On the Margins of Medical Care

By Anonymous / Winter 2020

In 2018, the television show Grey’s Anatomy aired the episode “(Don’t Fear) the Reaper” that illustrated and confronted discrimination in the United States medical system – namely, gender bias. In the episode, Grey Sloan Memorial Hospital’s Chief of Surgery Miranda Bailey recognized she was experiencing symptoms of a heart attack and went to a local emergency room. However, despite her prestigious accolade, doctors dismissed the possibility that she was having a heart attack because her EKG results were normal. Instead, they began to question her mental state, and implied that her symptoms were psychosomatic and that she was merely experiencing an anxiety attack. Dr. Bailey, however, immediately confronted the physicians’ implications and criticized them for amounting her symptoms to stress because she was a woman. This episode is short sighted in illustrating discrimination in the medical system because it overlooks the contradiction that exists between wealthy patients with insurance and those who cannot afford health insurance. However, it succeeded in illustrating that discrimination is intersectional – you can be wealthy or established like Miranda Bailey, but if you are a woman you may still face discrimination. Miranda Bailey was a well-established Chief of Surgery and held extensive experience in diagnosing and treating patients with heart attacks. If the doctors had consciously recognized her professional status, they may have realized that there was more likely than not merit to her complaints because of her medical background. Miranda Bailey and I both share this experience, as my family also experienced similar discrimination in the medical system when my grandmother was battling cancer. Unfortunately, discrimination in the medical system that stems from both patriarchal and capitalist ideologies is an issue that affects thousands of people.

Patriarchal ideologies in hospitals negatively impact its patients because they promote gender bias in patient care. Patriarchy is a system in society in which men are deemed superior to women and hold more power than women both personally and professionally. An ideology is a “system of beliefs [or] characteristics of a particular class or group” (Twohig, “Day 5”). Combined, a patriarchal ideology is a widespread belief in society that men are systematically superior to women. We can infer from these definitions that patriarchal ideologies harm women in the medical system because they are deemed inferior members of society and treated accordingly. When seeking medical attention, similar to Miranda Bailey, numerous women have reported being told their pain is psychosomatic. This toxic practice causes women to feel embarrassed to seek medical care out of fear that their symptoms will be minimized and belittled. As a result, many women hesitate to seek medical care or avoid it altogether. This has created an alarmingly high proportion of unnecessary complications and deaths of female patients. Female patients face a different reality than male patients. While men feel comfortable seeking medical care, women often ignore serious symptoms and avoid going to the hospital in fear of their pain being minimized.

For-profit hospitals in America are driven by capitalistic ideologies wherein their primary focus is driving profits, often at the expense of patients. Even the most basic hospital services are extremely expensive for patients who cannot afford medical insurance, whereas these services cost a fraction for those who are able to afford it. Hospital policies are created such that patients with private health insurance pay a lesser bill than patients who do not have insurance. Since private medical insurance protects the rich and denies coverage to the poor, medical insurance has become a commodity that is unattainable for poor patients who are faced with paying large medical bills out-of-pocket. This capitalist-driven pricing disparity causes underprivileged patients to delay and even avoid seeking medical treatment for potentially fatal conditions and further develops a system where two realities exist. Insured patients feel comfortable receiving treatment at any time while uninsured patients avoid the hospital at all costs because they are unable to purchase insurance or pay thousands of dollars in out-of-pocket hospital bills. Hospital insurance practices, created by capitalist ideologies, have caused healthcare to become a commodity rather than a basic right. I believe it is urgent to raise awareness in order to expose and confront discriminatory practices in the medical system. If society continues to ignore these practices, marginalized groups including women, racial minorities, and those who cannot afford medical insurance will continue to experience discrimination and mistreatment.

