Anna Bishop Bishop: 1

ProI. Presnell

English 1103

29 Nov. 2011

Health care: The Inequality oI Care

I am a nursing major because taking care oI people is a strong passion oI mine. Since I
have always been interested in health care, I decided to pick a topic related to health care. As a
hospital Volunteer and a CNA I have witnessed a lot oI unIair and unequal treatments within the
hospital and healthcare system; thereIore, I decided to research the diIIerent inequalities that
exist in health care and try to Iigure out what causes these inequalities. I Iound that there are
quite a Iew inequalities and even more Iactors that increase these inequalities.
MY EXPERIENCE WITH HEALTH CARE
As I previously mentioned I am a licensed CNA which is a CertiIied Nurse Aid. To
become a CNA, I had to take a class, do at least Iorty hours oI clinical internship personally I
had close to 90 hours- and pass a multiple part test that tested our nursing skills and our nursing
knowledge. I worked in the emergency room, medical/surgical unit, pharmacy, women`s health
(delivery) ward, Intensive Care Unit (ICU), nursing home and even in hospital purchasing. I also
volunteered over one hundred and IiIty hours in these departments on my own time. During this
time I saw several things that upset me because oI how unIair they were. For example, I once
witnessed a nursing home aid slap a patient because they went to the bathroom on the Iloor. Not
only was this poor lady deIenseless, she was also mentally ill and did not know what she was
doing. It really made me sad that a person could do that to another human being when they were
totally dependent on the aids to take care oI them. AIter I became a CNA, I got a job working in
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home health with one Iull-time patient and as a Irequent Iill-in Ior another patent who`s CNA
had quit.
I have also been a Irequent patient in multiple hospitals, doctors` oIIices, emergency
rooms, urgent care oIIices, specialist`s doctor oIIices and so on. These Irequent visits started
shortly aIter birth and are still continuing today. At birth, my hips had not Iully Iormed;
thereIore, I started having Irequent doctor`s visits almost as soon as I came out oI the womb.
Now, eighteen years later, I have an autoimmune condition called ReIlexive Sympathetic
Dystrophy in my upper back and another autoimmune condition called Reynaud`s Disease in my
hands and Ieet. Because oI these conditions, I have to see a rheumatologist every couple oI
months to check and make sure they have not progressed into something more serious and to
check to make sure my drug treatments are still working. Because I have been to so many
diIIerent doctors, I have a good idea oI what it is like to be a patient and I have witnessed some
disturbing things while being a patient. I have witnessed not only inequalities within the
hospitals or doctor`s oIIices but also with health insurance companies.
Patient
As I have previously mentioned, I have spent many hours as a patient in the medical
Iield. While I was in the hospital, I witnessed a Iew inequalities between the care diIIerent
patients received. For example, while I was in the hospital I noticed that nurses would develop
their Iavorites and spend more time and eIIort on them; while this may be a natural human
reaction, it causes other patients to receive less care than others. This can have a very negative
eIIect on the patient receiving care; not only will it make the patient uneasy, it can also have
serious and potentially dangerous consequences. Nurses, aids, technicians, therapists, and
doctors need to make sure that their patients are receiving the care that they need. When they are
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not giving their patients equal and Iair care because they are busy, have too many patients, or are
spending too much time with a particular patient, they tend to make more mistakes. These
mistakes can have negative consequences to their patient`s health and can even be deadly. II
they give a patient too much medication, they can overdose and die. II a bedridden patient is not
turned properly, they can develop bedsores. There are thousands oI ways in which a patient can
suIIer iI they are not getting enough attention Irom the hospital staII.
I know that I have been very lucky because I have always had very good medical
insurance through my dad`s work. We have almost always been able to Iind a doctor or
specialist that was covered by our insurance when we needed to see one. There is a treatment
called prolo-therapy that I needed Ior my knees, back and chest. When I had it done on my
knees, our insurance company paid Ior it like any other treatment. However when I needed it Ior
my back and chest the company reIused to pay Ior it and actually told us that they had never paid
Ior that treatment because it was considered 'natural and alternative medicine. They also said
that they did not pay Ior that kind oI treatment although we knew through experience that they
had. This treatment was rather expensive and because we had to have blood testing done at that
location they did not cover that cost either. Later, we learned that other people on the same
insurance company were able to receive prolo-therapy and it was covered. Our medical
company changed our policy based on previous costs that they had to pay because I was covered
on their insurance. This is not unusual Ior insurance companies. I have heard other similar
stories Irom Iriends and Iamily and later Irom some oI my patients. This experience really
opened my eyes to the cruelty that the insurance companies emit. These companies not only
deny people coverage, they also cost substantial amounts oI money and cheat people out oI
