The Positive and Negative Aspects of the US Health Care System - Research Paper Example

Module The Positive and Negative Aspects of the US Health Care System A number of sociological theories are applicable to the UShealth care system, most importantly structural functionalism, conflict and post-structuralism theories. Structural functionalism entails a distinctly sociological view revolving around the sick people’s role and interaction with the system. Here the patient is exempt from normal social responsibilities, is not held responsible for being sick, desires to get better and lastly, has an obligation to find proper help (Kaminskas and Darulis 111). Structural functionalism in essence depicts social order as healthcare is interpreted at the macro-level system and understood as so at the micro level (individual patient). In the USA, structural functionalism depicts a skewed system due to a number of factors; income disparities and lack of insurance to all would mean that individuals have to work while sick and cannot seek for proper assistance. Conflict theory entails the relationship between health and capitalist organizations. According to the conflict theory, the society consists of various groups striving to advance their interests and gain advantage. Hence inequality characterizes social life, leading to conflicts which then inspire social change (Kaminskas and Darulis 111). Conflict theory perfectly describes the US healthcare system, with many interest groups such as insurance companies, patients, government/policy makers, medical practitioners and pharmaceutical companies among others striving to exert influence. The conflict and inequality arising has led to changes embodied through Obama’s signing of Patient protection and Affordable Care Act (PPACA) signed March 23, 2010 and Healthcare and Education Reconciliation Act of 2010 on March 30, 2010 (Morgan 2011). Post-structuralism describes the dominant modern medical discourse that underpins health and illness as normality and deviance. Beneficiaries in this perspective are powerful, such as the medical profession. Post-structuralism describes a sociological perspective of health and illness defining individual roles and bio-politics (wider structures- power/control). In this perspective, the US healthcare system is far removed from the individual, who instead of being the main beneficiary is relegated to the background as bio-politics and economics take center-stage. Minority access to health care exudes disparity in all aspects. According to Wikibooks (2011), minority groups such as African Americans, Hispanics, Native Americans and Asian Americans suffer more from chronic illnesses, higher mortality rates and poor health outcomes in comparison to European Americans. For instance, the incidence of cancer remains ten times higher among African Americans compared to European Americans, which may bring forth sociological issues such as structural racism in the healthcare system. The interaction of children and the US healthcare system showcases the influence of economic disparities starkly. According to Pollitt (2011), poor children experience more health risks than non-poor children; 20% more risk from secondary smoking; 15% more risk from lead in blood; 8% more poor children lacking health insurance; and 7% more poor children lacking dental care. Among the senior citizens, the impacts of systemic bias and ageism lead to poorer health outcomes (Alliance for Aging research 2003). On a positive note, Mahon (2012) cites an international study that shows that universal healthcare (such as Medicare in the US) effectively availing quality healthcare to the elderly. The downside of this report shows that the elderly in the US pay strikingly more for prescription drugs than their counterparts in the UK, Canada, Australia and New Zealand. Agency for Healthcare Research and Quality (2002) state that research is underway investigating the decline in use of prescription drugs due to their high costs. Poverty is a major determinant of the effectiveness of healthcare in the USA; according to Morgan (2011), the US healthcare system is costly and delivers uneven care. As established earlier, poor children suffer worse health risks and outcomes than their non-poor counterparts. As prescription drugs are not covered by Medicare, a poor and elderly person in the USA would suffer more than their non-poor neighbor. The increase in number of suicides due to cuts in Medicare funding summarizes the impact of poverty on the US healthcare system (Farnham 2011). I do have medical insurance paid for by my parents at $130 bimonthly; last year, this totaled to $3300. Of note in our family is my grandmother’s medical expense. Although she has had coverage ever since she was young, she now has to buy her prescription medicine outside the cover. This issue has been the center of our family’s discussion and evaluation of the country’s healthcare system. We have come to a conclusion that the healthcare system has interests outside provision of healthcare to the individual. The insurance company would quit on you the moment they deem your costs untenable and bad for business, a view underpinned by their reluctance to cover patients with chronic illnesses. Thus, we have come to a conclusion, albeit subjective, that the US healthcare system is exclusionary and missing the whole point of healthcare provision. Personally, interaction with the US healthcare system has seen my medical expenses catered for on a number of occasions. However, medical cover has not addressed all instances in which I’ve needed it. For instance, I