Social Problems

An Advocate Group Approach

Sara Towe Horsfall

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367320188
• eBook ISBN: 9780429972737
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

This book represents a truly innovative and empowering approach to social problems. Instead of focusing solely on a seemingly tireless list of major problems, Sara Towe Horsfall considers how select key issues can be solved and pays particular attention to the advocate groups already on the front lines. Horsfall first provides a robust theoretical foundation to the study of social problems before moving on to the problems themselves, examining each through the lens of specific advocate groups working towards solutions. This concise and accessible text also incorporates useful learning tools including study questions to help reinforce reading comprehension, questions for further thought to encourage critical thinking and classroom discussion, a glossary of key terms, and a worksheet for researching advocate groups. Social Problems: An Advocate Group Approach is an essential resource for social problems courses and for anyone who is inspired to effect change.

Section II
The Problems

Chapter Five
Problems Addressed through Government Programs

As noted in Chapter 3, some problems are so large that they can only be addressed by a government-run program—health care, welfare, Social Security, Medicaid, and Medicare. Biases and political platforms can make these complex problems more difficult to understand. Issues may be oversimplified, and supporting facts may be selected to support a particular view. One must take care not to be “swallowed up” by rhetoric. Because the proposed changes take a long time to implement, they are also frustrating problems.

Government programs are not necessarily the solution everyone wants. There are different answers to the question, Who is responsible? Some favor socialized programs: they argue that government involvement in daily life leads to long-term social gain for everyone. Others insist that the essence of democracy is individual responsibility and choice, which is threatened by mandatory government programs.

Money is also an issue. Not everyone believes that funding these programs is money well spent. Some costs can be passed on to state or local authorities, or the user (as in medical copays), or donations (nonprofits). Still, each program adds to the national deficit, which has grown so large that it is almost meaningless to the common person. What are the consequences of the deficit? Whatever they are, the government has, so far, been able to continue.

There is a satisfaction in “digesting” the problems and examining the stand of the various players. That is my goal here in presenting these issues. For each problem that is addressed, a solution suggested by one advocate group is presented. All the solutions examined favor large-scale government programs. This does not imply that these are the best or only solutions. They were selected because they add something to the discussion. (1) Physicians for a National Health Program highlights the fact that doctors too face difficulties in the health care system; hence, they favor a nationalized program. (2) The National Committee to Preserve Social Security and Medicare is one of the optimistic voices on the scene at the moment, arguing for the viability of Social Security—a view that sometimes gets drowned out. (3) Legal Momentum advocates for those who fell through the cracks in the current welfare system (TANF). Because their need is so great, one can almost forgive Legal Momentum’s dramatization of the extreme poverty rates. (4) Also recommended is the Gray Panthers. They take an insightful if not strident defense of the federally run Medicare program. Their ardent lobbying has earned them a place at the negotiating table.

No ultimate solutions are given. Negotiations will continue beyond the particulars presented here. Readers are encouraged to research other solutions, and to discuss their strengths and weaknesses. The chapter also includes an analysis (with an aim to understand, not judge the success) of the solution of one health care advocate group, Physicians for a National Health Program, using the analytical tools presented in Section I. Additional advocate groups are given for each of the four problems.

Health Care

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

PREAMBLE TO THE CONSTITUTION OF THE WORLD HEALTH ORGANIZATION AS ADOPTED BY THE INTERNATIONAL HEALTH CONFERENCE, NEW YORK, SIGNED ON JULY 22, 1946, BY THE REPRESENTATIVES OF SIXTY-ONE STATES AND ENTERED INTO FORCE ON APRIL 7, 1948.

The definition has not been amended since 1948.

Around the world people today are healthier and wealthier, and live longer than thirty years ago (World Health Organization 2008). The improvements are even more dramatic when compared with the early 1900s, when the average American lived only forty-seven years. Today the average life span is 77.9 (CDC 2010). However, when the health of people in the United States is compared to those elsewhere, the picture is not so good. Regarding life expectancy, the United States ranks fiftieth, putting it in the lower third of developed countries. In the Virgin Islands it is 79.05 years, in Canada it is 81.23 years, and in Macau—which has the highest life expectancy—it is 84.36 years (CIA 2009a).

Another indicator of a nation’s health is its infant mortality rate.¹ At 6.29 per year, the United States is forty-fourth.² In comparison, Cuba’s rate is 5.82, United Kingdom’s is 4.85, Korea’s is 4.26. In Singapore—the country with the lowest infant mortality—it is 2.31 per year (CIA 2009b).

Medical Tourism

Despite this low international ranking, many Americans believe that we have the best medical care in the world—the most highly skilled doctors, the best-equipped hospitals, and the most advanced medical treatments. In the past, people around the world came to prestigious U.S. health facilities, such as the Mayo Clinic, to get treatments they couldn’t get anywhere else. But today, Americans are traveling to lower-income countries for medical treatment. Medical tourism is a growing industry, featuring less expensive dental, medical, or surgical treatment in places such as Mexico, India, Thailand, Costa Rica, or Turkey. Despite travel costs, lack of insurance, and increased health risks, this is an attractive option (Hareyan 2009).³

Cost of Health Care

Medical tourism points to the biggest health care problem today—expense. Costs have more than doubled since 1990, becoming approximately 16 percent of the economy (Kirkpatrick 2009). Since the 1960s, the average increase per year is more than 10 percent. Half of that increase comes from the complexities of medicine (Greenburg 1982) and new technologies (CT, MRI, organ transplants, and new drugs). The other half comes from increased needs of an aging population, fraudulent claims, malpractice lawsuits, and unnecessary tests recommended by doctors practicing defensive medicine (McBride 2002). Other analysts blame the for-profit system, which leads to rising insurance prices (Brownstein 2009), unpaid medical bills (Hunt 2009), and lack of competition among hospitals (Dafny 2008; Nelson 2009; Thomasson 2002).

