Please write a paper analyzing the film using the concepts from Chapter 14 on Health Care - Chapter 8 and 10 This is the film: https://www.vudu.com/content/movies/details/title/... I've attached the question and I would like to solve it using text book

20181203173604chapter_14_on_health_care.pdf

Home >Education homework help >Please write a paper analyzing the film using the concepts from Chapter 14 on Health Care - Chapter 8 and 10 This is the film: https://www.vudu.com/content/movies/details/title/... I've attached the question and I would like to solve it using text book

E DUCATION AND HEALTH CAR E 351

Despite assertions by politicians that this law has had a positive and “dramatic” effect, the results have shown that wide gaps persist in verbal and math test scores. The gap has actually widened under the NCLB law. Some of the gap in test scores, as we have seen, can be attributed to poor measurement and cultural bias in the tests, but the problems in the education system run deep and cannot be measured by test scores alone.

Other federal initiatives focus on school reform, with little success. Political controversy centers on how to fund education, where best to spend tax dollars, and what policies would be most successful. Key issues in the education debate are:

1. adopting standards and assessments that will pre- pare students to succeed in college and the work- place and to compete in a global economy;

2. developing good measures of student success that can be used to inform teachers and administrators about improving instruction;

3. recruiting, rewarding, and retaining the best teach- ers and principals; and

4. improving the lowest-achieving schools.

Educational reform is difficult to implement. Educa- tional reform must begin with a clear understanding of education as an institution, including how schools create and reinforce inequality. Continued research and governmental commitment will help create a more balanced, fair, and successful model for educating Americans.

Health Care in the United States Like education, health care in the United States is also an institution. The United States still has some of the most sophisticated health care treatment in the world, but is it affordable? Who has access? Why are costs for medical insurance so high? Why are some Americans at greater risk for illness than others? What role should the government play in providing health care to its citi- zens? These questions are at the core of current political struggles about health care, but they are also informed by sociological research and theory.

Generally speaking, the citizens of the United States are quite healthy in relation to the rest of the world. As we will see, there are very great discrepan- cies among people within the United States in terms of how healthy they are and their access to health care. Although health is a physiological phenomenon, it has social dimensions. The field of medical sociology stud- ies these social dimensions of health and illness, the social organization of health care institutions, and the inequality of access to quality health care.

Health and Illness Illness and how to treat disease have advanced greatly over the course of American history. Scientific break- throughs in the natural sciences have brought us to a remarkable time in Western medicine when Ameri- cans have access to diagnosis, treatment, and cures for so many diseases once believed to be fatal. Under- developed countries are far behind American medi- cal schools and hospitals in availability of treatments, diagnostic tests, and social support for the sick. In many ways, the modern American system of health care and medicine is a model of success.

There are, however, problems in the U.S. health care system. Much like our education, medical institu- tions are social structures that create different experi- ences for different groups of people. The system is not perfect. The issue largely revolves around unequal access to good health care. The debate over affordable health care and equality of care has dominated the recent political landscape.

Another problem for U.S. health care is the overall model of how we treat disease. Because of technologi- cal advances in science, the assumption is that the most up-to-date treatments are better for patients and have better success. In many cases, this is true. It is better to put antibiotic cream on an open wound, than “bleed” it with an unsterile cut. Non-Western techniques, however, are not entirely without merit. There are examples of people traveling to India to practice yoga to cure nerve disorders. Right here in the United States acupunctur- ists are successfully treating people for everything from chronic back pain to breach pregnancies. One complaint of our health care system is that these alternative medical practices are not always endorsed by physicians and are rarely paid for by insurance. The most recent survey finds that Americans paid at least $34 billion in one year on complementary and alternative medicine—that is, things such as herbal supplements, chiropractic, yoga, medita- tion, acupuncture, and other products and services that are not part of traditional medicine (Valles 2014; National Institutes of Health 2007).

