to people's expectations of respectful treatment and client orientation by the health care providers.
   
3. It should ensure financial protection for everyone, with costs distributed according to one's ability to pay (WHO, 200).
   

In making their comparison of "good" health care systems, several basic facts emerged: the United States has, by far, the most expensive health care system in the world, based on health expenditures per capita and on total expenditures as a percentage of GDP. The United States spent $4178 per capita on health care in 1998, more than twice the median, and far more than its closest competitor, Switzerland, who spent $2470 (WHO, 2000).

In addition, the US is the only country in the developed world, except for South Africa, that does not provide health care for all of its citizens (Ayres, 1996). Instead, private insurance is used, coverage by which depends mostly on employment, along with public insurance coverage for the elderly (Medicare), the military, veterans, the poor, and also for the disabled (Medicaid – which varies greatly in its implementation across states). Such a system creates serious gaps in health care coverage, which coupled with the high cost of insurance, means that often employers are forced to either drop the insurance benefits, or to raise premiums and pass this on to their employees (Massachusetts Medical Society House of Delegates Report 207, A-99).

According to recent figures, 42.6 million people in the US were uninsured in 1999. This is an embarrassment to politicians, but a matter of life or death to many of these 42.6 million people. As Martin Luther King Jr. said "Of all the forms of inequality, injustice in health care is the most shocking and inhumane". People without health insurance tend to live sicker and die younger than people with health insurance. 80% of those uninsured are in working families, which has detrimental repercussions for the US economy as a whole.

In addition, the WHO report found that the US ranked 26th among industrialized countries for infant mortality rates (WHO, 2000), at 7.2 infant deaths per 1000. These figures are the highest among the OECD countries, and also mask a general disparity in infant mortality among racial groups, which is based in large part on economic differences (Massachusetts Medical Society House of Delegates Report 207, A-99). The US Department of Health and Human Services estimates that the infant mortality rate for black children in the US is 14.3 per 1000, which is more than twice that for white children (at 6.0 infant deaths per 1000). Most health care professionals consider these figures to be a shocking indictment of the living conditions for certain segments of the population of the richest country on earth.

The WHO report also showed that the US ranks very low, at 24^th, on the disability-adjusted life expectancy (DALE) among high-income OECD countries. The US also has a highly skewed distribution of DALE, particularly among males. This should perhaps not come as a surprise: with a great proportion of the US population lacking access to health care, particularly preventive care, it should be expected that some of these people live their lives with a higher frequency of, and more years of, disability (Massachusetts Medical Society House of Delegates Report 207, A-99).

The same WHO report looked at the degree to which financial contributions to health systems are distributed fairly across the population, and it was found that the US was the least fair of all the OECD countries. This unfair system of financing has implications for much of the population, but especially for those who are uninsured, or underinsured. As the WHO stated "the impact of failures in health care systems is most severe on the poor everywhere, who are driven deeper into poverty by lack of financial protection against ill-health" (WHO, 2000, cited in Massachusetts Medical Society House of Delegates Report 207, A-99).

In evaluating the world's health care systems using the above noted criteria, the WHO also ranked the world's countries based on overall attainment of their health care system, and the performance of their health care system. It was found that the US health care system ranked 15th in the world for overall attainment, and 37th in the world for performance (WHO, 2000, cited in (Massachusetts Medical Society House of Delegates Report 207, A-99). The same study found that only 40% of Americans are satisfied with the health care system in the US.

Further studies by other organizations have uncovered similar depressing statistics. In 1999, the United States Congress commissioned the Institute of Medicine (IoM) to study the issues of racial and ethnic disparities in health care (Betancourt, 2002). The IoM study found that minority Americans suffer disproportionately from preventable and treatable conditions - cardiovascular disease, asthma, cancer etc. - and attributed this to a lack of access to medical care. The IoM also found disparities in the quality of care for those from the ethnic minority communities with access to medical care (Byrd, 1990). The IoM report stated that "whereas racial/ethnic disparities in health were deemed to be "unacceptable yet understandable" given the persistent racial and socioeconomic inequalities in the US today, the racial/ethnic disparities in health care highlighted by this research seemed unconscionable" (cited in Betancourt, 2002). Possible solutions put forward by IoM included: raising the awareness of these issues with health care professionals; making legal, regulatory and policy interventions; providing interpreter services in health care settings; providing cross-cultural education as part of the curriculum for all health care professionals.

