Brasfield 6-end

This section begins by stating a major problem with American Health Care: coverage for the aging population.  Brasfield states that nursing homes are an expensive and relatively recent institution, beginning in the mid twentieth century.  Care for the elderly has evolved from what once was a family responsibility to what is now a complex, socially regulated institution, as seen in its effects on the Hill-burton hospital construction act, the MAA, and other acts specifically created to pay for our aging population.  With the government providing payment in most of these legislative additions, it questions the validity of switching what was once a familial matter to a financial burden on the public.  A particularly interesting statistic that Brasfield mentioned on this matter was the fact that private insurance pays for less than 10% of all long term care services. In my opinion, this really brought home both the biases of private health insurance for making it difficult for the elderly to obtain coverage and the magnitude of financial burden the elderly and disabled have on the national economy.
In the next chapters, Brasfield describes the ACA and speculates about its future along with citing some examples of health care systems of other countries.  He list ways which the law would be repealed if Republicans were to take the majority, stating that the most viable path would be through the legal action of questioning the reforms constitutionality.  Brasfield also offers some inconclusive speculation on the bill's effect on the national deficit.  With the current state of the US economy I feel the financial side of this bill is the most important, and with our aging population it seems unpromising that the ACA can lower the national deficit.  Through this course, I have decided that my opinion as a whole on health reform would be to provide only the essentials to those who don't contribute to the tax base while leaving the maximum choice to those who do.  I feel that money should buy people convenience and comfort and those that don't have it should be left with something to gain; otherwise what would be the incentive for earning it?  Through the readings, I have decided that the ACA has a noble purpose but its financial issues are too unclear for it to be a completely agreeable bill, especially given the current economic climate.

Brasfield 3-5

In this section Brasfield focuses on the specific institutions of Medicare and Medicaid and each of their respective contributions to the issue of uncontrolled costs.  In Ch. 3 he describes the evolution of medicare and how, during the Bush campaign, it was proposed to include prescription drugs.  one major issue he chase to highlight was whether the biggest monetary risk should be put on the government or the insurance plans.  A compromise, called the doughnut hole, was thought up to solve this issue.  It suggests that after a copayment of 25% the person would be fully responsible to pay out-of-pocket and once they reached a certain amount medicare would pay 80% to the enrollee's 5%.  This out-of-pocket "doughnut hole" gap was used to bridge the gap between the insurance plan paying the majority in the beginning to the government paying the majority in the end.  I found this to be an interesting way for a cost solution to develop, but I feel it still puts too much pressure on the enrollee for them to have to pay completely out of pocket for up to $4550.  It was also interesting to see the origin of the social insurance vs. privatization.  The premium support system idea on the side of privatization is similar to the current system with the difference of allowing plans to discrimination against unhealthy participants, but is this a thing insurance plans should be prohibited from doing even if it helps them control their costs?
In the next chapter it was interesting to learn at just how huge the medicare program had grown to.  A particularly surprising figure was the fact that medicaid funds 4/10 births in the US.  With close to half of the births in the US to be from families under medicaid show that a disproportionate amount of people are being born into poverty, and with cases made for the inescapable nature of the American poverty cycle, this could become a major factor in increasing health care costs.  This also brings up the recurring issue for the government funding of contraceptive measures.  Overall what I gained from this reading, and many of the preceding assignments, is that there are an overwhelming amount of historical and monetary aspects to health reform and these contribute to the ambiguity of the decision making process when a reform is put to a vote.

Brasfield 1-2

 In this book Brasfield  presents the information in a very scientific fashion.  In the first chapter he goes over many of the historical event we learned in previous books.  He does not give many personal examples of how the health care system has affected him, but he gives many researched statistics on the economics of our current healthcare system.  Among these statistics, one I found surprising was the concentration of healthcare spending in our population.  The bar graph displayed that half of all health care cost is accounted for by only 5% of the population.  This brings about the issue of how health insurance should charge its users.  If it functioned like other insurances by charging those who used it most often a larger fee, the sickest people would eventually go broke (as many do currently).  Also, it doesn't seem right to charge patients for pre-existing conditions if it is not their fault.  Is a patient to blame for their health condition? In my opinion this is what sets health insurance apart from other insurances.  Unlike something like auto-insurance, a patient is not always to blame for their health.  There are other factors like bad genetics or bad environment that can affect a patients health.  So it seems if health insurance was to function this way there would be a fair amount of discrimination towards the people who would need the service the most, which suggest the government should be involved to avoid this.