Critics of the health care system also contend that there is a lack of emphasis on prevention. Medicine in this country follows mostly a disease model in which patients are first diagnosed and then treated for the illness. Despite evidence that prevention of many ill- nesses is possible, the system is structurally set up for treatment rather than prevention. Most health insur- ance does not, for example, reimburse a health club or gym membership for someone at high risk for diabetes. The cost of managing diabetes far outweighs the cost of supporting an active lifestyle to prevent diabetes.

If health care institutions turned attention to pre- vention, several costly and difficult health problems could be significantly reduced in the United States.

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352 CH APT ER 14

Obesity is a major health concern in the United States, and a contributing factor for heart disease, stroke, diabetes, and some cancers. Recently, the Centers for Disease Control and Prevention classified obesity as an ep idemic, with about 35 percent of adults and 17 percent of children aged 2 through 19 classified as obese (Ogden et al. 2014). Obesity occurs when more calories are consistently ingested than are burned through physi- cal activity. The epidemic of obesity, costing the United States nearly $150 billion annually, is a social problem well beyond the scope of individual behavior (Centers for Disease Control 2011). Individuals do not simply lack self-control when eating. Instead, environmental factors have created a society focused on food, where what we eat, when we eat, and how much we eat are contributing to Americans’ obesity.

One environmental factor is the unavailability of fresh, affordable, and healthy foods for many. Many peo- ple in low-income inner-city neighborhoods, for exam- ple, have to go miles before reaching a grocery store with fresh, affordable produce. Convenience stores, vending machines, and fast-food restaurants dominate the city landscape, certainly in poorer areas. These places pro- vide inexpensive, calorie-rich foods that fill people up. Unfortunately, these foods are also rich in fat and lack key nutrients needed for healthy bone development and childhood growth. The racial and socioeconomic characteristics of these neighborhoods mean that some racial groups are more likely than others to be obese, especially among children (see ▲ Figure 14.4). A steady diet of high-fat, high-sugar, and highly processed foods increases the likelihood of obesity.

Scientific knowledge provides the know-how to battle obesity. Health professionals are aware of the benefits of healthy foods and physical activities, and more emphasis is being placed on staying physically

fit and eating well. Given the social and cultural dimensions of overeating, however, the struggle to reduce the number of obese Americans is still chal- lenging. New governmental guidelines for nutrition, state and federal initiatives for physical activity, and media emphasis on weight loss are all part of a good start for reversing the obesity trend. Health care insti- tutions can also be part of the solution by includ- ing healthy eating and exercise as part of an overall prevention-focused medical plan.

The Social Organization of Health Care Health care is now a vast institution, including not only hospitals and doctors but also many auxiliary sectors, such as nursing homes, rehabilitation centers, drop-in clinics, and various “alternative” health care services, such as homeopathy, wellness centers, and even exer- cise and nutrition centers. The colossal factors in the organization of health care institutions are the for-profit insurance and pharmaceutical companies. Health is big business. The connection between for-profit compa- nies, the government, and health care lies at the heart of current debates about health care.

The United States is one of the few industrialized nations that does not provide universal health care to its citizens. The 2012 passing of the Affordable Care Act (referred to as Obamacare) aimed to address the prob- lem of too many uninsured Americans. Health care in the United States is a labyrinth of health care deliver- ers, for-profit insurance companies, and government programs that provide health care for the aged and for the poor. Entitlement programs like Medicare (which provides health insurance to older Americans) and

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▲ Figure 14.4 Percent of Children Aged 12–19 Who Are Obese, 2009–2012 Obesity among children is health problem in America, especially among minorities. Source: Centers for Disease Control. 2013. Health United States 2013. Hyattsville, MD: National Center for Health Statistics. www.cdc.gov/nchs/data/hus/hus13.pdf

Supersized food is contributing to the problem of obesity.

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Medicaid (which provides health insurance to poor Americans) remain the subject of political debate, as does the Affordable Care Act.