A paper by Mangalore (2002), attempts to provide some sort of solution to this crisis of inequality in the US health care system. The paper starts with the premise that as long as command over health-production inputs are dictated by the ability to pay for them, health inequality will persist within and among countries. A globally-acceptable definition of equality therefore needs to be defined, says Mangalore, and to be adopted practically.

Mangalore then goes on to provide a definition of equity, as the equal probability of reaching a desired end. He argues that an equitable health policy will then ensure that everyone belonging to a particular age group will have an equal probability of reaching a certain desirable health status (Mangalore, 2002). This, however, has to be coupled with two crucial conditions, in order for the objective of equitable health care to be achieved: equality of access to care, and care in proportion to the need (Mangalore, 2002). He argues that many of the current problems in the US health care system have arisen because conflicts have arisen between equity and efficiency, with the correct definition of equality of access (the freedom and ability to make use of relevant health medical care for those in need) being largely ignored in the efficient (and therefore not equitable) delivery of health care in the US.

Mangalore concludes by saying that a new definition of heath equity demands an equal probability of achieving a desirable target level of health. Medical care, he says, should be of primary importance, and should be available to all in an equitable manner. Equality of care, and of access, are therefore, essential conditions for this equity (Mangalore, 2002).

As we have seen, then, the US health care system ranks very low on many indices used by the WHO in their comparisons of health care provision worldwide. The inequalities that arise from the poor health care provision in the US have many repercussions, for the poor, for the disabled, for the elderly, and for those from ethnic minorities who tend to be disproportionately poor, in the US. These problems are now being recognized by health care professionals in the US, and now the discussion of how to solve these problems is opening up in health care journals, as we have seen, from the studies by Betancourt and Mangalore presented here. This, however, will not be an easy task, and will take a concerted "bottom-up" effort from health care workers, to influence policy-makers, who in turn will have to influence politicians and law-makers.

Those powerful words of Martin Luther King Jr. should ring in our minds as we ponder the question of inequality in health care provision in the US, and the plight of the 46.2 million people in the US should be changed for the better.

References

Ayres, S.M. (1996). Health Care in the United States: The Facts and Choices. Chicago and London: American Library Association.

Betancourt, J. (2002). "Unequal treatment: the Institute of Medicine's findings and recommendations on health care disparities". Health Policy Review. 3(2): 6-9.

Budrys, Grace.(2003) Unequal Health: How Inequality Contributes to Health or Illness.

Byrd, W.M. (1990). "Race, biology and health care: reassessing a relationship". Journal of Healthcare for the Poor and Underserved. 1: 278-296.

Evidence from the Philippines. University of California, Berkley. Retrieved from http://faculty.haas.berkeley.edu/gertler/working_papers/gertler-solon%20philippines%20hopsital%20paper%203-1-02.pdf on 06/01/2009.

Mangalore, R. (2002). "Forging a new definition of health equity". Health Policy Review. 3(2):15-18.

Massachusetts Medical Society House of Delegates Report 207, A-99 (2001). "The US health care system: best in the world, or just the most expensive?"

Morris, Robert. Journal of Health Politics, Policy and Law. Aging Devolution and Aging Policy. 29.2 (2004) 335-337

WHO (2000). The World Health Report 2000 – Health Care Systems: Improving Performanc

Feelings Check - Take a Load Off, Annie

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." - MLK

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With all this talk these days about Universal Health Care, Health Care Reform, Socialism and the Health Care Industry in general, I thought I 'd chime in with some thoughts of my own.
You probably already know what that means. Yes, I am very opinionated. Yes, I am very passionate with my views and opinions.