Altman Part 4

In this section of the book, Altman described all aspects of the Obama plan for health reform.  He summarized Obama's plan at the end of Ch. 11 as essentially a near universal system achieved through an expansion of Medicaid, insurance reform, and employer mandates.  A main issue with the Obama plan was how to control the already high costs.  Altman was apparently a big contribution to this issue in the obama plan, as he claims to have recommended the cost control measure in the Obama plan.  Altman is realistic on this topic, stating that high reductions of costs are fairly unlikely in the future.  The main thing that stuck out to me in this section was the amount of negotiating that had to be done in order for any reform to pass through our bureaucracy.  Obama's plan couldn't be as comprehensive or universal as he wanted it to be because he basically had to deradicalize his reform ideas to an addition to existing medicare and medicaid in order for it to be politically viable to pass.  What also caught my attention was the amount of social implications that come along with homogenizing a healthcare system.  Issues such as paying for contraceptives bring a whole element of morality in the issue of what the government should use its taxpayers money for.  These social issues become major problems when a reform is votedon in the house. In my opinion I contribute these problems to the lack homogenization in our country.  The different areas of our country (rural vs urban) have their own culture that affect their inhabitants opinions.  Since individual states have a more homogenized culture within them than the United states as a whole, I feel it would be best to leave more power in the states' governments on this issue.

altman pts 2-3

This section of the book went into more detail of the specific laws that have been attempted or passed on the subject of healthcare reform.  Among these laws was the Hill-Burton act, which had something to do with the government funding of hospitals. It was Interesting to see how certain court cases like the one involving Marilyn Rose can expand the powers of a bill.  I was surprised at the effect this law could have on individuals such as the pregnant woman who was sued for overstaying her medicaid coverage at a hospital.  This section also gave insight to the intense amount of politics in many of these bills.  The efforts of the AMA in denying the surgeon general's conclusions on smoking and cancer to win a congressman's support was especially shocking.  It was also interesting to see the role of race on the southern states acceptance of federal controlled health, as seen in the pursual of Wilbur Mills vote. Aside from the legislative pressures, the sections also discuss the financial issues with the bill after it passed, such as the federal "matching" of state funds that could result in the federal government bearing close to 75% of the burden in some cases.  This results in the annual $2.5 trillion we currently spend on healthcare.   This turned out to be a problem, especially in recession years.  The magnitude comparison Altman gives in section 3 on the size of a trillion was eye-opening.  Through this section Altman goes over the specific variables that make cost control so difficult for the American Health care system.  Altman concludes the section by comparing the present prices of the US healthcare system to the costs of other developed countries: it is apparent that there needs to be a change.

Altman part 1

Altman began the book by telling about his personal dilemma of deciding on whether or not to put his 96 year old mother through triple bypass heart surgery.  He did this to introduce the problems with American healthcare. He personally faced a decision on whether to put his fragile mother through a possibly life threatening procedure or to let her die naturally.  He said cost was not a central issue in his problem despite the fact that it is among the most prominent problems in the American system.  The rest of the section was devoted to thoroughly describing the attempts of the Nixon and the Clinton administration to improve the american healthcare system.  In Altman's description of the Nixon attempts he mentions the emergence of the HMO idea.  I found his description of HMO's interesting because before reading I had only heard of the name.  I feel the HMO model is a good concept for governmental cost control in its set salaries for doctors; however i also feel that this practice could harm the quality of care that doctors give by decreasing the incentive for quality care and also decreasing the incentive for student to become doctors.  

Altman also described the attempts of the Clinton administration and I was surprised at how fiscally centered many of his plans were. Due to party stereotypes, I would have assumed the Clinton administration would have been less fiscally responsible. At the end of this section Altman described earlier attempts at universal health care by the bolsheviks, and by FDR (which we read about in the last book).  I found it interesting to see how the issue evolved both inside and outside the US.  