The Affordable Care Act works through a market- place of health insurance exchanges that vary state to state. People obtain coverage through competing health care providers, enrolling during periods of open enroll- ment. The key provisions of the Affordable Care Act are:

1. expansion of the availability of health care insur- ance to all Americans;

2. insurance companies may not deny coverage to children (under age 19) because of preexisting conditions;

3. elimination of lifetime coverage limits on insurance coverage, although there can be annual limits;

4. insurance plans must cover preventative care, such as mammograms and colonoscopies, without charging deductibles and co-pays;

5. young adults are allowed to stay on parents’ plan until age 26;

6. early retirees keep their employer-sponsored ben- efits until they are eligible for Medicare.

Early reports show that, on that last goal, the Affordable Care Act is helping minimize the number of

uninsured people. Fewer Americans are without health insurance (across all race groups; see ▲ Figure 14.5). According to the official website of the Affordable Care Act, over eleven million people signed up for health insurance through the government marketplace in 2015.

The critics of the Affordable Care Act claim that insurance costs will rise for companies that employ workers, leading them to cut back on jobs and force many companies to fail. Another analysis argues that, under the new policy, physicians will be unable to col- lect payment for much of their work, leading to fewer quality doctors in practice. Despite the passing of the new law, debate continues in the political arena and among health care professionals over how to best pro- vide care for people in the United States.

The American health care system has been com- pared to those of other Western countries and revealed some clear differences. For example, in European coun- tries like France and Germany, health care is much more unified in approach, allowing patients to experi- ence more cohesive care from diagnosis to treatment to cure (Reid 2010). In the United States, a specialist, a doctor who concentrates on one specific area of medi- cal care, is desirable for almost any illness. Primary care physicians are not expected to treat disease, but rather

How does one best care for a dying family member? The current health care system has few options for end- of-life care. Because the disease model currently in place in the United States emphasizes treatment, few doctors will guide patients through the end of life. Insurance companies often

When Should Treatment Stop?: Issues for End-of-Life Care

do not cover the cost of palliative care (not to cure or fix, but simply to keep comfortable) or hospice care (to keep comfortable through the dying process). Less than one-third of Americans die in hospitals. Most people prefer to die at home with family around them (Ko et al. 2013). Caring

for the elderly typically falls to women (Jordan and Cory 2010), and clear cultural differences among different American families should be consid- ered when reforming end-of-life care (Ko et al. 2013; Cravey and Mitra 2011). Sociologists examine the cultural expectations and structural inequality in caring for dying family members. At what point are doctors and hospitals no longer needed?

what would a sociologist say?

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▲ Figure 14.5 People without Health Insurance Coverage, 2013–2014 This chart shows the declin- ing percentage of people in different race groups who did not have health insurance from 2013 before the Affordable Care Act to January through June 2014, after the Affordable Care Act. Given what you see, who benefitted the most? Source: Martinez, Michael E., and Robin A. Cohen. 2014. Health Insurance Coverage: Early Release of Estimates from National Health Interview Survey, January–June 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, National Center for Health Statistics. www.cdc.gov/nchs /data/nhis/earlyrelease/insur201412.pdf

354 CH APTER 14

to simply manage good health and then refer patients to a specialist when needed. This contributes to the confu- sion, the high cost, and the ineffectiveness of American health care. Patients often complain that diagnostic test results are not shared between doctors or are not done at all. Multiple doctors may be involved in diagnosis and treatment, and they are not in agreement or are not communicating effectively with one another.

The confusion and frustration in managing care is challenging even in the best of cases. For fully insured Americans with high education and good incomes, navi- gating through the health care system is often complicated and difficult. For the millions of Americans who are not insured, have less education, and are financially vulner- able, an illness can be devastating in more ways than one.

