Author Archives: leilahoushmand

‘Opting-Out’ of Child Insurance Plans

It was so fitting to find this article on health reform with the discussions we have had in class the past few weeks.  The article tells the story of Phillip and Diann Green who took in their granddaughter and raised her as their own.  Now that the Greens have reached retirement age and are beginning to be able to draw from Medicare, they went to seek an insurance plan to cover the health of their granddaughter.  Unfortunately, with health reform, the task was a bit more difficult than they had expected.

Because insurance companies are not allowed to refuse health insurance to children because pre-existing conditions, many health insurances are now ceasing to offer plans strictly for children, to avoid this stipulation all together.  Now, the Green family is at a loss for finding health insurance for their young granddaughter.

Insurance companies are arguing that children who are applying for health insurance alone are generally those with pre-existing conditions, leaving insurance companies at a huge loss if they offer plans only to children.

As far as my own opinion, I find that this sort of manipulation of the law should not be allowed.  I do not believe that a business should get to ‘opt-out’ of things that are passed simply because they are not beneficial to the company.  Companies should be held responsible both for the benefits of the market they chose to engage in and the negative aspects, and that includes legislation that may be less than favorable. As far as if this practice is going to continue, only time can tell.  If other insurance companies across the nation continue to follow suit, it is possible that the government will need to intervene yet again, or a class of children with too much money for CHIP, will be left uninsured, and an unhealthy and uncovered youth will foster a poor future for all of us.  What is your opinion on the matter? Do you think such practices are just?

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Money for Malnutrition

Back to the grind after spring break, and it was nice to come across an interesting article so quickly.  Once again, here at the New York Times, this article tells the story of the Quinoa industry in Bolivia.

I know Quinoa, like so many other Americans, as the fancy new health food that is most likely found on the shelves of Whole Foods and Dierbergs.  Some blend of pasta, rice, and a vegetable ,Quinoa has been praised by many health gurus including the likes of Dr.Oz and Fitness Magazine as a super-food.  I knew of its supposed health capabilities, but had never even thought of the idea of where it came from.  Come to think of it, I almost never contemplate where the food on my shelves comes from, let alone the repercussions that come with providing it to me.  However, this article sheds light on the people who are effected by the ever-changing diets of the developing world.

As the article tells the story, Quinoa is an age-old staple part of the people of Bolivia’s diet, and is quite possibly the main source of nutrients.  With the new demand for this ‘superfood’ in developing worlds, and partnerships with corporations, the farmers in Bolivia are making much more exporting their crops than they were years ago.  While the increased income is welcomed, at what price does it come?  Quinoa, a formally very cheap crop for Bolivians, is now five times the price of basic white rice.  The increased income for farmers has not brought an increase in the funds of others to make them able to afford the crop.  Instead, the Bolivian people are turning to noodles and rice as their main source of nutrients, which has no where near the nutritional value of Quinoa.

The article tells of a new wave of increased malnutrition in the areas where Quinoa is being exported the most.  Not only is Quinoa more difficult to attain, younger generations are also favoring eating noodles and rice that they are accustomed to, rather than Quinoa.  Since these other grains do not have the same nutrients as Quinoa there is a concern that the younger generations may begin to be more unhealthy than their elders.

This story shows just how much lower-income countries that export crops to high-income countries rely on the lifestyle of the people half a world away, and our ever changing diets.  Also, is this trade-off of the increased income for farmers fair to those not in the farming industry forced to face malnutrition and poor health.  I think one area worth exploring would be what structures can be put in place by the government in order to distribute the wealth that is brought to the country by this industry, in order to achieve justice where there may not be fairness.

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Grey Areas and Life-Altering Decisions

As another article on here referenced, end of life decisions are extremely difficult, especially for families.  But is it even more difficult when the family is not the one making the decision? This article from the New York Times explains the journey that the family of Ms.Nyirahabiyambere has went through with the end of life decisions surrounding their mother’s feeding tube removal.  It sounds odd that the family of Ms.Nyirahabiyambere isn’t the one making the decision about the removal of her feeding tube, but a court appointed guardian.  We often talk about the lower health status of immigrants, but I was always under the impression that this lack of health services usually applied only to illegal immigrants.

