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May 26, 2005

POLICY: On Social Class and Health Care
by the Industry Veteran

A WEEK AGO, the NY Times ran a front-page article presenting three case histories of people who sustained MRI’s.  The article by Janny Scott, “Life at the top in America isn’t just better, it’s longer,” is part of an ongoing series examining the effects of social class in the US.  I highly recommend it to all THCB readers as the real heart and soul of what health care analysis is all about, or at least should be.

It will come as no surprise that Scott finds social class determines every aspect of each patient’s episode, “from the circumstances of their heart attacks to the emergency care each received...It shaped their understanding of their illness, the support they got...[and] their relationships with their doctors.  It helped define their ability to change their lives and shaped their odds of getting better.”  In the best traditions of feature journalism, Scott supplies copious detail to illustrate that the enormous treatment differences meted out to patients and the commensurate outcome disparities varied according to social class.

Just within the realm of health care services, the same disparities apply to stroke, cancer, diabetes, chronic viral infections (HIV, hepatitis C) and a raft of other episodes and conditions.  Of course, we could examine most of the other issue areas at the core of contemporary life — education, retirement, child care, leisure, on and on — and find in these that social class is also at the root of discrepant life chances and life styles.

The Times’s article also underscores a point that you and I have both made on TCHB several times, namely that the holy-of-holies under Reagan-Bush-Bush, the omnisciently unregulated market, is a piss poor way of delivering goods and services that have such enormous impact upon the length and quality of lives.  Markets stratify the public into segments, they often require long periods to self-correct, and they tend to evolve in ways that subvert the very preconditions for a market.  Some of those market system shortcomings, within moderate limits, may be acceptable for consumer packaged goods, luxuries and certain other sectors.  Health care is too important, however, to leave in the hands of the oligopolists and plutocrats who run markets.

May 26, 2005 in Policy | Permalink

Comments

Thank you for articulating these issues.

I would like to add that it's more difficult for poor people to resolve billing problems because bureaucrats seem to assume they won't be able to get help. A good-looking, well-dressed, "classy" person probably has the resources to have their rights enforced.

And I can vouch personally for the way poverty shapes health problems and visa versa. I have genetic disorder that could be practically invisible at my age, but since I don't have access to even basic treatment (I need a doctor to prescribe - that scrip pad is such a racket!), I suffer from various related health problems. Mostly minor, but enough to impact the quality of my life and have ramifcations for my potential and opportunities.

Hey, this is a good opportunity to gripe yet again about how the DMHC procrastinated and tried to shrug off my HMO complaint (re: HMO - Kaiser - refused to interview the right doctor about the issue). Later, when Kaiser becomes the DMHC's client against me, the first thing that happened was that the DMHC dropped my case. The explanation was my complaint didn't fit under the Knox-Keene Act, which is RIDICULOUS. What kind of society do we live in where State Agencies just ignore and dismiss poor people, but serve as attack dogs for major corporations who want to quash some thorn in their sides? I say we just capitulate to reality and transfer all citizenship rights to High Networth Individuals and their lawyers, investment bankers, and lobbyists.

Posted by: gadfly | May 26, 2005 5:48:46 PM

How do they define class in these articles. In the UK if you've got a good university degree, you're middle class even if you make next to nothing, and that level of education affects what you get. I mean, go into the Radcliffe Infirmary as the wife of the master of an Oxford College who is a trustee of the hospital and you'll probably get better care than somebody with more money who goes private.

Posted by: Abby | May 26, 2005 8:36:06 PM

One way of levelling the field somewhat, is to send your complaint to an important person. DMHC, for example, has a special set of procedures, labelled "VIP procedures", for handling complaints referred down from the Governor, Director, etc.
Of course, you still need to be educated enough to express yourself fairly rationally.

Harvey

Posted by: Harvey S. Frey | May 27, 2005 9:25:13 AM

The Governor's Office doesn't even respond to my letters, so I need VIP access to the Governor's Office to get VIP access to the DMHC. :-/

Frankly it really bothers me that a State agency would consider some citizens better than others to the point where they would develop special procedures.

Posted by: gadfly | May 27, 2005 12:04:51 PM

gadfly,

It is sort of expensive. I think the basic thrust is that politicians know that they can get voted out. So if you address your complaint to them, they will make sure that it gets taken care of. If you're crazy though, they may not bother to push on your behalf. The special procedures might reflect the fact that there's been an additional level of screening before the complaint went forward.

Posted by: Abby Vigneron | May 28, 2005 7:14:20 AM

//So if you address your complaint to them, they will make sure that it gets taken care of.//

I'm going to ask for the benefit of the doubt that I'm not crazy, and I don't come across as crazy when I ask for help.

California politicians and agencies are genuinely non-responsive. In the last two years of writing repeatedly for help, I have only gotten a couple generic responses. These asked for me to provide information so the politician can start a case file. Then nothing happens. Both Feinstein and Boxer have each given me the courtesy of a response - with the remark they were passing the problem on to the Governor's Office. I've never managed to get a response from the Governor's Office to follow up on this. Apparently my vote doesn't matter.

Also, Don Perata, who is my local State Senator, after ignoring me for a year, helped me for five minutes while I had some press. His Office contacted a State agency for me, but the State agency lied to him about a deadline being passed because they didn't realize I had already filed my complaint with them. When I went back to Perata's Office to say that they had been misinformed about the deadline, they told me that they "couldn't" help me further. I.e., the 5 minutes of press was over.

On the Federal level the Office of Civil Rights is not responding to me at all. No one is compelling them to.

In California, the DMHC has broken a settlement with me and has failed to apologize for putting an Order and press release out with a false accusation. They both overstepped their jurisdiction and were duped into hijacking my first amendment rights. You'd think that my political representatives would be interested. Nope.

The Attorney General has not replied to me.

The FTC, which is a longshot in this situation, has provided an automatic response to acknowledge my inquiry.

I've tried writing the President a few times as well: nothing but canned responses from the White House.

I think the public believes that there are certain safety nets in place. If the cause is just, the ACLU or some high-minded law firm will provide pro bono help. If the person isn't crazy, then their political representatives will help. People have a constitutional right to petition the government, so they can just fling themselves before a Judge, and they will get justice. The average person on the street might not trust the media, but they look to whether this assured safety net has come into play to cue them as to what to think. Meanwhile the ostensible safety net is looking at the people (the "voters") to see if they have to bother. This situation is creating a class of people who are outside the community, who do not enjoy the protection of the law or the benefits of citizenship. Meanwhile the people who are enjoying and/or don't currently need that sort of protection or benefit maintain the illusion of the safety net.

Someday, I hope I can point all this out from a podium, so people might listen and care.

Posted by: gadfly | May 28, 2005 1:19:33 PM

Does anyone remember when it was called "medical treatment"? Then it turned into "medical care" and quickly morphed into "health care". Is this really caring for health? Doesn't this system concern itself with disease and the disease caused by the medical treatment of disease? Doesn't it exclude the people who really do concern themselves with preserving health?

Is actual care of health covered by insurance? No, only medical treatment is covered. So why do insurers call this "health care"?

Posted by: Jana Hill | May 22, 2007 7:29:59 PM

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