→ SEE for YOURSELF ← Mapping Food Identify two neighborhoods in your community that differ by their social class and/or racial composition. Draw a map of each neighborhood and then take a drive through each with your map in hand. Mark every place where you see some kind of food outlet, and mark whether it is a major grocery chain, a convenience store, fast-food outlet, or other provider of meals. You might also note what kind of transportation is needed to get to each location. When you have finished, what patterns do you see about the availability of healthy food in each neighborhood? If you lived in either, how far would you have to go to purchase fresh, good-quality food? Can you get there without a car? What does your experiment suggest about class and race disparities in health outcomes?

Health and Inequality Medical options are not equally available to all Americans. Health care institutions re-create the struc- tural inequality of society. Prominent problem areas in the U.S. health care system include the following:

● Unequal distribution of health care by race– ethnicity, social class, or gender. Health care is more readily available and more readily deliv- ered to White people than to others. Yet, as late as 2012, 19 percent of White adults still had no usual source of health care. This compares to 22 percent of African Americans, 21 percent of Asian Americans, 24 percent of American Indians and Alaska natives, and 34 percent of Hispanics. Men are less likely than women to have a source of health care (Centers for Disease Control 2013).

● Unequal distribution of health care by region. Each year, many in the United States die because they live too far away from a doctor, hospital, or

emergency room. Doctors and hospitals are concen- trated in cities and suburbs; they are much less likely to be situated in isolated rural areas (Hartley 2014).

● Inadequate health education of inner-city and rural parents. Many inner-city and rural parents do not understand the importance of immunizing their children against smallpox, tuberculosis, and other illnesses, and they are often suspicious of immuni- zation programs. This hesitancy is reinforced by the depersonalized and inadequate health care that resi- dents of low-income communities often encounter when care is available at all.

DEBUNKING Society’s Myths← Myth: The health care system works with the best inter- ests of clients in mind. Sociological Perspective: The health care system is structured along the same lines as other social institu- tions, thus reflecting similar patterns of inequality in society (Barr 2014).

Race and Health Care Racial disparities in health mean that African Americans are more likely than Whites to fall victim to various dis- eases, including cancer, heart disease, stroke, and dia- betes. Although the occurrence of breast cancer is lower among African American women than White women, the mortality rate (death rate) for breast cancer in African American women is considerably higher than it is for White women (Centers for Disease Control 2013).

Hispanics, like African Americans, Native Ameri- cans, and other minorities, are also significantly less healthy than Whites (Centers for Disease Control 2013). Hispanics contract tuberculosis at a rate seven times that of Whites. Other indicators of health, such as infant mortality, reveal a picture for Hispanics similar to that of African Americans and Native Americans.

Although differences in culture, diet, and lifestyle account for some of the racial disparities in health care, it is well established in study after study that African Americans and Latinos simply do not receive medical attention as early as Whites. When they do get treat- ment, the stage of their illness is often more advanced and the treatment they receive is not of the same qual- ity. African Americans and Hispanics, especially when they are poor, are less likely than Whites to have a regu- lar source of medical care (see Figure 14.5). When they do, it is likely to be a public health facility or an out- patient clinic. Because of language barriers as well as other cultural differences, Hispanics are less likely than other minority groups to use available health services, such as hospitals, doctors’ offices, and clinics (National Center for Health Statistics 2013).

E DUCATION AND HEALTH CAR E 355

Social Class and Health Care In the United States, social class has a pronounced effect on health and the availability of health services. The lower the social class status of a person or fam- ily, the less access available to adequate health care (National Center for Health Statistics 2013). Conse- quently, the lower one’s social class, the less long one will live. People with higher incomes who are asked to rate their own health tend to rate themselves higher than people with lower incomes. The effects of social class are nowhere more evident than in the distribution of health and disease, showing up dramatically in the rates of infant mortality, stillbirths, tuberculosis, heart disease, cancer, arthritis, diabetes, and a variety of other illnesses. The reasons lie partly in personal habits that are themselves partly dependent on one’s social class. For example, those with lower socioeconomic status smoke more often, and smoking is the major cause of lung cancer and a significant contributor to cardiovas- cular disease (Centers for Disease Control 2013).

