Anna Bishop Prof. Presnell English 1103 29 Nov.

2011

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Health care: The Inequality of Care I am a nursing major because taking care of people is a strong passion of 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 of unfair and unequal treatments within the hospital and healthcare system; therefore, I decided to research the different inequalities that exist in health care and try to figure out what causes these inequalities. I found that there are quite a few inequalities and even more factors that increase these inequalities.

MY EXPERIENCE WITH HEALTH CARE

As I previously mentioned I am a licensed CNA which is a Certified Nurse Aid. To become a CNA, I had to take a class, do at least forty hours of 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, womens health (delivery) ward, Intensive Care Unit (ICU), nursing home and even in hospital purchasing. I also volunteered over one hundred and fifty hours in these departments on my own time. During this time I saw several things that upset me because of how unfair they were. For example, I once witnessed a nursing home aid slap a patient because they went to the bathroom on the floor. Not only was this poor lady defenseless, 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 of them. After I became a CNA, I got a job working in

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home health with one full-time patient and as a frequent fill-in for another patent whos CNA had quit. I have also been a frequent patient in multiple hospitals, doctors offices, emergency rooms, urgent care offices, specialists doctor offices and so on. These frequent visits started shortly after birth and are still continuing today. At birth, my hips had not fully formed; therefore, I started having frequent doctors visits almost as soon as I came out of the womb. Now, eighteen years later, I have an autoimmune condition called Reflexive Sympathetic Dystrophy in my upper back and another autoimmune condition called Reynauds Disease in my hands and feet. Because of these conditions, I have to see a rheumatologist every couple of 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 different doctors, I have a good idea of 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 doctors offices but also with health insurance companies.

Patient
As I have previously mentioned, I have spent many hours as a patient in the medical field. While I was in the hospital, I witnessed a few inequalities between the care different patients received. For example, while I was in the hospital I noticed that nurses would develop their favorites and spend more time and effort 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 effect 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 fair 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 patients health and can even be deadly. If they give a patient too much medication, they can overdose and die. If a bedridden patient is not turned properly, they can develop bedsores. There are thousands of ways in which a patient can suffer if they are not getting enough attention from the hospital staff. I know that I have been very lucky because I have always had very good medical insurance through my dads work. We have almost always been able to find 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 for my knees, back and chest. When I had it done on my knees, our insurance company paid for it like any other treatment. However when I needed it for my back and chest the company refused to pay for it and actually told us that they had never paid for that treatment because it was considered natural and alternative medicine. They also said that they did not pay for that kind of 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 for insurance companies. I have heard other similar stories from friends and family and later from some of 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 of money and cheat people out of

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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 familiar with the inequalities of medical system through the eyes of a patient, I also have seen inequalities while I was working or volunteering in the field. As I previously mentioned, I am a CNA and I have worked in many different sections of the medical system. I have seen many examples of 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 of these women would not be able to speak much English, if 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 for the important information, everything else was left up to gestures and feeble attempts at Spanish. While this inequality was not the fault of the nurses, others were. These women were less likely to have medical insurance and less likely to have received prenatal care, which frequently led to complications with delivery. Because of this, some of the nurses would tend to give them less attention, spend less time with them, or use less equipment on them since they are unsure if they will be reimbursed for 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 of drunks and addicts and alcoholics for free 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 often was that the Emergency Room had an incredibly high percentage of poor and uninsured people come in for treatment. They could not afford medical care from a doctors office and instead came into the emergency room where they

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had to wait sometimes for hours before they could receive treatment. While emergency room personnel can give a patient antibiotics or pain medication to help them feel better, they cannot give them the same care that they could receive in a doctors office. Doctors who work in offices generally know the patients history and are less rushed than emergency room doctors.

GOVERNMENTAL PROGRAMS
The government, both state and federal, has many programs to aid people who are unable to pay for medical insurance or healthcare. Medicare and Medicaid are the two largest and well known programs, because of this; I am going to focus mainly on those two programs. Many people believe that Medicare and Medicaid take care of the poor and elderly but the truth is these programs do not solve the problem, they merely provide a very fragile safety net to those who qualify.

Medicare
Medicare is a governmental program that provides health insurance for those who are 65 and over. It was founded in 1965 with Medicaid as an extension of the Social Security bill. Medicare helps the elderly pay for hospital stays, skilled nursing facilities -- such as in home health care -- doctor visits, and outpatient hospital services. The program also provides assistance to pay for prescriptions. (Medicare and You) Medicare currently covers 39.7 million people or about 14 per cent of our population. (Overview) As more and more of the baby boomers start collecting social security and using Medicare, the benefits of the program are expected to continue to decrease. In America, we not only have more people becoming elderly we also have a higher life expectancy rate which means the elderly are living longer. Because the elderly are living longer, they are using more money from 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 of this, the benefits of Medicare are expected to decrease because the government does not have enough money to provide all of these benefits to that many people. Most of the people on Medicare have to purchase a Medicare supplement plan in order to have quality healthcare. To those living off 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 qualify one for Medicaid. Medicaid was created in 1965 through title nineteen of the Social Security Act; it is jointly funded by the Federal and the state governments, but managed by the state governments. Since the state governments manage it, the requirements vary slightly from state to state. (Medicaid, 13) However, two major qualifications do not change from state to state. Firstly, one has to be considered needy due to blindness, disability, and/or age. In addition, they must be financially needy. This means that ones income and financial assets must fall under a certain limit set by the state in which you live. Some other qualifications may include your age, whether you are pregnant, your income and resources, and whether you are a U.S. citizen or a lawfully admitted immigrant. (Medicaid Eligibility) Medicaid only covers 41 per cent of the people below the poverty line and only 15 per cent of people below the poverty level receive health insurance through their jobs; this leaves 37 per cent of those below the poverty line uninsured.