had a neck surgery which cost $150 for the doctor and $100 to the hospital that all it cost to have C3 to C7 decompressed and fused. I find it improper that while paying $130 bimonthly, one still has to fork out $250 to cover a medical procedure. This defeats the purpose of having medical insurance in the first place. According to Kaminskas and Darulis (113), the feminist theory argues that the concepts and definitions of health and illness are gendered. From this perspective, medical care involves male control over female identity and body, use of the male body as a standard for medical training and social constructions of women’s illnesses such as colo-cervical fistulas. In the USA, nearly 16 million women were uninsured by 2005. Factors such as economic constraints on women rule them out of individual covers, while restrictive Medicaid eligibility criteria rule them out. For instance, women would need to have low incomes, be parents, pregnant, disabled or above 65 years to qualify for Medicaid. Thus, there is a gender disparity in the US healthcare system. I do not feel that my race influences my access to health care and health outcomes. I am a White American who, despite perceiving the entire set up of our healthcare system is wrong, cannot claim that my race influences my interaction with the healthcare industry. Literature and perceptions of other individuals brings the view that minorities have a different/worse experience with the healthcare sector. The fact that I cannot discern this advantage, and I also feel aggravated by our healthcare system would perhaps confirm institutional/structural racism that is salient/covert. This would explain why I do not feel the claimed advantages of the healthcare industry to me, while I am aware that health disparity according to race/ethnicity is a reality in the USA. As already discussed, Americans have different experiences of the healthcare industry according to their ages, with factors mediating the age issue being gender and socio-economic background. The elderly have access to Medicare, but have to buy their own prescription drugs. For children, a poor economic background translates to having poor access and outcomes from the healthcare sector as discussed earlier. The element of gender also co-determines the experience of healthcare with age. For women, access to Medicaid pegs on a number of eligibility criteria of which being above 65 years is one. Overall, over 89.5 million individuals under the age of 65 lacked cover of at least a month in 2006-2007 (Ginsburg et al. 55). Although a number of lessons on innovative control of health costs can be gained from developing countries (Ehrbeck, Henke and Kibasi 2010), how the USA healthcare profile compares to other industrialized nation can offer important insights. In times of male/female life expectancy, the USA has 76/81, compared to 78/85 for France, UK’s 78/82 and Canada’s 79/83. The probability of dying under five in the USA is 8/1000 births; France has 4/1000; UK has 5/1000 while Canada has 6/1000. The male/female probability of dying between ages 15-70 for the USA is 134/78 per 1000; France 117/54; UK 95/58; Canada 87/53. The total health expenditure as a percentage of GDP (controls for differences in total population) for the USA is 16.2; France 11.7; UK 9.3; Canada 10.9 (WHO 2012). This data shows that the USA spends more on health and achieves worse outcomes in comparison to other industrialized nations. The Medical Expenditure Panel Survey (2011) and Robertson (2008) confirm that the healthcare premium costs in the USA are quite high. Hence, the need to revolutionize healthcare in terms of quality and care is highlighted, with Obama’s administration seeking to address this through the PPACA legislation 2010. A sociological view of the structure-agency debate on US healthcare provides insights into access and outcomes of healthcare. As Germov and Poole (6) explain, this debate entails the philosophical question championed by Max Weber on the extent of human free will as opposed to external control. Practice of will among Americans is torn between two groups; those who would prefer the healthcare system to be a social welfare system; and those already in opposition of taxes to fund Medicare. The structural disposition, however, is through the state-funded Medicare and the skewed power balance towards the insurance companies. The eligibility criteria for Medicare access depict how structures impact access to healthcare, locking out some individuals and catering for others and, thus, promoting disparity. Racism and exclusionism through the structures are to blame for the noted health access and outcome disparities in the USA. The impact is lower life expectancies among the poor and minority groups, alongside a lower national life expectancy in comparison to other industrialized countries. It is perhaps conceivable that the structural exclusion of certain groups from the healthcare system leads to their developing poor health lifestyles and, thus, debilitating health conditions. The US is famed the world over as the Land of Opportunity, as mostly evidenced by the influx of high numbers of immigrants that has led to wild debates over immigration policy. A true land of opportunity would go the distance to ensure that these opportunities are equitably accessed by the population. One of the aspects in which the land of opportunity idea should be appraised lies in the provision of healthcare services. The USA largely fails to live up to the billing as all Americans do not have equal access to healthcare (Relman 1-2). Disparity exists across