Social circumstances also have an effect on health. Poor living conditions, elevated levels of pollution in low-income neighborhoods, and lack of access to health care facilities all contribute to the high rate of disease among low-income people. Another contrib- uting factor is the stress caused by financial troubles. Research has consistently shown correlations between psychological stress and physical illness (Taylor 2010). The poor are more subject to psychological stress than the middle and upper classes, and it shows up in their comparatively high level of illness.

Medicaid is the government program that provides medical care in the form of health insurance for the poor, welfare recipients, and the disabled. The program is funded through tax revenues. The costs covered per individual vary from state to state because the state must provide funds to the individual in addition to the funds that are provided by the federal government. Medicaid, Medicare, and now the Affordable Care Act are as close as the United States has come to the ideal of universal health insurance.

Gender and Health Care Although women live longer on average than men, national health statistics show that hypertension is more common among men than women until age 55, when the pattern reverses. This may reflect differences in the social environment men and women experience, with women finding their situation to be more stress- ful as they advance toward old age (National Center for Health Statistics 2013).

Health and Disability The disability rights movement, a movement that has defined disabled people as a social group with rights

similar to other minority groups in society, has trans- formed how people think about disability, challenging many preconceived ideas. For example, within a social context, there is a tendency for people to see someone with a disability solely in terms of that social status— what sociologists call a stigma. A stigma is a social iden- tity that develops when a person is socially devalued by others because of some identifiable characteristic. When someone is stigmatized, that identity tends to override all other identities, and the person is treated accordingly.

Understanding the social dynamics associated with disabilities has resulted from the efforts of the disability rights movement. The movement has called attention to the social realities of disabilities, even questioning the very language used to identify people with disabilities—for example, using the term physi- cally challenged rather than the more negative conno- tation of disabled.

One of the most significant achievements of the disability rights movement is the Americans with Dis- abilities (ADA) Act, passed by Congress in 1990. This law prohibits discrimination against people with dis- abilities. The ADA legislates that people with disabilities may not be denied access to public facilities—thus the presence of such things as ramps, wheelchair access on buses and stairways, handicapped parking spaces, and chirping sounds in crosswalk lights for blind pedestri- ans, all social changes that are now so prevalent that you might even take them for granted. They have resulted, however, from the social mobilization of those who saw a need for social change.

The Americans with Disabilities Act also requires employers and schools to provide “reasonable accom- modations” such that those with disabilities are not denied access to employment and education. For

The disability rights movement has opened up new opportunities for those who face the challenge of disability.

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many students with various learning disabilities, this has meant making accommodations for taking tests with extended time or in settings where the test taker is not subject to as much distraction as in a crowded classroom. The increased awareness of disability rights has transformed society in ways that have opened up new opportunities for those who, years ago, would have found themselves with less access to education and jobs and, therefore, more isolated in society.

Age and Health Care As people age, their health care needs are no doubt likely to increase. Until recently, many of the nation’s elderly were also likely to be low income. Although class status varies among the nation’s elderly, all older people at this point are beneficiaries of the national Medicare program. Medicare was begun in 1965, under the administration of President Lyndon Johnson. It provides medical insurance, including hospital care, prescription drug plans, and other forms of medical care for all individuals age 65 or older. The Affordable Care Act also aims to strengthen Medicare benefits.

Medicare is partially funded through payroll taxes whereby both employees and employers pay a small percentage of employee wages to cover some of the cost of this large (and costly) federal program. But, with so many people in the population now living longer, and with the now aging baby boomer population being such a large share of the total population, many wonder if Medicare can be sustained in the near future. With the number of workers paying payroll taxes shrinking, the elderly population growing, and the cost of health care rising, there is a looming fear that Medicare simply can- not be financially sustained. Though not the sole basis for the nation’s challenges in health care, the health needs of the older population are clearly a major challenge.

