A Healthy Fight

By Alexis Doan / Winter 2020

Throughout my upbringing I had always been taught to care for my elders, to want to give back in any way I can. I understand the deeper part of this message when I think of my dad, he is the reason my grandparents had the medical treatment and service that they did when they were ill. We see so many families in the news, who just like my dad, try their best to care for their loved ones. At the end of the day they still rack up unreasonable debt even when they are sent to institutions who do not provide the best services. I have empathy for these families because more often than not the institutions within the medical/health care system tend to worry more about the improvement of their profits than their service to the public. These issues are disheartening to see as they affect millions of people across our country today.

The problems surrounding our medical/health care system have been something I’ve only recently thought about in the past 3 years. From September of 2017 to June of 2018 I lost 3 family members, my uncle, grandfather, and grandmother, all of which are on my dad’s side. They passed away so unexpectedly and each within a span of a few months from one another. This truly was the hardest year of my life, I had never really lost anyone close to me so learning how to cope was difficult and at times put my family and I into dark places. The process of grieving, comforting one another, and coping with these events continuously throughout that year in the midst of returning to college is what really put things in perspective for me. We were fortunate enough to have given my grandparents good health care, one that would make sure they were at peace when the time came, one that we could trust would aid our loved ones and us through these hardships. That year changed my lens on the medical/health care system, it made me wonder how people who did not have the means to financially pay for these institutions dealt with the “unexpected.” How would others take care of their loved ones when they are dying from lung cancer or when they are on an operating table fighting for their life after a 3 AM heart attack? How would the institutions treat them if they had no money, if they could not contribute to the “profits”? When as a democracy are we going to be proactive?

Diving into these issues from a macro lens, we see that every year, under our current medical/health care system, around 50 million people lack health care insurance at some point. This goes beyond surface-level rebuttal such as arguing about unreasonable pricing for healthcare because at the end of the day access to medical service is a necessity that every American should be provided with. Low income communities across the states face these adversities the hardest, constantly cycling in and out of insurance plans, trying to figure out how they will be able to provide healthcare to not only themselves but their families. According to The Behavioral Risk Factor Surveillance System (BRFSS) (2014-2015), a massive ongoing public health survey, “one in four adults between the ages of eighteen and sixty-four — 50 million people — face a spell of uninsurance.” Their bar chart reveals the unfortunately large number of people in our communities who face the heavy burden of our country’s broken healthcare insurance system. Today, America’s system constantly causes people to lose their health insurance at nearly every critical and unexpected moment in their life whether that be losing your job, losing your spouse or loved one, losing medicaid upon income increase, reaching an age of 26, moving states, and countless other things we truly have no control over. Even the groups of people who manage to stay insured are eventually forced to switch plans resulting in them losing their doctors and preferred providers. It’s a complex matter, but choosing to look at the system in a wider lens helps us detect these issues that affect not just this group or that set of demographics but issues that affect all of us in some way or another.

Now that we have examined the communities most impacted by the privatization and unaffordability of America’s healthcare institutions, we can consider the obstacles that prevent us, as a society, from fixing our healthcare system. At the forefront we see people rallying to promote real change in the healthcare system, hoping that people will listen to their cries, the cries of those who have experienced the hardships firsthand. Most people don’t think it applies to them because we are all competing to “live” and “everyone needs to fight for themselves”, this is the neoliberalist attitude. Growing up in the United States, this is all anyone ever learns, be the best and out-compete everyone. David Harvey reminds us in his paper on “The Neoliberal State”(76) that, “The social safety net is reduced to a bare minimum in favour of a system that emphasizes personal responsibility. Personal failure is generally attributed to personal failings, and the victim is all too often blamed” and if you live your life by the rules of neoliberalism, you will never have to suffer through or acknowledge the broken cracks in our country. Harvey reveals the unjust reality of neoliberalism’s effects in countries like China, Indonesia, India, and Mexico where, “it would seem that labour control and maintenance of a high rate of labour exploitation have been central to neoliberalization all along. The restoration or formation of class power occurs, as always, at the expense of labour” (76). Right now our health is being turned into a commodity, our system is being corrupted with temptation of private goods, monopolization, and the idealized social hierarchy. What prevents us from solving the issues of a profits over people healthcare system is this constant force of social hierarchy, taking the power away from a democratic voice and giving it to people in the position of company control like the CEOs of these institutions. They want to maintain “class-consciousness” for themselves but treat others like individuals, they don’t want people to know they are oppressed because this allows them to keep a one-sided control. Their control over individuals, like the 50 million who cannot afford healthcare, leads to an unacceptable amount of Americans falling through the cracks every year.

