In terms of social work, explain what you think are the main injustices of the US health care system. Do Americans want to eliminate inequalities in the health care system? Do you think that there...

In terms of social work, explain what you think are the main injustices of the US health care system. Do Americans want to eliminate inequalities in the health care system? Do you think that there even are inequalities in the health care system?

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durbanville | High School Teacher | (Level 2) Educator Emeritus

Posted on

The perceived injustices in US health care exist universally unfortunately and, even in those countries who do not operate private health care systems, where, like the UK, there is a National Health Service, there are still inequalities. 

Social work is all about recognizing and minimizing human suffering and assisting in righting social wrongs. Life expectancy in many developing nations is an indicator of their health care problems and a contributor to the increasing illegal immigrant populations in more developed nations, as people go to great lengths to better themselves and create a future for their families. This increases the burden on social workers, working in already compromised areas where unemployment is high and crime and poverty are not unusual.  

As far as wanting to eliminate the injustices in US health care, the fact that it is based on profit, as pointed out by Jessica Gardner, is a major factor. People are “managed” according to a risk profile and care is apportioned to them based on their level of risk – are they worth it? Furthermore, a glaring injustice is the issue of affordability. If one person’s health care program is inferior to someone else’s, despite significant personal cost, that person’s health care is compromised (as indicated by littteacher8). This also has a direct impact on the efforts of social workers because the economic, social and political issues that surround affordability are complex. 

This is not a twenty first problem either. Litteacher8 put it all in a nutshell:

“Until everyone has equal access to equal health care, we will not have equality.”

It really is that simple. However, any system, in practice, just becomes another controlled environment (cue Animal Farm) and, managed by human beings, usually results in inequality. Even in those countries like the UK, where there is a massive free health service and where there is a distribution of services, there is inequality because they also use risk-profiling and take things like age and other health factors into consideration when deciding on care. It is definitely a more-balanced system but, ask an 81 year old male who needs some treatment or a 76 year old female who has an abscess on her knee (my parents-in-law) if they think it’s fair and they will give you a resounding “no.” They are too “old” to take up space in hospital! Their 50 year contribution to the economy (working from age 15 to age 65) and, therefore to the health service, is not a consideration anymore. They should count themselves lucky that they are still alive is the common attitude!

It seems that the governments need to rethink their priorities, especially in relation to the amounts spent on other services. The reason why so many people are unwilling to pay more taxes or make compromises of their own is because they do not see their government ministers doing the same. In the context of social work, it is not enough to uplift the poorest communities; there is a need to maintain the existing structures; otherwise, collapse is assured and then social work will benefit no-one. 

In an ideal world, there would be no need to spend billions on defense (which obviously directly impacts health care as so many people are wounded or need psychological care) and there would be more than enough for health care. Resources would be shared and those who need the most care, wherever in the world they are, would receive it. When can we start? 

kipling2448's profile pic

kipling2448 | (Level 3) Educator Emeritus

Posted on

Clearly, there are inequities inherent in the existing processes by which the American public receives medical care and, clearly, the wealthier the individual the better care he or she receives.  That is not limited to health care; on the contrary, virtually every facet of life involves distinctions based upon income.  The wealthier drive safer cars, live in better homes, eat better food, so on.  To the extent that any democratic system built upon certain ideals should tolerate substandard medical care based upon those class distinctions, then corrective actions are warranted.  I've seen and experienced enough to appreciate the travails endured by lower-income families.  The question comes down to how far the American public is willing to go to impose -- or install, depending upon one's biases -- a more equitable system akin to those provided in countries like Britain and Canada. The problem is multifaceted, and not easily addressed.  The cost of a medical school education instills an expectation on the part of American students of a monetary pay-back down the road.  Eliminating that expectation would require subsidization of the education.  The highly litigious nature of American society, which drives up health care costs because physicians want to recoup the costs of malpractice insurance, is another factor.  Does this mean capping monetary awards to patients who prevail in court?  Does it mean broader efforts at tort reform, which would be adamantly opposed by the Trial Lawyers Association?  What constitutes a reasonable cost to the patient seeking care?  Is it calculated solely upon ability to pay? Absent some level of copayments and deductibles, Americans will most assuredly pursue the least efficient means of seeking medical care, for example, by visiting emergency rooms for non-emergency conditions.  Should the private sector be removed from the payments process (in affect, eliminate health insurance providers)?  A case can be made for a single-payer system.