 

Paper topic

My initial topic idea is to write on the conflict between the AMA and the proposal of Medicare.  I have also been thinking about writing on the Americans with disabilities act and the problems and benefits it brought about.

Hoffman 6-end

The end of this book really illustrated the confusing perspectives that were forced upon americans.  Beginning with the the proposal of Medicare, propaganda and other solely political methods were used to sway the public's votes. It shows how politically loaded healthcare became and how party loyalty most likely affected people's opinions, as seen in the failure of Clinton's health reform. This section also put emphasis on the struggle of African Americans during the early phases of health care reform.  I found it interesting that the proposal of Medicare came right around the same time as the Civil Rights Movement.  It seems the 50-60's were a hot bed for social activism.

Hoffman 1-5

This section began by discussing the problems the Great Depression brought to healthcare by hindering the patients payment to doctors.  I found it interesting how these drastic times basically started the discussion of universal health care as a right.  This section also mentioned that universal healthcare was brought to discussion but it took a back seat to the fiscal issues.  The following chapters then described the schism between private and public healthcare, and how hospitals could even have the right to refuse people who were unable to pay.  I found it impossible not to sympathize with the victims in some of the examples of people getting turned away by hospitals.

Howell chs 6-8

This section of the book both focused on the emergence and use of the blood test and summed up the major trends cited in earlier chapters with chapter 8.  Chapters 6 and 7 first described how the blood count emerged and evolved, then cited the 3 diseases that it was especially used for: pneumonia, typhoid, and appendicitis.  The chapters also dealt with the timespan it took for the blood count to be regularly used.
Howell cited the frequencies that each test was given at the Philadelphia and the New York hospitals. He mentioned that the inconsistent implementation of the blood test was due to doctors' personal preference their diagnosis. Many doctors felt they could evaluate blood with the naked eye better than they could by counting through a microscope.  This point culminated in the description of the debate between hematologist John Da Costa and Surgeon John Deaver. Da Costa advocated new school lab diagnosis while Deaver felt his intuitive diagnostic skills could only be impeded by time taxing lab tests.
Although Dr. Deaver's point of view may produce some questions about physicians egos it also suggests that many of the costly test done in our present healthcare system are arbitrary and unneeded. Howell further supports this by stating the New York hospital, in progressive era style, tested for everything regardless of the condition by using a standardized form.  Howell concludes the book on this note by stating the most important technology in hospitals today are still the ones with communicating and business purposes.

CH.3-5 Technology in the hospital

In chapters three through five the book discusses the increase in the use of tests in the hospital by describing the changes in urinalysis and the use of the X-ray machine.  The urinalysis had been used since maybe the 15th century; however it was modified in the early 19th century.  Aside from color and specific gravity people also began testing for things like sugar and urea.  This was made more efficient with the use of new centrifuges. When the author showed the frequency of each test, urea was shown to be rarely tested on.  The author seemed to have no conclusive reason for the sparsity of this test, but he suggested it was just up to how partial the physician was to performing the test.  This was interesting because, in light of the recent publication claiming the urea test's usefulness, it showed the reality of how new discoveries don't always result in immediate application.  

This reading also revealed how new tests and machines, such as the X-ray and the new urinalysis, forced many patients to become dependent on hospital care as opposed to care at home. X-rays and lab equipment were near impossible or inconvenient to bring to the home so, despite transportation issues, most patients needed to be in a hospital for these tests.

  It was also strange to learn that women were less likely to receive X-rays than men.  The author suggest it may be the result of the different lifestyles the two genders led, citing facts such as men were more likely to be hospitalized for trauma than women.  Still, with the unsafe nature of the X-ray it was suggested that maybe physicians assumed women would react badly to the scary machine and possibly pursue legal action on the hospital.  This is plausible with the given example of the women and her child getting knocked down by a spark from the machine, but it still shows the sexist assumptions of the times.  Aside from the negatives, these tests and machines allowed the physician to further objectify himself from body examinations and improve diagnoses.