But what if we look beyond this dominant political narrative, what if we choose to criticize the power structure? Oftentimes you are seen as un-american, atomized from society and looked down upon. As the social safety net crumbles and the health care system can no longer provide acceptable service to those with low income, we have to ask why so many American’s face these adversities? Upper class Americans love to use the phrase, “It’s because they didn’t work hard enough”. This is the common myth of what it means to be a “hardworking American”, as a society our common views neglect to acknowledge the years of class-consciousness and social hierarchy instilled in our “healthcare world”. Understanding this shared perspective that us Americans tend to cling to, I hope we can learn to debunk these misconceptions. Go to rougher neighborhoods outside of your community and you will see that most of these families work 3 to 4 jobs compared to a CEO who for a living thrives off of overpriced healthcare insurance. It's not that these families did not work “hard enough” but it’s the privatization of public goods such as healthcare that unfortunately results in a majority of hard working Americans falling deeper and deeper into debt.

Now that we see the depths of neoliberalism and its parallels to social hierarchies we can uncover the dominant ideologies circulating the health care world as they center around economic growth. Healthcare institutions are constantly caught in a confluence of market place power because they choose profits over strong ethical values and social equity, also known as the “development ideology”. This is one of the dominant ideologies currently destroying the integrity of our healthcare institutions today. We can see a clear example of this when we examine what happened after the ACA (Affordable Care Act) introduced the “guaranteed issue”, a requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Since the ACA’s implementation of the “guaranteed issue”, most of America’s largest insurers of healthcare have placed an ever-increasing financial and administrative responsibility onto individual patients where more than 40% of Americans with private insurance have high deductibles, typically exceeding what the average American household has in liquid assets. As of 2018, “the maximum out-of- pocket expense for individual ACA marketplace policyholders is over $7,000 for in- network care”(Shure, 2). All of these expenses amount to a high and unreasonable tax, naturally falling on the shoulders of those with the most frequent encounters with the healthcare system: people with preexisting health conditions. By moving to insurance designs that increase segmentation of the private insurance market, the sickest and most vulnerable people bear more of the costs while the well will be able to get coverage more inexpensively (Shure, 3). Until we overcome these unethical institutional practices, the costs of health care will continue to rest on our ability to pay rather than our bodies’ relative need for it.

Placing a more comprehensive lens on the cracks in our healthcare system we unravel new perspectives, perspectives that go beyond the immediate damage caused by a neoliberalism mindset. The ideologies surrounding healthcare insurance affect way more than just our traditional identity groupings such as race, gender or class. Although the affordable care act’s “guaranteed issue” promises to offer everyone healthcare despite these “categorizations”, the cases of discrimination in the medical system have not been addressed in the slighest and continue to grow year by year. The theoretical framework known as “structural intersectionality” discussed by Kimberlé Cresnshaw’s excerpts from “Mapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Color”, allows us to understand how multiple aspects of one’s social identity can combine to from unique modes of discrimination. Crenshaw explains how more often than not these problems worsen for people categorized in more than one of these groups, inherently taking on all of these categories and hardships at the same time. Through an awareness of intersectionality, we can better acknowledge and combat the unjust acts of discrimination happening across our nation’s medical institutions as they result in health disparities. Dr. David Satin of the University of Minnesota Medical Center gives us a real life glimpse into how medical students have carried their biases into their field of work, providing us with an explanation as to why black patients are sometimes undertreated for pain, “with some students believing that black people feel less pain and have thicker skin than white people” (Satin, PBS [1]). Dr. Satin goes on to say that his findings revealed that these medical students’ false beliefs and myths about biological differences based on race is actually very much rooted and fundamental to the way medical education works in the U.S., as they are taught to notice the race of their patients and to then treat those patients differently. Stemming from education we see this early formation of intersectionality evidently unfold when it comes to our data on the medical treatment of African American women in the United States. Senator Warren has spoken about these health disparities, illustrating the effects on black moms expecting in rural areas to which low-mortality rates have become an epidemic. Data shows that “Black women are three to four times more likely than white women to die from pregnancy or childbirth-related causes. This trend persists even after adjusting for income and education.” (Warren, 1). In a report by ProRepublica, Warren highlights the grim reality of our healthcare system as it pertains to not just women, but women of color. These findings show that the vast majority of maternal deaths are preventable however decades of racism and discrimination mean that all too often doctors and nurses don’t prioritize Black women’s health issues in the same way when it comes to other women. The influence of societal discrimination examined within the lens of healthcare institutions and even education is more complex and dynamic than most of us realize. Today, these dominant ideologies exist in various forms, continuing to develop into unethical actions and becoming detrimental to our society.