I've struggled with this question thousands of times, including while watching my father endure intensive -- and enormously expensive -- rounds of chemotherapy for the leukemia that would take his life anyway.  Scrutinizing bills for unfair or unreasonable additions -- specialists who stick their head in the hospital room door and ask how you're doing, then billing your insurance a $1,000 -- all the while knowing that part of that process is oriented towards recouping costs associated with treatment of the uninsured by sticking it to you the "good" insurance plans all add up to a huge question mark.  The existing processes, however, are deeply flawed. Whether the American public will accept the level of taxation needed to pay for a socialized system remains to be seen.  I know for a fact that almost no member of Congress read or was particularly conversant with the content of the legislation that became the Affordable Care Act ("Obamacare"), and the full ramifications of that legislation were always going to take at least a decade to become apparent.  Room for improvement exists; whether the Affordable Care Act is the answer, however, is a fair question.

jessica-gardner's profile pic

Jessica Gardner | High School Teacher | eNotes Employee

Posted on

I wholeheartedly agree with litteacher8's responses, and as a British immigrant to America, I may also be able to provide some perspective on why the healthcare system in the US strikes me as unjust. Hopefully this will help you to determine what reforms might be achieved through social work.

When I moved to America, one of the aspects of medical care that struck me as unjust was that it is treated as a for-profit retail business rather than a service. In my mind, adequate healthcare is a basic human right and should not be reserved for those who can afford it--which in the States is a small group, given the astronomical prices of prescriptions and procedures. In fact, in describing the cost of a surgery a health insurance representative once told me that it "retailed" at a certain price. Nowhere else in the world would somebody find it normal to be quoted a price for a compulsory procedure as though they were shopping for a car or a piece of clothing. 
 
This is because unlike shopping for such luxury items, we do not really have the option of selecting whether or not we want to receive medical care. When we're sick we have to accept the care we need, and, in the case of living in America, grit our teeth to bear the cost. I think private health insurance companies and hospitals have abused this basic need and driven costs to an absurd high. That is the greatest injustice done to Americans by the healthcare system as it stands now. How else would a hospital be able to charge $546 for a bag of sterile saltwater (at a cost of $1 or less to the hospital)?
 
Now I have moved and once again live in a country with socialized healthcare, Canada. The stress I once had over the sheer possibility of being bankrupted by hospital bills should I, say, have an accident has entirely dissolved. The worry of being charged $10,000 to have a baby in an American hospital has disappeared. That's because not only do I pay one third of the monthly cost in insurance premiums I used to pay in California, I also know that if I need a prescription or a procedure, I'll be 100% covered with no crazy deductible to meet. On top of this, I feel much better knowing that those who earn less than me have access to the same level of care due to my province's tiered payment system.
 
Many Americans feel that in a system such as mine the care must somehow be inferior, or the waiting period to receive that care too long. To that I say that my significant other received two emergency surgeries as he needed them, at no cost to him. Had he received those surgeries in America, he would be tens of thousands of dollars in debt, years on. In the case of delivering a child in America, the care certainly isn't better. In fact, it's for the most part worse, as the first link below shows. I think it's certainly ignorant and distrustful to assume that other countries cannot provide the same level of care as in the States. Then again, maybe the system of paying huge amounts for necessary care is so ingrained in America that nobody can quite believe good healthcare can actually be affordable. 
 
For my part I hope that future healthcare reform in America targets the source of the problem: the private insurance companies and facilities that have pushed proper care so out of reach for ordinary citizens. Only then will affordable healthcare be attainable for everyone.
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litteacher8's profile pic

litteacher8 | High School Teacher | (Level 3) Distinguished Educator

Posted on

The main injustice of the United States health care system is that we still don't really have one.  Although we have something in this social safety net of what some like to call Obamacare, it's not real universal health care.  It's a system in which states set up clearing houses where Americans can get access to the same health insurance companies that existed before, regardless of employment.  It's progress, but not a real health care system.  People say you don't want the government nanny state to determine your health care.  Perhaps not.  However, I also do not want an accountant at an insurance company to determine it.  That's why I've been sick for over fifteen years.

Until everyone has equal access to equal health care, we will not have equality.  Right now, the people who say there is nothing wrong with health care are wealthy.  They have high quality jobs with excellent health care. When they are ill, they see the best doctors in the best hospitals.  They get better.  Naturally they don't understand what the poor are complaining about.  They don't know what it's like to choose between food and medicine, or skip going to the dentist because you don't have insurance until you have to have your tooth pulled.  They don't know, and they never have because they probably grew up well off.  They were raised healthy. 

Most Americans do care about this issue, because health care costs are rising.  People pay more and more for less, and are less able to afford it.  However, the issue is political.  Many consider government health care socialism and are afraid.  They may not know what that is , but they grew up afraid of political enemies and they know the issue falls down party lines.  So, like many things, nothing gets done or doesn't get done well.