many considerations such as gender, age, race and ethnicity and socio-economic backgrounds among others. The poor of the society have it so differently from their rich counterparts it is difficult to perceive them as being from the same country. It has already been established that an individual over the age of 65 has to go out-of-pocket to access prescription drugs as compared to his under 65 years counterpart. Millions of Americans still cannot afford insurance, while those with serious conditions have to reveal and discriminated against by the insurance company. Importantly, minority ethnic groups find it difficult to access healthcare in the USA, besides the different outcomes they receive after accessing health services. This translates to a situation where such groups feel left out, discriminated against and lesser citizens in their own country. For the American society as a whole, the situation of the healthcare system is a source of concern as the disparity can be extrapolated to other societal issues. Questions then have to be raised on how to achieve equity in the American society; it is unacceptable to have such a healthcare system in the 21st century. In my view, conflict theory properly captures the historical and contemporary situation of healthcare in the USA as it describes nearly everything discussed on the system. This theory correctly captures the structure-agency debate and its impacts on healthcare access, health outcomes and policy/legislative issues on health. In the agency perspective, Americans as individuals or interest groups strive to advance their interests in the healthcare sector. However, the structural disposition in place curtails the interests of individuals, while bringing into the debate capitalist organizations (insurance firms) exactly as argued in conflict theory (Kaminskas and Darulis 111). Conflict theory entails the aspect of inequality due to the skewed power balances among the parties interested in advancing their interests. The US healthcare industry typifies this inequality in nearly every aspect; racial, ethnic, age and gender, which has become a structural issue due to the historical development of the healthcare system. Once a conflict arises, the theory indicates that changes have to occur at a point in time. The US healthcare ticks this criterion as depicted in President Obama’s signing of healthcare reform bills in 2010 to address the problems in the US healthcare system. Basing on this discussion, my proposals for change that could be instituted at the macro-level supplement the bid by Obama’s healthcare reforms to widen the pool of the insured through incorporating the views of Luft (33-34). In essence, the healthcare system should primarily serve the interests of the people (like in the other industrialized nations). Hence, my structural suggestion involves the establishment of two broad categories of people to be insured; the highly expensive major acute and chronic illnesses and second, the minor acute diseases and preventive care. The first category would have mandatory coverage either directly or indirectly (employer), with low income members of the society receiving help to cover the costs. The second category would have voluntary coverage; individuals can either buy cover or pay out of pocket for medical expenses. The role of the government would be regulatory, with the system made economically incentive to keep the insurance flowing. This system would be equitable, catering for socio-economic backgrounds and thus other considerations such as race/ethnicity, gender and age. For instance, a chronically ill elderly patient would not have to buy out of pocket prescription pills, which are covered for a young working man who would afford the out of pocket if he wishes. At the micro level, encouraging behavior change (healthy lifestyles) to lower costs due to lifestyle diseases- such as obesity complications- and drug-related problems alongside patient-centered care would be practiced. CONCLUSION AND REFLECTION The US healthcare system is flawed from a sociological point of view, promoting inequity in access and outcomes according to age, race, ethnicity and income status. Comparisons with the health profiles of other industrialized nations confirm the considerably poor state of health affairs in the USA; poor access and outcomes alongside massive spending. While Obama’s cost reduction and increased inclusion reforms are commendable, my proposal involves a responsive system that provides care where necessary or deemed mandatory and lets people choose where appropriate. Upon reflection, the information I have gained about our healthcare system greatly impacts my perspective; I believe I can now argue from an informed sociological perspective on the healthcare debate. Along the structure-agency lines, I realize I need to work hard in order to access coverage. However, I am not out of the woods yet in regards to the recent healthcare reforms as having a sufficient income would help to guarantee access to medical services. At the agency level, I figure I should adopt a healthy lifestyle to avoid illnesses that may be chronic and shunned by coverage. Works Cited "Agency for Healthcare Research and Quality." Health Care Costs: Fact Sheet. 2002. Web. 10 Feb. 2012. "Alliance for Aging Research." Ageism: How Healthcare fails the Elderly. 2003. Web. 10 Feb. 2012. Ehrbeck, Tilman, Henke, Nicolaus and Kibasi, Thomas. The Emerging Market in Health Care Innovation. 2010. Web. 10 Feb. 2012. Farnham, Alan. Rural Suicides Follow Medicaid Cuts. 2011. 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