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money by changing the treatments that they cover based on a particular individual, which is what
happened to me.
Caregiver
I am not only Iamiliar with the inequalities oI medical system through the eyes oI
a patient, I also have seen inequalities while I was working or volunteering in the Iield. As I
previously mentioned, I am a CNA and I have worked in many diIIerent sections oI the medical
system. I have seen many examples oI inequality while working as a CNA. For example, when
I worked in the Delivery Ward, we would have many Hispanic women come in to have their
babies. Many oI these women would not be able to speak much English, iI any. This language
barrier would cause inequalities in treatment because we did not have a nurse who could speak
Spanish. While we used translator phones Ior the important inIormation, everything else was leIt
up to gestures and Ieeble attempts at Spanish. While this inequality was not the Iault oI the
nurses, others were. These women were less likely to have medical insurance and less likely to
have received prenatal care, which Irequently led to complications with delivery. Because oI
this, some oI the nurses would tend to give them less attention, spend less time with them, or use
less equipment on them since they are unsure iI they will be reimbursed Ior the equipment they
use on them. I have also seen patients be denied care such as a transplant surgery because they
were unable to pay but have also taken care oI drunks and addicts and alcoholics Ior Iree because
they were brought to the emergency room where we have to treat everybody without considering
their ability to pay.
Another thing that I witnessed very oIten was that the Emergency Room had an
incredibly high percentage oI poor and uninsured people come in Ior treatment. They could not
aIIord medical care Irom a doctor`s oIIice and instead came into the emergency room where they
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had to wait sometimes Ior hours beIore they could receive treatment. While emergency room
personnel can give a patient antibiotics or pain medication to help them Ieel better, they cannot
give them the same care that they could receive in a doctor`s oIIice. Doctors who work in
oIIices generally know the patient`s history and are less rushed than emergency room doctors.
'ERNMENTAL PRRAMS
The government, both state and Iederal, has many programs to aid people who are unable
to pay Ior medical insurance or healthcare. Medicare and Medicaid are the two largest and well
known programs, because oI this; I am going to Iocus mainly on those two programs. Many
people believe that Medicare and Medicaid take care oI the poor and elderly but the truth is these
programs do not solve the problem, they merely provide a very Iragile saIety net to those who
qualiIy.
Medicare
Medicare is a governmental program that provides health insurance Ior those who are 65
and over. It was Iounded in 1965 with Medicaid as an extension oI the Social Security bill.
Medicare helps the elderly pay Ior hospital stays, skilled nursing Iacilities -- such as in home
health care -- doctor visits, and outpatient hospital services. The program also provides
assistance to pay Ior prescriptions. ('Medicare and You) Medicare currently covers 39.7
million people or about 14 per cent oI our population. ('Overview) As more and more oI the
baby boomers start collecting social security and using Medicare, the beneIits oI the program are
expected to continue to decrease. In America, we not only have more people becoming elderly
we also have a higher liIe expectancy rate which means the elderly are living longer. Because
the elderly are living longer, they are using more money Irom the Medicare system. This means
that the money has to be stretched across more people because there are more people eligible to
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receive Medicare, the baby boomers, and people are not leaving the system because the elderly
are living longer. Because oI this, the beneIits oI Medicare are expected to decrease because the
government does not have enough money to provide all oI these beneIits to that many people.
Most oI the people on Medicare have to purchase a Medicare supplement plan in order to have
quality healthcare. To those living oII social security payments these supplement plans are too
expensive, which leaves them without quality care.
Medicaid
Many people believe that all poor people have health insurance through Medicaid and the
government. This however is a myth; living in poverty does not necessarily qualiIy one Ior
Medicaid. Medicaid was created in 1965 through title nineteen oI the Social Security Act; it is
jointly Iunded by the Federal and the state governments, but managed by the state governments.
Since the state governments manage it, the requirements vary slightly Irom state to state.
('Medicaid, 13) However, two major qualiIications do not change Irom state to state. Firstly,
one has to be considered needy due to blindness, disability, and/or age. In addition, they must be
Iinancially needy. This means that one`s income and Iinancial assets must Iall under a certain
limit set by the state in which you live. Some other qualiIications may include your age, whether
you are pregnant, your income and resources, and whether you are a U.S. citizen or a lawIully
admitted immigrant. ('Medicaid Eligibility) Medicaid only covers 41 per cent oI the people
below the poverty line and only 15 per cent oI people below the poverty level receive health
insurance through their jobs; this leaves 37 per cent oI those below the poverty line uninsured.