This social problem is deeply rooted in society’s enforcement of contradictions. Contradictions exist when two social groups living alongside each other experience antithetical social realities (Twohig, “Day 3b”). Contradictions are prevalent in society’s historical practice of creating and enforcing inequitable social hierarchies that have relegated inferior positions to marginalized groups in society. Consequently, women, minorities, and those who are poor have been historically devalued in society and excluded from rights and resources enjoyed by superior groups. In A Different Mirror: A History of Multicultural America, Ronald Takaki illustrates the existence of these contradictions by examining the evolution of American society from the 1600s to the 1900s. American society has attached negative racial images to racial minorities since the early 1600s, and as a result, degraded their status and opportunities in society solely based on their race (Takaki 52). In the 1800s, wealthy American business owners holding capitalistic ideologies put their profits above the wellbeing of female factory workers, often subjecting them to labor-intensive and even fatal jobs in order to increase their profits (Takaki 149). For example, on January 10, 1860, due to dangerous factory conditions, over one hundred “factory girls” perished in a factory fire at Lowell’s Pemberton Mill (Takaki 150). The contradiction between high-level bosses and low-level workers hurt all low-level workers, especially women. In order to explore the depths of this issue, we must consider the concept of intersectionality – a method that examines how intersecting social categories shape ones’ opportunities (Twohig, “Day 3b”). In addition to class-based discrimination, women also suffered from gender-based discrimination. Low-level working women suffered from the social construction of gender and the gendering of jobs, which limited them to jobs that were deemed a woman’s occupation (Lorber 91). These jobs were often dangerous factory jobs that placed women at a higher risk than men. Even as women rose from the ranks of “the giddy multitude” to white-collared employment in the 1900s, they continued to hold educational or secretarial positions, which were stereotypically feminine occupations (Takaki 151). We can infer from Takaki’s evidence that elite individuals have taken advantage of their superior status throughout time and imposed social hierarchies onto marginalized groups which effectively limited their opportunities in society. Unfortunately, some of these contradictions are so deeply rooted in society that they continue to prevail in the medical system today.

The primary obstacle that prevents us, as a society, from breaking through these social contradictions, is the advertising industry (Requiem for the American Dream). The advertising industry has shifted the population towards a consumerist mindset, helping large corporations prioritize profits and causing people to accept problems in the medical system. The power of the advertising industry stems from economic shifts from socially secure policies to policies focused on corporate profits. As a result, insurance companies are able to prioritize driving profits over valuing people. The documentary Requiem for the American Dream suggests that since the 1970’s, private businesses have taken advantage of their control of the economy to drive profits and subdue society. There has been an increase in the role financial institutions, such as medical insurance companies, hold in the economy – to the point where, since 2007, insurance companies have held 40% of corporate profits (Requiem for the American Dream). This economic expansion has given businesses powerful legislative influence in Washington, and through lobbying, they continue to exert political pressure to uphold their profit-driven and inequitable business models (Requiem for the American Dream). Once businesses in the United States began to establish a political stronghold in the 1970s, they also made sure to control the general public’s attitudes through advertisements (Requiem for the American Dream). Now that we’ve explored the depths of the problems associated with the advertising industry, we can understand that it was created to divert peoples’ attention from policy issues to superficial consumption (Requiem for the American Dream). From this data, we can gather that society not only lacks the political influence to exert real change in insurance companies, but also lacks a conscious awareness of the root of the problem. Much of society is trapped in a consumer reality, similar to The Matrix, and lack the conscious awareness that there is a deeper reality that businesses are strategically distracting them from (The Matrix).

I argue that insurance companies thrive in such an atomized and docile society, in which people are not only unaware of the oppression they face but are also isolated from each other. We live in a society focused on obtaining things rather than strengthening relationships with people. This becomes clear when we turn to Martin Luther King Jr.’s Letter from Birmingham Jail, in which King illustrates the notion that society “relegates persons to the status of things” (King, “Letter from Birmingham Jail” 123). This relegation caused medical care to become a commodity, something that can be bought on the market, as opposed to a basic right. As society began to perceive medical care as a basic commodity, it further classified people as expendable “things”. As long as big corporations and hospitals could profit at the expense of patients, these patients were relegated to the status of cash sources rather than humans who should have a basic right to access medical care. This shift was caused by consumerism brainwash tactics employed by the advertising industry, which diverted people’s attention away from interpersonal relationships and towards consumerism. As a direct result, many people became “evil” and void of empathetic emotions, and only cared for themselves in their pursuit of material wealth, which allowed healthcare to become a commodity rather than a basic right. However, King suggests that people are not inherently evil, and if we look deeper, we can see that something in them causes them to act in such a way (King, “Beyond Vietnam”).

