Healthcare Reform Requires More Than Just Good Policy

We need to understand the motivations of the institutions and norms behind the status quo.

Oregonians need to know and understand that our designed current health care delivery system is a socially constructed institution. It follows along with the principles behind our educational, political, family, and economic socially constructed institutions (Social Institutions, Sept. 29, 2021). Historically, this system was to address society's fundamental social health and healthcare service needs. The system's current strengths and weaknesses stemmed from the public's perceived cultural values, beliefs, traditions, and expectations of the behaviors of others.

Our system was not designed based on empirical evidence regarding how to effectively deliver healthcare. Instead, many community participants and stakeholders shared their ideas, expertise, and valued lived experiences in developing this system. These participants included philanthropists, donors, grant funders, nurses, doctors, health insurance executives, etc. Rarely does the public have a sufficient role in the evolution of this system, despite being the ones who experience the end product (i.e. receive the care or lack thereof) and who deal with the resulting emotional, social, and financial uncertainties associated with an imperfect system. For the public to have a more meaningful role, it's important to first understand the motivations of those currently at the table.

Understanding the social concepts requires having a clear meaning of the relevant terms. For example, the definition of healthcare services is a provision of medical services to prevent, diagnose, and treat health problems. Health is the extent of a person's physical, mental, spiritual, and social well-being. Understanding the terminology and principles behind these elements is of utmost importance because it helps garner public buy-in by reflecting on social facts, attitudes, behaviors, and health outcomes. Understanding our healthcare system's processes and structures can be best achieved by knowing the pathway and the social theoretical framework used to develop it.

So, how did we get here? Health inequities and economic inequality has propelled the need to transform the healthcare system to meet 21st century needs. The areas ripe for transformation include costs containment, quality of care, access to services, consumer provider choices, and organizational health equity. These transformations must get at the core of the system because we're dealing with a system that, over time, became rife with inefficiency, excessive profits, poor objectives, and financial investments from powerful factions.

For too long our health system was steered by those other than the end users (the public) it is intended to serve. For example, special interest groups, politicians, policy idealists, corporate lobbyists, and other high-ranking corporate officials were behind structures and policies that served their interests without thinking about the long-term effects on the public nor the effects on the ability of the system to function. To address these issues is not, as some opponents want you to believe, resorting to Socialized Medicine. Socialized Medicine is a situation where the government owns all the resources such as the hospitals and clinics, properties, and the land. It determines reimbursements and manages the salaries for the physicians, nurses, and all other personnel staff.

Yet, efforts to reform our healthcare system have been branded as socialism in disguise and many members of the public have taken the bait. In our social media driven world, members of the public have been pushed to think of reform in one of two ways:

The first group identified as the functionalists perceives the system to be socially functional in meeting and serving health consumers' health care needs. This belief leaves many urban and rural minority communities, individuals, and families in dire need of critical health care services. Those in this camp are right to think that with money Americans can access great healthcare. But they're wrong to ignore that those lacking funds experience low-cost quality care services, a lack of access to rural and long-term care health facilities, unaffordable health care premiums, limited health coverage plans, few multi-cultural and unbiased services, and, rarely, timely and preventative care treatments. As a result, our system denies too many people access to high-value quality care services at an affordable cost.

The beliefs of the second group, the conflict theorists, have evolved from the concepts of the haves versus the have nots argument. The haves are those with more money, power, and social and political positions such as the major medical associations and large corporations. The have-nots lack social elements of wealth, inadequate health insurance coverage, public representation, recognition, political powers, community voices, and other equal and equitable assets. The haves in this framework do not see the need for drastic reform to our healthcare system because they profit from the status quo and are the people at the table making the decisions about how our healthcare system is structured. When the have nots seek reform, the haves perceive it as attacks on their profits, rather than efforts to improve health outcomes. The distinction between these two classes of people is important because of the insufficiencies in health outcomes that the have nots often experience, which leads this group to think that the focus of the haves, the corporate powers that be, are more profit-oriented than they are in the public's general welfare. Therefore, the need exists to transform our health care system.

The need to transform our system exists because the empirical evidence reveals needed changes in our organizations, practices, policies, and programs. These issues expose multiple harmful outcomes built into our existing healthcare system model. These outcomes make access to quality services too expensive, inefficient, and bureaucratic despite implementing the 2010 Affordable Care Act Patient Protection Clause health insurance plan. How will we achieve transformational success?

The transformed system will be successful, accessible, high-value quality, publicly funded, and affordable for all. We will accomplish this feat by recognizing and understanding existing factual, evidence-based realities that reflect the immediate need for social change to save lives. We will succeed in this effort only by adjusting and adopting new attitudes of our viewpoints. The behavioral and belief changes will enable us to see the world and ourselves differently while interpreting and assigning meanings to the situations witnessed in our internal and external environments. What are the benefits and outcomes of this social change?

In conclusion, the benefits will manifest themselves in enhanced services, elimination of out-of-pocket costs, disassociated private market employer-sponsored health insurance benefit plans, and eliminated cost-sharing. We can also affect minority health disparities, medical bankruptcy, economic inequalities, competitive monopoly market pricing, control, and profit gauging corporate governance. If we adhere to these principles, the anticipated outcomes will lead us to a healthcare system model that is feasible, flexible, reliable, manageable, and sustainable. It will also help achieve our overall goals of expanding medical coverage, ensuring the high-value quality of care, and decreasing healthcare costs.

In doing so, we demonstrate courage and will lead the way as the first transformers of a comprehensive single-payer universal health care delivery system in our state and across the nation.

Glendora was born and raised on a plantation in Blytheville, Arkansas. She endured social injustices, school segregation, and other Jim Crow racial discrimination. 

"Health Care Rally for a Public Option in front of Senator Bill Nelson´s Office" by leoncillo sabino is licensed under CC BY 2.0