I keep seeing these anti-universal health care campaigns on tv. They show a patient in a doctor's office, with the Dr. and a man in a suit with a clip board wedging himself between dr. and patient. The voice over says " I don't want some government bureaucrat making decisions about my health care on behalf of my doctor and myself."
Guess what? You already have a third party making those decisions. Do you really think that your doctor gets to do what he/she thinks is best for you each and every single time you see him/her? Absolutely not. Unless you are completely privately paid, meaning you pay out of your own pocket for every test, procedure, and prescription, there is someone at the insurance company who is approving or denying your doctor to proceed with what they feel is necessary to treat you. I've seen it first hand. It's the reason I left nursing after a life time of wanting to be a nurse. It is so disheartening to see insurance companies deny potentially life saving treatment and opt for more cost effective treatment that often is inadequate for the patient's needs. Heartbreaking.
Walk a few miles in my shoes:
Try watching your patients suffocate slowly day after day until they finally die because the insurance company refused to pay for proper respiratory treatments.
Try watching your patients moan in pain with each touch, because the insurance company denied coverage for the pain medication that the doctor prescribed, and substituted the equivalent of Tylenol instead. Would you want Tylenol for truly, truly severe and excruciating pain?
How about watching your patients become sicker and sicker because of an infection that festers and becomes systemic, all because the insurance company denies coverage of appropriate antibiotics, choosing to pay for old, ineffective antibiotics instead.

These things need to be regulated. It has become apparent that left to their own devices, the insurance companies can not be trusted to monitor and regulate such abuses.
Enter the need for government intervention.
The second most frequently heard backlash (at least around here) is "That's socialism!"
Socialism? When did a little socialism become such a bad and scary thing? We don't seem to mind our public schools and law enforcement being institutions of socialism. Take a look at them. They are. So is Medicade and Social Security. No, they aren't perfect. Nothing is, or ever will be. But they serve to help those who need their help and I don't hear of too many people saying do take away public schools or public law enforcement. Why then do we get in such a tissy when it comes to health care? Everyone deserves the right to protection under the law and to an education just as everyone deserves the right to adequate health care. Neither is a privileged, all are a right.

Here's some Fun Facts to chew on:

• We have 46.6 million uninsured Americans, of those 8.3 million are children.
• In any given year, close to 50 percent of all health care spending pays for the care received by only 5 percent of the population.
• Census Bureau reports show that in 2004, America's total health care bill came to $1.8 trillion. If you added up every dollar earned by every American worker in the first two months of the year, this would be the sum. In that same year, about one in 20 Americans reported that costs prevented them from obtaining needed care.

I was listening to a right wing talk show idiot one day, and heard him say, in reference to homeless and health care, "the problem with the homeless is that they don't have a job." Eluding to the idea that if they just had a job, they'd have a home and insurance.
Gah! I was screaming at the radio. "Brilliant observation you psychopath!" But what if the same homeless guy has a chronic health condition such, as epilepsy, in which seizure control meds can, without insurance, cost well over $300.00/month for each prescription. Added to the cost of this medication, you have a person with a neurological condition that renders him/her useless every now and again and causes them to miss work and have erratic behavior occasionally. Suddenly, holding down that job may be even more impressive than affording that medication on the minimum wage such a person is likely to be making.

Now, lets talk for just a minute about the cost of mental health care. How many homeless people are actually psychiatric patients who had no home to go to once insurance stopped paying and the hospital kicked them to the curb? According to the University of California, San Diego (UCSD) School of Medicine researchers, homelessness was most frequently associated with people who were diagnosed with schizophrenia or bipolar disorder, who were substance abusers, and who had no public-funded health care. The study's senior author, Dilip Jeste, said " Homelessness is an increasingly important public health issue, with seriously mentally ill persons most at risk for homelessness" ... and went on to say that "In addition to the trauma experienced by these individuals, there is also a cost to society. Homeless persons have a significantly more-frequent use of expensive emergency services and are more likely to spend more time in jail."

This health care system, as it is, can not continue. We will never have any real economic recovery until Americans are not going bankrupt from medical costs. Until small businesses are not going under from the cost of insuring their employees. Until people can afford preventative treatment in order to sustain healthy lifestyles today preventing expensive, hard to treat chronic illnesses later.

Just my two cents.