CMPARED T THE REST THE WRLD
T.R. Reid wrote an article Ior The Washington Post about common myths Americans
have about healthcare around the world. He writes that as we look Ior a solution to our
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healthcare woes 'we`ve overlooked an invaluable source oI ideas and solutions: the rest oI the
world. His article, 5 Myths about Health Care around the World, explains how we have
dismissed ideas Irom other countries that could help us solve our problems because we consider
them to be socialist. He says that while some countries have socialized medicine with the
government paying bills Irom the government hospitals other countries such as Germany and
Japan provide coverage to all their citizens using private doctors, hospitals, and insurance plans;
the government is not in control oI the healthcare system in these countries and thereIore means
these countries do not have socialized medicine. America even has more socialized medicine
than many Ioreign countries. For example, Native Americans and veterans do not pay Ior their
medical bills, the government provides healthcare through taxes. This is more socialized than
Canada, Germany, France, Japan and many other countries.
Americans also generally believe that overseas there are always long wait lines or limited
choices. This is in Iact not the case. While some countries like Canada do make patients wait
weeks up to months Ior nonemergency care as a way to keep cost down this is not the norm.
Reid says that 'Germany, Britain and Austria outperIorm the United States on measures such as
waiting times Ior appointments and Ior elective surgeries. He goes on to say that in some
countries, such as Japan, the wait is so short that most patient just drop in without appointments.
He then told a story oI how he went into an orthopedic clinic at Keio University Hospital Ior a
consultation on his shoulder. The doctor recommended surgery and when Reid asked when they
could do it the doctor responded 'Tomorrow would be pretty diIIicult. Perhaps some day next
week? To Americans who have ever had to wait to see a specialist, this seems ridiculously Iast.
In America, it can take months to get into see a specialist and then at least a Iew weeks iI not
longer to get surgery.
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In many oI these countries the cost oI care is actually cheaper. Insurance companies in
America spend twenty per cent oI every dollar Ior administration costs. France`s health
insurance spends only Iour percent on administration and they cover all oI their citizens.
Canada`s universal system spends only six percent on administration and Taiwan spend less than
two percent. When Reid compares the cost oI American healthcare and treatment to that oI
Japan we see how much less Japan spends and how much more they get. Japanese citizens tend
to go to the doctor three times more than U.S. citizens. They have twice as many x-rays and
MRIs and the recovery rates Ior serious illnesses are better than the United States. However
Japan spends less than halI oI the amount oI money per person yearly than the United States.
Japan spends on average $3,400 annually while the United States spends $7,000. Because there
are strict cost controls overseas many Ioreign countries have Iound new and cheaper ways to
perIorm the same procedure. For example, a MRI oI the neck in America costs about $1,500,
but the same scan in Japan only costs $98 and the labs still make a proIit.
Medical insurance is also very diIIerent overseas. American companies constantly reject
applicants do to preexisting conditions. These tend to be the people who are most likely to be in
need oI medical insurance. Medical insurance agencies also employ people to look through
records so that they can cancel a person`s plan iI the hospital bills are more than they want to
pay. However, in other countries around the world insurance companies must accept everybody
who applies and they are unable to cancel your policy unless you are not paying your premiums.
They are also required to pay any claim and it has to be within a tight time limit.
Reid says that the biggest myth oI all is that Americans believe that our healthcare system
is the best in the world. Looking at the inIormation above, I cannot see how we could possibly
have the best system. For starters, unlike every other developed country we do not provide Ior
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all oI our citizens. There were 45.8 million uninsured individuals in 2004. ('Overview) Almost
every other developed country has better national health statistics than the United States. We
also pay the most money per capita out oI the 193 countries in the World Health Organization.
As Reid says, 'In terms oI Iinance, we Iorce 700,000 Americans into bankruptcy each year
because oI medical bills. In Franc, the number oI medical bankruptcies is zero. Britain: zero.
Japan: zero. Germany: Zero. I think that the United States should have the best healthcare in
the world. But to get there we are going to have to use some oI the ideas Irom other countries.
However, Americans seem generally happy with their healthcare and their health insurance. 82.2
per cent oI the people I interviewed were highly satisIied or satisIied with their health insurance
agency and 89.3 per cent oI the people I interviewed were highly satisIied or satisIied with the
healthcare they were able to receive with only 3.6 per cent oI the people being highly
dissatisIied. The income oI the people I interview varied signiIicantly as well as their type oI
insurance, iI insured. This helps show that people tend to be happy with what they have without
regard to their insurance type or income.