Technology in the Hospital CH 1&2

The first chapter of this book read like an abstract of a scientific paper; it was mostly concerned with outlining what the book would explore.  The author also used a fair amount of graphical data in making his points.  Most of them showed how hospital use and organization trended from 1900 to 1925.  In relation to graphs, one of the authors main topics in the second chapter was the evolution of record keeping in the hospital.  This became more efficient with standardized forms and typing and calculation machines.  These improvements were vital in the wake of Americans transitioning from home-care to hospital care, which we were introduced to in Marrow of Tragedy.
With this increased use, I was surprised at how the hospitals image changed as paying middle to upper class people began frequenting the hospitals.  It seems this was what spurred the money centered system of healthcare we still see today.  With this business-oriented hospital it was also surprising to see the heightened importance of administrators.  This translated in the latter part of Ch.2 in the description of the "efficiency craze", where people began to use quick and efficient business practices to allow for quicker surgeries so the hospital could have more vacant beds resulting in more money.

Ch.7- Afterword

After seeing the Unions side of war healthcare it was interesting to see how similarly the Confederate healthcare system evolved. It was also shocking to learn of the ordeals the confederate states faced at the same time the Union was flourishing.  One of the things that stuck out to me was the affect that the trade embargo had on confederate healthcare.  Along with other basic goods, the primitive drugs mentioned in previous chapters (such as quinine and anesthetics) were in much shorter supply for the confederacy compared to the union.  This caused confederate physicians to have a hard time providing sufficient care to their patients resulting in less men on the battlefield.
An especially hard part to read in this section was Ch. 9's report of the prison camps.  Its horrifying to think of the wrongs each side committed in those prison camps.  The gruesome pictures published in the Narrative of Privations and Sufferings and the included claims of the much better treatment of confederate prisoners by the union are an interesting hint at propaganda, especially given the claims in some rebel prisoners memoirs that the USSC made no pictures of the confederate prisoners condition.
The book concludes with the image of a new and energized healthcare system beginning to be established in America.  The war gave experience and posed new questions to healthcare professionals, which led to innovations in future decades.

In reading Ch.4-6 of Marrow of Tragedy I was introduced to the specific ways that the USSC improved conditions in battlefield medicine, ways they were criticized for it, and how the Union improved their general hospital.  In the first chapter, It was surprising to hear such deficiencies as a lack of an ambulance service on the battlefield.  To think soldiers would be stranded for numerous days before they received care is a nasty thought.  It was interesting to learn that for the amount of work they did the sanitary commission functioned through donations rather than official government funds.  Being organized like a charity, the USSC faced problems of running a volunteer-based system and eventually had to pay their workers; however, with the significant amount of women participation, the fact that only men were paid is a testament to this era's disregard for women's' rights.  It was interesting to see how the hospital carried over to post war times and how briefly they lasted immediately after the war.  Even after all the innovations in the general hospital, the importance of home care was still highly prioritized by the postwar patient.  I look forward to learning how the hospital became the primary place of healing in America.

The beginning of Marrow of Tragedy really made it clear to me about just how inept the science of medicine was during the Civil War.  Humphreys made it clear that it was much more the organization and policy changes made in medicine than the scientific discoveries of the time that made the difference in the healthcare of the war.  It was interesting to see the impact that women had on these policy changes.  To think that the simplicity of being away from "motherly" care could make such a huge impact on health is surprising.  When I found that many of these policies and organization improvements were initiated by women I was surprised.  To think such policies could be implemented by an androcentric culture at such an unstable time is impressive. I look forward to finding more about the progression of healthcare during the Civil War.

The first day of class for Hist 424 was a syllabus day in which we discussed what we were to expect from the class and were told what we will be reading.  The first book we will read will be Marrow of Tragedy, a book about medicine and health in the civil war.  We listed things we might expect to see in the book.  These included: ways diseases spread, the knowledge of this spread at the time, and the treatments used with the current theories of the time.  We established that the germ theory of medicine had not yet developed and the "professionals" in health at the time believed in hackneyed theories such as the theory of humors or the miasma theory, the latter being more plausible as it suspected bad air to be the culprit of disease spread.  We also hit on the point that it was women in the home (precursors to the modern nurse) that were responsible for most patient health improvement through providing comfort, rest, and food to the injured.  The harsh and often harmful roles of the doctors were discussed; however, we did not discuss what experimental backing, if any, these treatments were based on.  I am curious to find out whether or not there was any viable medical research that common battlefield doctors would have been exposed to in their training, or if their treatments were just a result of ignorance.