Feelings Check

The weather was beautiful, the sun was shining, and a cool breeze was blowing all weekend long.
I got to do some much long overdue gardening, and the Sunnydog got to enjoy some fresh air and sunshine along with me.
It was so nice, the Wifester even brought the laptop out on the front porch and watched a movie out there while I played in the yard.
With all the sunshine and overall good vibes, this week's Feelings Check song is one I haven't heard in years, but I always think of it when I am outside enjoying a nice day
What ever did happen to Jeb Loy Nichols, anyway?

Sunday Feelings Check , A Day Late

Well, Sunday came and went, and I totally spaced out on my blog posting obligations. Don't feel shunned, I spaced out everything yesterday. I totally put off school and work until the very last second. As a matter of fact, I had to set my alarm and get up at 4 am today just to finish some work and write a paper for my Sociology class.
Now here it is 9am and I'm yawning and ready for bed already!

It hasn't helped that around here, the Fourth of July apparently never ended. The incessant barrage of screeching bottle rockets and projectile explosives has continued nightly since about a week or two before the fourth. I wonder when it will ever end? In case you are new around here, HERE's my post from last year about why I hate the fourth of July. I guess it's a bit of residual PTSD, I donno, but it drives me nuts and makes me nervous wreck. But I'm just weird that way, I suppose.

Sotomayor's confirmation hearings start today. So far, from what I gather from the trusty news guys and gals at FOX, is that she's a racist, empathetic, liberal, feminist.
Lets start with accusation #1. "She's a racist!" If that's not the pot calling the kettle black, I sure don't know what is. Besides, what she said was not racist in the least bit. I totally agree with her, any person with her background, education, and life experience would be better equipped to make judgments than someone who has not had those same life experiences, education, and background.
I just love how one segment of a statement can be taken out of context and construed into a completely different meaning than it was ever intended. But that's what politics are all about. The great spin cycle. I think most people are smarter than to fall for that one.
#2. Empathy. When did this become such a bad word? I thought empathy was a good thing to be in possession of. Especially when you are in a position to directly affect the lives of so many people. I think that if Ms. Sotomayor has an abundance of empathy, we could all learn from her. When I worked at the phone company, we had special classes on a regular basis to coach us on our empathy and empathetic statements. We held long discussions on the importance of empathy in our society and how a little bit of empathy goes a long way in negotations. I think maybe some of our world leaders could take a queue from the empathetic Sonia Sotomayor.
I think so much of empathy, that I wrote a paper on it, even posted a variation of it to my blog a while back, for you guys to read. Here, check it out.

#3's and 4 I will group together. How many conservative, male Supreme Court Justices do we have right now? N'uff said.

Fireworks, homework, Sociology papers on the detremental effects that the lack of health care causes to our society, worries about our failing economy, my own personal lack of health care...all of these are why today's feelings check video is one of my all time favorite bands, one of my all time favorite songs:

Dear Station Manager at the Nashville CBS affiliate,

I realize that Big Brother 11 is a silly, waste of time and energy, but it is what I choose to waste my time and energy on. I could care less that some football player didn't have the decency to be faithful to his wife, made some poor choices and ended up dead before his time, but I would much prefer to distract myself from such tragedies with the nonsense that is Big Brother, and that should be my choice. Considering the fact that every other station in Nashville was airing the service, one would think that someone would have been progressive enough to offer an alternative to those who do not wish to participate in the canonization of a person who failed to meet the basic principals of decency and integrity. So pardon me if I am frustrated.
I hope that we will be seeing the Season Premier of Big Brother immediately following the McNair memorial...

Political Statement or Desecration?

"You can't desecrate the flag that way!"

"But it's my artistic expression of my opinion on religious zealotry and separation of church and state!" I protested.

She would not be budged. Never mind that it was just a small little 3 inch decorative flag meant for table top decor on Fourth of July picnic tables. Never mind how many of them will just be thrown into garbage, while I am preserving this one into a very poignant statement that expresses my love of my country.

All my wife heard was two words "burn" and "flag" and the rest may as well have come from Charlie Brown's teacher.