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litteacher8's profile pic

litteacher8 | High School Teacher | (Level 3) Distinguished Educator

Posted on

Yes, there are inequalities in the American health care system.  I think that some Americans do not even see them.  Sometimes I think the politicians don't see them.  Congressmen and Senators have their own health care.  Government workers have their own health care.  The “Obamacare” issue shows that public health care is a political issue.  I have a job, and a fairly good one, and my health care is atrocious.  I can barely afford what I need.  I don’t even have children.  My significant other and I are not married yet, and he has a decent job too.  His health care, also provided through work, is terrible—maybe worse than mine.  I dread the day when I have a baby, even though I want children.  It terrifies me, because I see what I have gone through with my own health care.

I keep hearing about how we have the best health care in the world, but I do not see it.  Take the dental system.  I pay for half of my dental care.  It costs me thousands of dollars a year for basic dental work.  I can’t afford this on a teacher’s salary.  Since I know I will soon be marrying and having a family, I can’t imagine raising children and having to deal with things like braces, it keeps me up at night.  I heard a story on the radio that 50-60% of the social medial coupons, deal sites like Groupon and Living Social, are for health care related deals.  I think this tells you something.

I would like a fair system, where everyone has access to high quality health care that can be trusted.  Right now I don't trust my doctor or my dentist half the time, and I can barely afford to stay healthy.  I am employed.  I feel for those who are not.

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akannan's profile pic

Ashley Kannan | Middle School Teacher | (Level 3) Distinguished Educator

Posted on

The second question helps to establish much in the first question.  I think that a good case can be made that a sizable number of Americans do seek some type of reform of the nation's health care system.  Putting aside the debate on the Affordable Health Care Act which has been infiltrated by political misleading on both sides, the issue of health care is something that Americans feel needs to change.  The question becomes how this change is enacted and what form it takes.  This is where the issue becomes very complex in the domain of American public opinion:

Many of these articles report significant dissatisfaction with the current U.S. health care system and a preference for some form of national health program.  Others note apparent inconsistencies in popular views.  The most obvious example is that while Americans express a preference for a "national health plan," they do not want to pay additional taxes to support such a program.

This is the dynamic that governs the issue of health care today.  Research shows that "many Americans are dissatisfied with aspects of our present system, and, as a result, they show support for change."  The public does see that there is a problem with health insurance companies denying claims based on past medical history and that health care costs must come under control.  In these ways, Americans do attest to the injustices within the health care system.  They seek to eliminate these realities, but are conflicted as to how this should be done.

In terms of social work, this is where some of the most brutal injustices exist.  Social workers find that the denial of health care for whatever reason impacts the psychological development of their clients.  It is difficult to ask a client for trust when the social worker realizes that the health care system has not done enough to earn such trust.  Social workers whose clients are denied health care find their own progression inhibited.  Whether this is because of finances or insurance companies denying claims, social workers battle another adversary when adequate health care cannot be provided to their clients.  The connection between receiving consistent and quality health care and psychological advancement is a reality that social workers recognize in every moment of their practice with clients: "Social workers have long recognized the connections between access to such care and physiological, economic, and social functioning, says Stephen Gorin, PhD, MSW, a professor of social work at Plymouth State University in New Hampshire."  As the political hand- wringing over health care continues, the social workers see their clients hanging in the balance.  The client is denied the care they need, and this becomes the injustice.  When the social worker is able to see a client become the benefactor of expanded health care services, they can recognize the change as expanded health care coverage helps to "restore people."  It is in this light where there is an injustice regarding health care that is denied to the clients of social workers.  It limits this chance at restoration that both client and social worker can share.  

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mwestwood's profile pic

mwestwood | College Teacher | (Level 3) Distinguished Educator

Posted on

There has always been social injustice, and it seems likely that it will continue even though efforts are made to correct such injustice. For, as Charles Dickens pointed out in his novel Great Expectations, when the poor convict Magwitch was given a longer sentence than the upper class convict who had orchestrated their crime, there is a justice for the rich and a justice for the poor.

In socialized health care programs, programs that attempt to provide good care for all citizens of a country, there are still many problems. One of the most glaring is the injustice to taxpayers of a country such as the United States who are forced to contribute to the care of people who are not citizens and who are in the country illegally. Perhaps, there could be some humanitarian group who cares for such people, but it does not seem fair to all those who pay taxes that their money should be taken for people who are not even citizens of their country. 

A November 12, 2009 article from US News and World Reports addresses this issue, pointing to the tremendous financial burden imposed upon taxpayers, 

Americans recognize that extending the full range of benefits to people who have no legal right to be in the country is unjustified and would add billions of dollars to the cost of a healthcare overhaul. Taxpayers—at the federal and state level—already spend about $11 billion a year on unreimbursed care for illegal aliens.

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