Gender driven bias thrives in an atomized society. Materialism has atomized the population, and as a result, individuals in society have learned to view themselves as separate “atoms” from their counterparts (Twohig, “Day 9”). When people fundamentally lack compassion for others, regardless of gender differences, differences only further drive wedges between different people. When people adopt certain gender stereotypes as inherent truths, they fail to see others as individuals beyond their stereotype. This stereotype threat has caused women in the medical system to fear going to the doctor because of the prevalent stereotype that women are emotional and exaggerate their symptoms. I contend that the major obstacle society faces in ceasing to engage in discriminatory practices in the medical field stems from its inherent atomization. Society must not only forge relations with members of the opposite sex but also make a conscious effort to personally gauge who they are beyond their gender stereotype.

We can infer from our earlier discussion that the advertising industry causes people to act in “evil” ways by orienting them away from caring about others and towards acquiring things. In King’s Letter from Birmingham Jail, King suggests that society needs to change its ethical principles. Society needs to recognize that businesses are orienting people towards things and isolating them from each other. People need to recognize that viewing themselves as separate entities and solely chasing material wealth will often lead them to live in isolation from others and not yield them true “wealth”. In order to confront society’s atomized state, people need to become “cognizant of the interrelatedness of all communities and states” (King, “Letter from Birmingham Jail” 121).  In practice, person-oriented principles are stipulated in Franklin D. Roosevelt’s Second Bill of Rights. This bill states that all of society should be prosperous and enjoy the same opportunities and basic rights to security - regardless of race or creed (Roosevelt 97). Roosevelt’s Second Bill of Rights sheds light on the principle that society should focus on valuing people and ideally provide everyone equal rights and access to medical care (Roosevelt 98). If people begin to view themselves as a cohesive unit rather than atomized individuals, they will be able to slowly break free from consumerism and shift their interests towards building relationships with each other and organizing to confront inequality in the medical system.

In addition, to break free from a selfish and atomized mindset, people need to be motivated by “love in the sense of the Greek word agape, which means “understanding,” or “redeeming good will for all men”” (Twohig, “Day 11”). If we understand where those who are different from us are coming from, we can slowly stop discriminating them (Twohig, “Day 11”). In the simplest sense, if we learn to love one another, regardless of gender or status, we can transform from an atomized society to a cohesive unit. To illustrate this point, if doctors had simply practiced agape and made an attempt to understand Miranda Bailey’s standpoint, they would have understood her ailment was not stereotypically psychosomatic.

People guided by ethical principles such as agape and interrelatedness can confront discrimination in the medical system. As a starting point, in order to confront the existing wealth hierarchy in the medical system and alter discriminatory perspectives and ideologies, society should alter what is taught in schools and expressed in the media (Twohig, “Days 4 and 5”). Knowledge is power, and similar to The Matrix, providing members of society with a “blue pill”, or the awareness that they have been brainwashed by consumerism, will encourage them to become disillusioned with corporations and aware of their conscious efforts to subdue the general population (The Matrix). Schools should begin to implement mandatory coursework that will teach its students a basic understanding of economics, politics, and the role lobbying plays to benefit large corporations. Equipped with both ethical principles and an educated understanding of the underlying causes of social injustice in various institutions, students engaged in relevant coursework will likely be incentivized to organize and protest on campus to confront these injustices. In the long term, as these students become leaders in their respective fields, they will be ethically educated to change the system from within.

Several celebrities and social media influencers, equipped with strong ethical principles and an understanding of social issues, have engaged in political activism to encourage their followers to vote for candidates and propositions focused on reducing and regulating the power of corporations and transforming the medical system to a universal healthcare system. For example, Democratic political candidates similar to Bernie Sanders take it upon themselves to promote Medicare For All and believe that everyone should be insured (“Medicare for All”). Taylor Swift is an American singer-songwriter turned political activist who has publicly backed a couple of Tennessee Democratic candidates including Phil Bredesen, a supporter of Medicare for All, during the 2018 midterm elections and encouraged her fanbase to go out and vote (Coleman). Swift explained her political activism as a desire to be on the “right side of history” (Coleman). We can see a clear example of agape and interrelatedness in Swift’s actions – she selflessly risked potential backlash and ostracization from members of her fan base for expressing her political opinions to promote candidates she believed would bring about positive change in broken systems (Coleman). Taylor Swift is one of many celebrities who use their platform to shed light and bring awareness to problems people should care about.