Great. So the Jesus hanging from the syringe of steroids causing a nuclear explosion scared her, and now the burnt and tattered flag insults her. I wonder what else about this painting is going to upset the Wifester. This is the first time she has ever come right out and disapproved of one of them. Oh, she's offered constructive criticism here and there, but in the end, she usually likes them. And my writing, oh wow, she has no problem pointing out how verbose I can be, or when I misspell or use improper grammar. She LOVES to find my run on sentences and double negatives and oxymoron's. She even fact checks me. Regularly. I'm not even kidding.
But this aversion to my art is something new.

Oh sure, there was that one time with the naked mermaid, when her aunt and cousins were coming to town...but that wasn't a disapproval of the art, or the content of it. It was a concern she had for the children who would be visiting, and their exposure to naked mermaid breasts. Besides, the "CENSORED" label that I taped across her chest makes a statement, I think, and I kind of like that piece just like that. I've kept the "Censored" label on her just because I liked it, so that all worked out for the best in the end.

I cannot compromise on this one. The flag must be burned.

There are still a few more elements I want to add to it, but here's what I've done so far:

You may remember I started with this:

and I wasn't really sure where to take it. I set it aside for a while and worked on other things. I came back to it and this is how it has gone:




And because the painting shares the same name as a poem I wrote last year, and is in fact inspired by that poem, I thought I'd share it with you again:

Religion on Steroids

The phone ring, ring, rings,

and I ignore the incessant tone

of Patriarchy submerged in Zealotry:

Religion on steroids, I muse

Closing my eyes, I imagine ignorance

Feeling its warm embrace

for too brief a moment...

In a flash, its gone with the ring, ring, ring

of technology's death to privacy

Bringing me back again

To the persistant realization

that you are no longer the people

I once knew.

Angela J. Schleicher © 2008

Let it Be

I'm almost finished with my "Religion on Steroids" painting. No one likes it. I guess that's OK, I mean, I don't really paint for anyone but myself anyways, but I think that it gets a bad rap.
I just think it's misconstrued.
Wifester frumps up her face and says "It's kinda scary, hunny..."
My friend L tilted her head to the side and said "getting in touch with your darker side?"
Others say nothing at all, while Cole patted me on the back and said "I get where comes from, but it's just not for me, but it's definitely gonna piss some people off."

Sigh.

I don't know why it's so important to me for Religion on Steroids to be understood. Or if it really is important for that specifically to be understood, or just everything I do, generally, to be understood as I originally intend. Why do these things even linger in my mind for so long? I should be able to do my thing and never look back at how others interpret and fret over some imaginary or self imposed need to explain.

I need to learn to just put things out there and let them just be. Not just with art, but with writing, with my thoughts, whatever.

I've been thinking about Michael Jackson Mania. You know, I will say that I had my moment of awwww...the guy that taught me to moonwalk is gone. I had flashbacks of my Thriller Trapper Keeper. I get it. He was a pioneer in the music industry. But we must also remember that for many, he conjures very dark and horrid memories.
A week before his death, mention his name, and most people had a negative response to him and the controversy that enveloped his media coverage for the later part of his life. Suddenly, in death, he has been elevated to sainthood.
I know I'll probably get some backlash for this one, but all I'm saying is that we need to keep in mind that the jury never said that they found him innocent, just that they could not prove beyond a reasonable doubt...and there is a difference.
I know what it is like to wish you could remember your virginity. I know what it feels like to be doubted because you didn't say something right away, or within some prescribed time frame. I've heard those words "It's not that I don't believe you, its just that I can't believe HE would do this..."I know what it feel like to watch this man who stole your innocence rise up to become a pillar of society, celebrated on the news and see billboards around town with his face on them, touting what a wonderful person he is. And when he dies, I'm sure local stations will go amuck and thousands in this area will mourn, but I and a half dozen others that I know of will think, one thought in solidarity; " Now the kids are safe"
And all I'm saying is that weather Michael Jackson did what he was accused of or not, his image reminds a lot of people, just like me, of their situations and how someone, just because he is popular and seen by so many as good, will go unpunished, at least during this lifetime. So please, take a moment and remember all those kids that so bravely spoke up and said, hey, I know you love this guy, but let me tell you something ...Because kids should always be listened to.

And there I go again, explaining my position, rather than just letting it be...so today's feelings check Sunday song is of course, Let it Be


and the bonus, with Religion on Steroids in mind, is :