Theoretical Perspectives of Health Care The sociology of health is anchored in the same major theoretical perspectives that we have studied through- out this book: functionalist theory, conflict theory, and symbolic interaction theory (see ◆ Table 14.3).

Functionalist Theory Functionalism argues that any institution, group, or organization can be interpreted by looking at its posi- tive and negative functions in society. Positive func- tions contribute to the harmony and stability of society. The positive functions of the health care system are the prevention and treatment of disease. Ideally, this would mean the delivery of health care to the entire popula- tion without regard to race, ethnicity, social class, gen- der, age, or any other characteristic. At the same time, the health care system is notable for a number of nega- tive functions, those that contribute to disharmony and instability of society.

Functionalism also emphasizes the systematic way that various social institutions are related to each other, together forming the relatively stable char- acter of society. You can see this with regard to how the health care system is entangled with government through such things as federal regulation of new drugs and procedures. The government is also deeply involved in health care through scientific institutions such as the National Institutes of Health, a huge gov- ernment agency that funds new research on various matters of health and health care policy. As a social institution, health care is also one of the nation’s larg- est employers and thus is integrally tied to systems of work and the economy.

◆ Table 14.3 Theoretical Perspectives on the Sociology of Health

Functionalism Conflict Theory Symbolic Interaction

Central point The health care system has certain functions, both posi- tive and negative.

Health care reflects the inequalities in society.

Illness is partly socially constructed.

Fundamental prob- lem uncovered

The health care system produces some negative functions.

Excessive bureaucratization of the health care system and privatization lead to excess cost.

Patients and health professionals serve specific roles. What is deter- mined as illness is specific to cultural context.

Policy implications Policy should decrease nega- tive functions of health care system for minority groups, the poor, and women.

Policy should improve access to health care for minority racial–ethnic groups, the poor, and women.

Determining something as disease will make insurance reimbursement more likely.

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Conflict Theory Conflict theory stresses the importance of social struc- tural inequality in society. From the conflict perspec- tive, the inequality inherent in our society is responsible for the unequal access to medical care. Minorities, the lower classes, and the elderly, particularly elderly women, have less access to the health care system in the United States than Whites, the middle and upper classes, and the middle-aged. Restricted access is fur- ther exacerbated by the high costs of medical care.

Excessive bureaucratization is another affliction of the health care system that adds to the alienation of patients. The U.S. health care system is burdened by endless forms for both physicians and patients, includ- ing paperwork to enter individuals into the system, authorize procedures, dispense medicines, monitor progress, and process payments. Long waits for medical attention are normal, even in the emergency room. Pro- longed waits have reached alarming proportions in the emergency rooms of many urban hospitals in the United States and can only deepen the alienation of patients.

Symbolic Interaction Theory Symbolic interaction theory holds that illness is partly (although obviously not totally) socially constructed (Armstrong 2003). The definitions of illness and well- ness are culturally relative—the social context of a con- dition partly determines whether or not it is sickness. Consider the example of alcoholism and other addic- tions. During the era of prohibition, people who drank were considered deviants and lacking moral fortitude. Now, however, alcoholism is a diagnosable disease, listed in the Diagnostic Statistical Manual as an illness. The medicalization of alcoholism refers to how Ameri- cans culturally and socially label abuse of alcohol as a disease that requires treatment. This has profound con- sequences for how people with alcoholism are treated. People who are ill receive more sympathy and more care than those who are labeled deviant.

Symbolic interaction also highlights the roles played within the health care institution. There is a hier- archy that puts medical doctors at the top and medical assistants, nursing staff, and orderlies at the bottom. Patients take on the role of a child, with little agency in how treatment is administered. The diagnosis, the treatment plan, and the prognosis are managed with little input from the patient. Insurance companies and pharmaceutical companies play an entirely different role, one that oversees the availability of medical care by determining what procedures or treatments will be financially covered.