Now that we’ve examined tangible actions celebrities and politicians can take in society, we can explore actions common people can take on an individual scale. If we look at historical grassroots movements, such as the Civil Rights Movement, we can see that collective individual action can drive forward positive change. There was systematic brutal violence towards African Americans in the 1960s. For example, in Selma, Alabama, in 1965, there was a brutal government response to peaceful African American protests (Twohig, “Day 10”). White citizens, at their own risk, joined their African American compatriots in protest and brought public attention to the social injustices occurring against African Americans. From this evidence, we can see that systematic violence and segregation is built into the system. Similar to the 1960s, where African American citizens were denied many basic rights, people are still being denied basic medical needs and have to fight for them. If, regardless of financial status, people in society shift away from the Neoliberal Capitalist notion that health insurance is a privately owned “public good”, they can follow the footsteps of society during the Civil Rights Movement (Twohig, “Day 16”). Motivated by principles of democracy, such as the Second Bill of Rights which defines medical care as a basic right, society can protest the current state of the medical system in America (Twohig, “Day 16”). If people are equipped with a belief in a democratic society and are able to draw upon historical actions taken by grassroot movements, they can drive change as a collective whole. Medicare For All is a growing movement and has accumulated a growing number of advocates comprised of people from various backgrounds who advocate for the belief that medical care should be accessible to all members of society.

People should be concerned with discrimination in the medical system because their friends or family members could be deemed inferior solely on the basis of their financial status or gender and face unequal treatment and opportunities. Anyone can fall victim to discrimination in the medical system and as a result, either fail to receive adequate medical treatment or avoid it altogether. With this thought in mind, people should care to confront discriminatory practices in the medical system to prevent future discrimination of their loved ones that can potentially lead to medical misdiagnoses and even death. To get involved, people can help raise awareness of social injustices in the medical system to help more people recognize this issue and help drive a positive change in this system. Similar to Taylor Swift, people can engage in political activism on social media. They can share educational content of injustices experienced in the medical system and promote political candidates whose platform promotes equitable change in the medical system. As more and more people increase political awareness in their social circle, awareness in the general population will expand and influence enough people to vote for political candidates who are committed to confronting social injustice and inequality in the medical system.

Works Cited

Coleman, Nancy. “I Used to Be a Taylor Swift Fan. 'Miss Americana' Reminded Me Why.” The New York Times, The New York Times, 4 Feb. 2020.

"(Don't Fear) the Reaper." Grey’s Anatomy. Writ. Shonda Rhimes and Elisabeth Finch. Dir. Nicole Rubio. ABC, 2018.

King, Martin Luther, Jr. “Beyond Vietnam – A Time to Break Silence.”

King, Martin Luther, Jr. “Letter from Birmingham Jail.”. WCWP 100: Systemic Analysis for Everyday Life.

Lorber, Judith. “Night to His Day: The Social Construction of Gender.” Paradoxes of Gender. Yale University Press, 1994.

“Medicare for All.” Bernie Sanders - Official Campaign Website.

Requiem for the American Dream. Directed by Peter D. Hutchison and Kelly Nyks and Jared P. Scott, performance by Noam Chomsky. Tubi.

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

Takaki, Ronald. A Different Mirror: A History of Multicultural America. Little, Brown and Company, 1993.

The Matrix. Dir. Andy Wachowski and Larry Wachowski. Warner Bros. Pictures, 1999.

Twohig, Niall. "Day 16 Is A Better World Possible”. 4 Mar. 2020.

Twohig, Niall. "Day 11 – Look Deeply to Understand Clearly”. 11 Feb. 2020.

Twohig, Niall. “Day 10 – Everything is Not Alright”. 6 Feb. 2020.

Twohig, Niall. "Day 9 – A House Divided”. 5 Feb. 2020.

Twohig, Niall. "Day 3b (for students)”. 17 Jan. 2020.

Twohig, Niall. “Days 5 Our Lens for Looking Deeply at Society”. 21 Jan. 2020.

Twohig, Niall. "Days 4 and 5 – What is the (Historical) Matrix?”. 18 Jan. 2020.