COMPARED TO THE REST OF THE WORLD

T.R. Reid wrote an article for The Washington Post about common myths Americans have about healthcare around the world. He writes that as we look for a solution to our

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healthcare woes weve overlooked an invaluable source of ideas and solutions: the rest of the world. His article explains how we have dismissed ideas from 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 from 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 of the healthcare system in these countries and therefore means these countries do not have socialized medicine. America even has more socialized medicine than many foreign countries. For example, Native Americans and veterans do not pay for 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 fact not the case. While some countries like Canada do make patients wait weeks up to months for nonemergency care as a way to keep cost down this is not the norm. Reid says that Germany, Britain and Austria outperform the United States on measures such as waiting times for appointments and for 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 of how he went into an orthopedic clinic at Keio University Hospital for 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 difficult. Perhaps some day next week? To Americans who have ever had to wait to see a specialist, this seems ridiculously fast. In America, it can take months to get into see a specialist and then at least a few weeks if not longer to get surgery.

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In many of these countries the cost of care is actually cheaper. Insurance companies in America spend twenty per cent of every dollar for administration costs. Frances health insurance spends only four percent on administration and they cover all of their citizens. Canadas universal system spends only six percent on administration and Taiwan spend less than two percent. When Reid compares the cost of American healthcare and treatment to that of 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 for serious illnesses are better than the United States. However Japan spends less than half of the amount of 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 foreign countries have found new and cheaper ways to perform the same procedure. For example, a MRI of the neck in America costs about $1,500, but the same scan in Japan only costs $98 and the labs still make a profit. Medical insurance is also very different overseas. American companies constantly reject applicants do to preexisting conditions. These tend to be the people who are most likely to be in need of medical insurance. Medical insurance agencies also employ people to look through records so that they can cancel a persons plan if 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 of all is that Americans believe that our healthcare system is the best in the world. Looking at the information above, I cannot see how we could possibly have the best system. For starters, unlike every other developed country we do not provide for

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all of 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 of the 193 countries in the World Health Organization. As Reid says, In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In Franc, the number of 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 of the ideas from other countries. However, Americans seem generally happy with their healthcare and their health insurance. 82.2 per cent of the people I interviewed were highly satisfied or satisfied with their health insurance agency and 89.3 per cent of the people I interviewed were highly satisfied or satisfied with the healthcare they were able to receive with only 3.6 per cent of the people being highly dissatisfied. The income of the people I interview varied significantly as well as their type of insurance, if 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 of the World. Washington Post 23 Aug 2009, n. pag. Web. 15 Nov. 2011.

United States Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Overview of the Uninsured in the United States: An analysis of the 2005 Current Population Survey. Association of 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/pdf/10050.pdf>.

United States. Department of Health and Human Services. Medicaid Eligibility. 2011. Web. <https://www.cms.gov/medicaideligiblity/>.

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Anna, your essay is really strong. Personal experience both as a patient and a caregiver gives you maximum credibility to set up your discussion that includes the sources. Then source input is smooth and your voice is still strong throughout it. My only suggestion comes at the end. It just seems to end, and actually I was quite surprised that it ended, seemingly in the middle of a point. Can you now take what you know, what youve learned, and bring your discussion to a satisfying or challenging or even disturbing conclusion? You have a couple of sentences in your reflectionesp. about your findingsthat may help you do that.

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Reflection When I first started looking for research I was looking for anything that made it harder for 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 different inequalities with care. That is what I thought I would find in my research. However, by the end of my research I learned that it is health insurance that makes the most difference to medical care. Whether you are rich or poor, old or young, or black or white health insurance is crucial for good health. When I was researching I found government websites to be most helpful and beneficial. Not only were they reliable they also were packed with information and charts with all of their references listed. The internet sources turned out to be pretty useful as well. I found a really good article from the Washington Post that I was able to use and validate credibility. Some of the websites I found had a lot of very useful information but it was hard to validate the credibility of the sources. A lot of the time the author was not named or there was not a publishing company listed. I did not find the electronic database search all that useful mainly because it was the last thing I tried. I found some things that would have been good if I had not already found the information someplace else. The survey also was not that useful to me because I was not able to survey a large amount of people so my results are probably biased. For example all of 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 helpful while writing this paper. What surprised me the most was how much information was readily available. I figured that health statistics would be easy to find but I did not think that a simple Google search about healthcare inequality would turn up so many useful sites. I found that access to health insurance was the largest factor which surprised me because I thought income would have been the largest

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factor. However, income comes in second behind access to health insurance. I was able to answer most of my questions in my essay, but not all of them which I feel is okay since I started with more than ten questions. However, due to the large amount of information I found I decided to omit a few of my questions and focus 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 fitting my sources together. In my high school if 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 of my paper changed depending on whether I was the speaker relating a personal experience or just relaying facts. When I started telling facts and tying them together I sound a lot more formal than when I am telling a story. I thought the emotion of my stories and experiences would show more if they were written informally. This paper had been different 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 if we wrote about things that were assigned to us and we had no real interest in. It was also different 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 information we had found. This is the first 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 of different people. I learned that a lot of the things we have been told about the healthcare in other countries is completely false. It is not just socialized medicine and in fact some of our programs are more socialist than other countries total healthcare systems. This reinforced 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 profit than they do about helping their clients.