Insurance Industry

Rising costs have made the insurance industry a dominant force in health care. The first health insurance was a prepaid hospital plan offered by Baylor University in Dallas in 1929. Health insurance benefits became popular during World War II as compensation for wage controls. Ten years after the war, nearly 70 percent of the country had some form of health insurance (Blue Cross Blue Shield Association 2009; McBride 2002).

Today the cost of insurance is itself an issue. In 2008, the average cost for private health insurance, which 66.7 percent of the population had, was $12,680 per family (U.S. Census). Most families (58.5 percent) have employer-paid insurance, but even so, costs are rising. High deductibles that lower insurance costs for companies are commonly $1,000 or more annually. Out-of-pocket expenses have also increased and insurance covers less and less (Abelson 2008).

Some analysts believe that insurance companies are actually causing the rise in health costs. A total of $300 billion a year, or approximately 15 percent of all medical expenditures, goes to payment processing (LeCuyer and Singhal 2007). The lack of competition is also a problem. There are about 1,300 companies nationwide, but in sixteen states, one company has half (or more) of the insurance policies (Brownstein 2009). Industry peculiarities are another factor. Managed care systems were introduced in the 1970s to control medical costs, but increased administration actually added costs. Income tax exemptions are a third factor. They led to increased premiums and, again, increased costs (McBride 2002).

Uncollected Bills and For-Profit Hospitals

A total of 46.3 million people in the United States, or 15.4 percent of the population, had no health insurance at all in 2008 (U.S. Census).⁴ In Texas the figure was even higher—one-quarter of state residents were uninsured in 2009 (Spangler 2009). An estimated 22 percent of those without health insurance were illegal immigrants (U.S. Census). Even worse off were those with serious health problems or chronic illnesses whose conditions made insurance prohibitively expensive, and yet, prior to the health care reform, they didn’t qualify for government assistance. As a result, they tended to forgo or delay medical treatment, which often exacerbated their condition (Tu and Cohen 2009).

In 2007, about 20 percent of the families in the United States couldn’t pay their medical bills, and 20 percent of them considered bankruptcy as a solution (Cunningham 2008). Sixty-two percent of the bankruptcies that year were due to illness and medical bills (Himmelstein et al. 2009). In 2009, health care costs were a contributing factor in an estimated 800,000 bankruptcies.

TABLE 5.1. FAMILIES WITH MEDICAL BILL PROBLEMS, 2003–2007*

	2003 (%)	2007 (%)
Total US	15.1	19.4
Age 65+	6.9	7.9
Insured <65	14.3	18.3
Uninsured <65	27.2	34.4

* Difference between 2003 and 2007 is statistically significant at p <.05.

Sources: HSC 2003 Community Tracking Study Household Survey; HSC 2007 Health Tracking Household Survey.

When people can’t pay, the costs are borne by others. Doctors and hospitals say the number of unpaid bills is increasing. For instance, in 2007, Texas doctors averaged $85,000 in uncollected bills and gave out an additional $48,000 in charity services. Texas hospitals were unable to collect $5.3 billion (out of $130 billion in total patient charges) and gave out $7 billion in charity services (Hunt 2009). Increased fees commonly offset that revenue.

Hospitals have become dominant players, as well. Some analysts argue that as businesses, they don’t have the competition they need. Sixty percent of the for-profit hospitals with little or no competition generate up to three times more profit. A higher profit comes from higher patient costs and more insurance (Dafny 2008; Nelson 2009; Thomasson 2002).

Complementary Medicine and New Directions in Health Care

The medical system in this country is, by and large, regulated by the American Medical Association (AMA), a professional organization of doctors that was founded in 1847. The AMA works with the state to license practicing physicians and other medical practices.

A lot of the world’s traditional medicine would be considered complementary or alternative medicine in the United States. For instance, the dominant Western model is that a patient is a sick person, whereas other approaches focus on keeping people well. In the West, healing practitioners such as herbalists, midwives, chiropractors, osteopathic physicians, and masseurs were squeezed out as the medical profession developed (Eskinazi 1998). Today, however, many in the United States are dissatisfied with the Western approach, and some 33 percent of Americans seek out complementary or alternative medicines.

In 2007, Americans spent a total of $33.9 billion (11.2 percent of their out-of-pocket medical spending) for alternative practices such as meditation, yoga, chiropractic care, and alternative therapies, as well as herbal supplements. The amount spent on natural products such as fish oil, glucosamine, and Echinacea was $14.8 billion, or more than 33 percent of out-of-pocket prescription drug spending. The amount spent on alternative practitioners such as acupuncturists, chiropractors, massage therapists, homeopaths, and hypnotists was $11.9 billion—a quarter of what was spent on doctors. The 38 million people who visited alternative practitioners spent an average of $122 on their visits (NCCAM 2009; Marchione and Stobbe 2009).

Western doctors have come to accept these treatments as effective in particular situations. In some cases, insurance companies will pay for them (Jonas 1996). Recognizing the importance of alternative approaches to health care, Congress created the Office of Alternative Medicine in 1992, which is housed in the National Institutes of Health.

Quality of U.S. Health Care

The quality of health care in the United States compared to its cost is a major ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Introduction
• SECTION I: THE THEORETICAL BASIS OF THE STUDY OF SOCIAL PROBLEMS
• SECTION II: THE PROBLEMS
• Appendixes
• Index