Rebecca Matteo, a lecturer in sociology at Wake Forest University, teachers the first-year seminar “Health Care Reform:  A Sociological View of America’s ‘Non-System.’”   From preventive health to cost containment, the class explores the fragmented landscape of health care reform from the sociological perspective.  Here Matteo shares her views on the most important issues in health care reform today.

By Rebecca Matteo

As I tell my students, I think one of the biggest “issues” in health care reform currently, is the lack of understanding we, as a country, have about the “health care system” itself. I am excited to hear my students talk about conversations they have with family and friends outside of class related to health care reform. Their eyes are open … and they feel confident to have an opinion that they can both articulate and defend. What I believe is that our system is not truly a “system.” We currently lack centralization, regulation, communication, and organization in the way health care is provided, which is not to say that a socialized system is necessary. But, there are so many gaps in our current fragmented medical complex that the “where to begin” question is overwhelming. I am reminded of this at the start of the semester, when I realize that there are never enough weeks in the semester to consider every relevant topic.

In terms of health care reform in general, I believe that our “non-system” is in need of major change. Compromise is inherent in sweeping policy, but I do agree with the specific focus of removing pre-existing condition clauses from insurance plans, and greater coverage of Americans in general, without losing options (or choice) in coverage. Furthermore, continuity of care is something I personally believe will improve our system, but this requires access and availability of both insurance and general practitioners (potentially facilitated through electronic medical records). In an era marked with the proliferation of chronic disease management and increasingly expensive, yet beneficial, health technology, there must be an effort to support preventive health, both through individual and system-level changes, rather than continued “reactive” and “defensive” medicine, which ultimately lead to wasted time and money.

Within the long history of attempts to provide major reform to the health care system in the United States, I feel that President Obama has forced conversation to an unprecedented level. Creating a dialogue and making decisions transparent are critical ways to help alleviate fears of government control that are pervasive in our society. Sadly, as medicine developed into “big business,” market ideals became entangled with the altruism of the profession. We all suffer for that trend – as the collective interests of health care are now intertwined in a web of fear about life-threatening chronic illness, medical bills, losing insurance, malpractice – on and on. What we do know, is that Americans are very diverse in both their opinions about what is best for the health care system and their own individual health care needs. Whether reform is based upon cost containment, health outcomes assessments, or the satisfaction of patients and health care workers, what we need most is a level of security and consistency for health care providers and their patients.

In the last of a three-part series, David Coates,  discusses why we will not fully resolve our health care crisis until we choose to start living healthily again as individuals, as an economy, and as a society. Coates holds the Worrell Chair in Anglo-American Studies at Wake Forest University. The argument developed here can be followed up in his Answering Back: Liberal Responses to Conservative Arguments, New York: Continuum Books, December 2009

Healthy as a Society

By David Coates

This is not to glorify the 1950s, a time that for many Americans was scarred by misogyny, racism and hidden female despair to which there must be no return. But it is to remind ourselves that in 1970 the ratio of CEO pay to average pay in the top Fortune 500 companies was 70:1. It now normally oscillates somewhere between 250 and 300 to one. We have watched a reasonably equal society separate itself off into an excessively rich minority and a financially challenged bottom third. Poverty and ill-health go together. A more equal society is a healthier society. There are routes to health, we need to remember, which run through social change and economic justice rather than through a resetting of the health care system, vital as that resetting is.

It is surely time to call on America to wake up and smell the coffee. The last years of the Roman Empire were marked by “bread and circuses”. We don’t do bread and circuses here in the United States. We do fast food and the NFL instead. The parallels are terrifyingly close.

In the second of a three-part series, David Coates discusses why we will not fully resolve our health care crisis until we choose to start living healthily again as individuals, as an economy, and as a society.

By David Coates

Healthy as an Economy

Why do we need fast food? We largely need fast food because we don’t have the time and energy to prepare food ourselves. That may be partly because of the need so many of us now seem to have acquired to watch American Idol,  and Monday night football, but it is mainly because we are all working such long hours for such poor pay. As Americans we work on average close to 2000 hours a year: that is, we now work at least 160 hours more than was common in the US at the end of the Vietnam War, and amazingly 400+ more hours than is currently the norm in Northern Europe. We do that in part because pay/hour has not risen for most working Americans (with the exception of a slight increase in the late 1990s) since the 1970s. In one generation we have transformed ourselves into a long-hours, low-wage economy with all the stresses on family life and personal health that such a mixture of work and pay entails. We have become two-income dependent for the maintenance of a modern life-style, and in the process we have lost more than time. We have lost skills – cooking skills. We have lost family meals, cooked and eaten at home. We have lost leisure. We have lost quality time together away from work. We have freed women from the drudgery of unpaid housework and loveless marriages only at the cost of doubling the female work load and pushing us all into a low quality food economy. We need a different economy as well as a different diet.