The symbolic interaction approach to study- ing health care institutions focuses on the roles of the patient and medical professionals and on the cultural

context within which disease is labeled and treated. Table 14.3 outlines the theoretical perspectives of health care and illness.

Health Care Reform Currently, the cost of medical care in the United States is approximately 18 percent of our gross domestic product, making health care the nation’s third leading industry. The United States tops the list of all countries in per person expenditures for health care (The World Bank 2014a). Other countries spend considerably less money and deliver a level of health care at least as good. For example, Sweden and the United Kingdom spend roughly half as much per capita as the United States, and Turkey spends a bit more than one-third as much.

The Cost of Health Care One of the challenges of health care is sheer cost. Most health care is provided by a fee-for-service principle in which patients are responsible for paying the fees the health care provider charges. Patients with health insurance are able to pass on health expenses, either in full or partially, to the insurance company, but the cost for health care services is high, in some cases, astro- nomically expensive. Hospital care can cost thousands, even millions, of dollars for any extended stay. Sophis- ticated procedures require expensive machinery and technicians, and the nation needs to invest in medical research that allows practitioners to stay abreast of new

Medical technologies add to the quality of health care, but also to the cost.

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technologies and new treatments for a wide array of medical conditions.

Most sectors of the health care system (hospitals, pharmaceutical companies, even physician’s office practices) are structured as for-profit businesses. Physi- cians, for example, may have to raise their rates to cover the high cost of malpractice insurance where annual insurance premiums (costs) have skyrocketed. The cost of these insurance premiums is passed along to con- sumers (patients) and has contributed to the rise in the overall cost of health care.

Adding to the high cost of health care is the role of big pharmaceutical companies. Spending for pre- scription drugs in the United States has increased from $40 billion in 1990 to a whopping $326 billion in 2013 (Schumock et al. 2014)! There is little sign that this spending will do anything but go further up. Prescrip- tion drugs are one of the fastest-growing components of health care costs. The rise in spending on drugs is partially attributed to increased use, but other factors include the actual cost of the drugs, the availability of new drugs for various maladies, and, without ques- tion, the cost of advertising directly to the public. The money spent on advertising directly to consumers has doubled since 1999 (Kaiser Family Foundation 2010). You can see this yourself as hardly an hour goes by on television without an advertisement for some kind of prescription drug.

The health care crisis in the United States is largely a question of cost, but it also entails a debate over the nation’s responsibility for the health of its citizens. Who should pay for the soaring costs of health care? Who receives the benefits of such sophisticated medi- cine? Should there be universal health care for all, like we are seeing through the Affordable Care Act? These

questions are at the heart of the current national debate about health care reform.

Health Care for All? Despite the success of the Affordable Care Act in get- ting many more Americans health insurance, there is strong opposition to the program. Many in Congress are working to repeal the Affordable Care Act. Why are so many in the United States resistant to provid- ing health care to its citizens in line with other Western nations? Sociologists offer several explanations. First, there is an antigovernment attitude among many in the United States that fuels resistance to a national health care system. The argument in Congress is that the gov- ernment should not force people to spend money on health insurance. Second, analysts argue that, unlike in other Western nations, there is a relatively weak labor movement in the United States, resulting in more lim- ited state-based benefits for workers. Third, racial poli- tics have also shaped the nation’s health care system; federal social welfare programs are associated in many people’s minds with racial groups, and this, too, fuels the politics of health care reform. Finally, the health care system in this country is fundamentally structured on private, for-profit interests (Quadagno 2005).

Without the Affordable Care Act, millions more Americans will be uninsured. This creates vulnerabil- ity for people, especially people in poor communities, when they get sick. For Americans without insurance, the main source for medical care is a hospital emer- gency room, often called the “doctor’s office of the poor.” This is a very expensive way to deliver routine health care—and there is rarely any follow-up care or comprehensive and preventative treatment.