Exploring the roots of the problems surrounding healthcare in the U.S. has allowed us to acknowledge the dominant ideologies that have placed burdens on our underrepresented communities, communities who do not fit comfortably into the “idealized social hierarchy”: those who lack able-bodiedness and those who come from differing backgrounds of race, gender, or income. By understanding these urgent issues we can apply ethical principles to help our communities overcome such obstacles through the means of demonstrating collective support and resilience in the face of adversity. I urge our nation to be more proactive, to call out and fight against institutions who make a profit out of misfortune, to acknowledge the cause and effects of health disparities, and to teach the younger generation of our medical system that they have a responsibility as a medical professional to know when an action is unjust and puts another human being’s life at risk. Empathy and fundamental values are truly the key to pushing beyond the confines of the neoliberalism mindset as well as societal beliefs/ideologies. We must look to leaders who will fight alongside us and listen to the people, those who have real solutions such as holding these health systems accountable by introducing bundle payment plans for medical services and rewarding those that help lower mortality rates, by supporting and pushing reforms that reduce the racial gap when it comes to affording healthcare and receiving the best medical treatment, by implementing safer and more reliable institutions in rural areas or even hiring more diverse medical professionals who communities feel they can trust. This is all in the effort to ethically fight for our fundamental rights, a right that is rooted in our nation’s history.

I want to leave you, the reader, with an appreciation of FDR’s Second Bill of Rights and how personally it answers the call to us as Americans “dying with dignity.” In his second bill of rights FDR states that we have, “The right to adequate medical care and the opportunity to achieve and enjoy good health, the right to adequate protection from the economic fears of old age, sickness, accident, and unemployment”. I take his words personally as my dad’s internal pain with what had happened to his brother and parents shifted my own outlook on “human happiness and well-being.” After the passing of our relatives, I broke that barrier my family was so used to being in. That barrier being a manifestation of my dad’s lack of vulnerability. For as long as I can remember my dad had shown little emotion, always protecting my family from a tumultuous environment of sorrow, anger, and hurt. In many ways I am exactly like him, afraid to be vulnerable and comfortable with the silence. But one day I broke that silence when I was trying to find a YouTube video on my dad’s phone to help fix a part of our washing machine. What I found instead was the top listing of his recently searched, which read the words “Where do we go after we die?” The beautiful thing about finding that search was when I opened up about my own pain to my dad, because despite the tough facade he had shown me growing up he did the same for me, tears and everything. What we are promised as Americans has been said in many different ways all throughout history but FDR truly recognized the deserving rights of the people, he recognized that we were human beings who would go through moments of loss and pain, who would need a medical/healthcare system to rely on. My dad needed to be reassured that we were there for him and he needed to be reassured that the healthcare system was there for my grandpa, grandma, and uncle. This is the reassurance we see torn away from communities, the “50 million” all across America today. The ugly truth about our world today is that the health care system puts a big price tag on dignity, it's as if the more money you have/the lighter your skin is/the more fluent you are at English, the more important your body and mind is and the more deserving you are of regaining your health, of receiving another chance at living another day. If we cannot attain the security in knowing that our bodies and health are cared for then we must fight for “our system”, one that does not rest on some social hierarchy, one that does not take away the power of its people, one that holds its integrity to the importance of medicine and to our rights as both Americans and human beings. I want others to know that our rights as Americans cannot be forgotten and red lined through. There is still an opportunity for us as a country, no matter our backgrounds, to prevent another era of American hardship and neglect, to make good on our promise of a better future for the happiness and well- being of the next generation.

Works Cited

Bruenig, Matt. “The US Health System Is a Nightmare Where 50 million Go Uninsured Every Single Year.” Jacobin.

Crenshaw, Kimberlé, “Mapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Color.” The Public Nature of Violence. Routledge, 1994. pp. 93-118.

Harvey, David. “A Brief History of Neoliberalism.” Oxford University Press, 2005. pp. 64-86.

Ifill, Gwen. “Is there a racial ‘care gap’ in medical treatment.” PBS.

Roosevelt, Franklin Delano. “State of the Union 1944 (The Second Bill of Rights).”

Shure, Natalie. “A Health System That Punishes the Sick.” Jacobin.

Warren, Elizabeth. “Sen. Elizabeth Warren On Black Women Maternal Mortality: 'Hold Health Systems Accountable For Protecting Black Moms’.” Essence.