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Works Cited

'Medicaid. World Book. 13. Chicago: World Book Inc., 2004. Print.


Reid, T.R. 'Five Myths about Health Care in the rest oI the World. Washington Post 23
Aug 2009, n. pag. Web. 15 Nov. 2011.


United States Department oI Health and Human Services. OIIice oI the Assistant Secretary Ior
Planning and Evaluation. Overview of the Uninsured in the United States: An analysis of
the 2005 Current Population Survey. Association oI Standardized Patient Educators, 22
Sept. 2005. Web. 15 Nov. 2011.
http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm~.


United States. Health and Human Services. Medicare and You. 2011. Web.
http://www.medicare,gov/Publications/Pubs/pdI/10050.pdI~.


United States. Department oI Health and Human Services. Medicaid Eligibility. 2011. Web.
https://www.cms.gov/medicaideligiblity/~.


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ReIlection
When I Iirst started looking Ior research I was looking Ior anything that made it harder
Ior people to receive care. I had some previous experience with the subject since I have worked
in a hospital, nursing home, and in home care. I have witnessed many diIIerent inequalities with
care. That is what I thought I would Iind in my research. However, by the end oI my research I
learned that it is health insurance that makes the most diIIerence to medical care. Whether you
are rich or poor, old or young, or black or white health insurance is crucial Ior good health.
When I was researching I Iound government websites to be most helpIul and beneIicial.
Not only were they reliable they also were packed with inIormation and charts with all oI their
reIerences listed. The internet sources turned out to be pretty useIul as well. I Iound a really
good article Irom the Washington Post that I was able to use and validate credibility. Some oI
the websites I Iound had a lot oI very useIul inIormation but it was hard to validate the credibility
oI the sources. A lot oI the time the author was not named or there was not a publishing
company listed. I did not Iind the electronic database search all that useIul mainly because it was
the last thing I tried. I Iound some things that would have been good iI I had not already Iound
the inIormation someplace else. The survey also was not that useIul to me because I was not
able to survey a large amount oI people so my results are probably biased. For example all oI the
people who took my survey were white. That was not intentional but it just worked out that way.
However my previous clinical observations were extremely helpIul while writing this paper.
What surprised me the most was how much inIormation was readily available. I Iigured
that health statistics would be easy to Iind but I did not think that a simple Google search about
healthcare inequality would turn up so many useIul sites. I Iound that access to health insurance
was the largest Iactor which surprised me because I thought income would have been the largest
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Iactor. However, income comes in second behind access to health insurance. I was able to
answer most oI my questions in my essay, but not all oI them which I Ieel is okay since I started
with more than ten questions. However, due to the large amount oI inIormation I Iound I
decided to omit a Iew oI my questions and Iocus more on certain questions.
The talking headers actually helped me a lot more than I thought they would. I thought
the assignment was pretty stupid when I was doing it because I thought I could better spend my
time actually writing the essay than by writing up a document saying what I needed to write in
each section. However, it probably helped save me time because I did not have to think about
organizing my paper or Iitting my sources together. In my high school iI you took AP English
you did not have to do a senior project so I had no real experience writing long research papers
when I started this paper. In high school, I was glad I did not have to do a senior project, but
thinking back, it probably would have helped me out a lot in the long run. The style oI my paper
changed depending on whether I was the speaker relating a personal experience or just relaying
Iacts. When I started telling Iacts and tying them together I sound a lot more Iormal than when I
am telling a story. I thought the emotion oI my stories and experiences would show more iI they
were written inIormally.
This paper had been diIIerent than other research projects because we were able to
choose something that we were interested in to write about. That made the process more
enjoyable and I think it will be more likely to stick with us than iI we wrote about things that
were assigned to us and we had no real interest in. It was also diIIerent because we were able to
have a voice in our paper. In other research projects I have done we were not supposed to tell
our opinions or thoughts on a subject we were just supposed to relay the inIormation we had
Iound. This is the Iirst time that I have used my own voice and experiences in a research paper.
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I learned a lot about the healthcare system and about the health oI diIIerent people. I
learned that a lot oI the things we have been told about the healthcare in other countries is
completely Ialse. It is not just socialized medicine and in Iact some oI our programs are more
socialist than other countries total healthcare systems. This reinIorced the idea that I already had
that all politicians just want to tell the public what they want to hear. I also learned how cruel
our health insurance companies are. I just thought that was how it had to be. Health insurance
companies in other countries are not cruel like ours are. They just care more about making a
proIit than they do about helping their clients.