Many uninsured people wait in long lines to sign up for government-run health and medical plans.

The high cost of prescription drugs is indicative of the problems generated by a profit-based health care system.

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→ SEE for YOURSELF ← Youth and Health insurance Identify a group of young people you know and ask them if they are covered by health insurance. If they are insured, where does their insurance come from? Who pays? Did they use the Affordable Care Act marketplace to find insurance? If they are not insured, ask them why not and whether they think this is important. Do they support a national health insurance program?

Having conducted your interviews, ask yourself how social factors such as the age, race, ethnicity, gender, and educational/occupational status of those you interviewed might have affected what people say about their insur- ance. Do you think any or all of these social characteristics are related to the likelihood that people are covered by health insurance and whether these characteristics are related to their attitudes about coverage? What are the implications of your results for public support for new health care policies?

What is the importance of the education institution? Education is the social institution that is concerned with the formal transmission of society’s knowledge. It is therefore part of the socialization process. Although the U.S. education system has long produced students at the top of the world’s educational achievements, the United States is falling behind other nations on stan- dardized test scores.

How does sociological theory inform our understanding of education? Functionalism interprets education as having various purposes for society, such as socialization, occupational training, and social control. Conflict theory emphasizes the power relationships within educational institutions, as well as how education serves the powerful interests in society. Symbolic interaction theory focuses on the subjective meanings that people hold. These meanings influence educational outcomes.

How does education link to social mobility? The number of years of formal education for individuals has important effects on their ultimate occupation and income. Social class origin affects the extent of educa- tional attainment (the higher the social class origins, the more education is ultimately attained), as well as occupa- tion and income (higher social class origin likely means a more prestigious occupation and more income).

Does the educational system perpetuate or reduce inequality? Although the education system in the United States has traditionally been a major means for reducing racial, gender, and class inequalities among people, the edu- cation institution has perpetuated these inequalities. Segregation of schools and communities keep minor- ity and poor children in schools that lack resources for success.

What current reforms are guiding education? The No Child Left Behind Act program emphasized accountability in the schools, largely through testing. Current educational reforms focus on achieving educa- tional standards, assessing school progress, and devel- oping strong measures of student and teacher success. Free community college is also an educational reform idea.

How does the United States compare to other nations in the area of health care? The United States is only recently providing universal health care for its citizens, through the Affordable Care Act. Despite disagreement with this program, more Americans now have health care insurance. The health care system is organized according to social patterns, including that disease itself is influenced by social facts, such as race, gender, and social class.

Chapter Summary B

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The Affordable Care Act was finally passed into law in June 2012, after the Supreme Court ruled it did not violate the Constitution. The debate over whether or not to appeal “Obamacare” continues.

3 60 CH APTER 14

How does sociological theory inform our understanding of health and health care? Functionalism interprets the health care system in terms of the systematic way that health care institutions are related to each other. Conflict theory addresses the inequalities that occur within the health care system. Symbolic interaction analyzes the interpretations that can affect people’s health care, such as the tendency to place patients in a sick role and label some ailments as disease and others not.

What is the health care crisis in the United States? High costs and questions about universal health care have created a policy crisis today in the U.S. health care system. The Affordable Care Act addresses some of the problems on universal health care, but the policy remains controversial.

achievement test 343 Affordable Care Act 352 Brown v. Board of

Education 341

cultural capital 348 individualized education

programs 349 Medicaid 353

Medicare 352 schooling 340 self-fulfilling

prophecy 344

stigma 355 teacher expectancy

effect 342 tracking 349

Key Terms

Ch 14: Education and Health Care

Health Care in the United States
Health and Inequality
Theoretical Perspectives of Health Care
Health Care Reform
Chapter Summary