Ms.Nyirahabiyambere is legal immigrant from Rwanda.  Her family was in a refuge camp when her two eldest sons were placed in the United States.  Six degrees later they were able to bring their mother over to join them in the states.  Ms.Nyirahabiyambere suffered a massive stroke that left her in a vegetative state.  Usually, this sort of thing is covered by Medicaid as Ms.Nyirahabiyambere did not have private health insurance.  However, being in the country for less than five years she is not eligible for Medicaid, and the cost to keep her alive for her family is just too high.

Since it is the government and Georgetown University Hospital footing the bill, they are the ones making the decision.  This leaves me at a crossroads in my thinking as to if this sort of decision making is ethical and just.  Can a set of humans who have nothing invested in the cause make a life-altering decision simply because they are supplying the funds?  The article shares that the family does wish to keep their mother alive if funding would allow.  I do not agree that it should simply be the people who are losing money that are making the decision as it is obvious that they would agree to protect their investment.   It seems that the story of Ms.Nyirahabiyambere is one of those that simply falls in a grey area and leaves her at a loss.  I don’t know of another way that this type of conflict could be solved, but I’d be interested to see your opinion on the matter.

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Equal Opportunity

The obstacles put in front of those with severe disabilities are abundant and extensive.  This topic of the injustices that face those who have disabilities is no stranger to our class discussions.  Many times when deciding who is disadvantaged when speaking of social cooperations it has been the severely disabled who always seem to land a spot on our list.  This recent article from the New York Times tells of a new piece of legislation that aims to minimize at least one of the obstacles for the severely disabled and chronically ill.

This legislation aims to allow these people to continue to live in their homes and have long term care.  Sounds great, right?  Not to about half of the U.S. Senate, mostly the Republican side.  Their argument addresses another one of the topics those of us in the public health field are no stranger too, sustainability.  The legislation’s opposition argues that such a program will simply be too costly and is not feasible.  Even those heading up the democratic camp in the Obama Administration, agree that such legislation is too costly.  As the article explains, many democrats are calling for a restructuring of the program, rather than a repeal.  These senators argue that no person should be forced to live in an institution.  While it sounds like a great step towards equal opportunity for those with disabilities, can such a program be successful without sustainable funding?

Those who oppose the legislation say no, and that the people seeking such insurance will most likely be those in need of care, and therefore this will cause the program to be unfeasible.  However, I struggle with the idea of whether the social benefits for those with disabilities may just be worth giving such a program a try.  People with severe disabilities have usually been the group that usually falls into the disadvantaged category, and is this a non-arbitrary or arbitrary distinction?  Until now it seems as a society that we have said this is a non-arbitrary distinction and brushed it off.  Perhaps is this new legislation a step in the right direction?  I think the idea is a good one and would be interested at what proposed changes can be made to allow this legislation to be in effect, although if the funding is not found it is likely that those with severe disabilities will once again remain facing another injustice.

 

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All is Fair in Budgeting and Recession

Many of us are well aware that the United States is in the process of evaluating our health care delivery system and the services that we offer to those who do not have access to health care.  However, even more of us are probably familiar with the constant news stream of budget cuts and individual states struggling to make ends meet.  It seems as of lately that not only are the American people struggling to find new and innovative ways to budget, but so is our government.  This past week, major news came when Arizona announced that their Medicaid system was going to stop financing organ transplants.  Here you can read the story of  Francisco Felix, who was lucky enough to find a liver donor.  However, when the state announced they would no longer fund his transplant, and the efforts at raising money for the transplant failed, Felix was back at where he began, without a liver and this time without any hopes of ever receiving one.

These sudden changes in state medicaid systems have had dramatic impacts on those who rely on government services.  Arizona is not the only state to make such cuts as Washington and California have both proposed state budget cuts to their medicaid programs.  The topic of medicaid budget cuts brought me back to so many class discussions where we brought up the idea of what is fair?  As many people brought up the idea of fairness usually depends on who is getting the benefit of the doubt.  However, in this case it is clearly low-income people who are bearing the weight of these budget cuts.

In Rawl’s theories he acknowledges that there will be differences, but if there are differences they should favor those who are worst off.  These differences showcased in our health system show the exact opposite of Rawl’s ideas, with systems that aid the  poor seeing budget cuts first.  We have discussed that Rawlsian ideas are very idealistic, and maybe not the most realistic theories to apply to life, but is their fairness in his difference principle?

We also discussed the idea that those who are advantaged, and usually the decision makers, should idealistically be making decisions in the best interest of the disadvantaged.  In this case, this is not happening either.  Is their some element to the equation that we are missing, such as logistics and financing, which make the execution of a fair and just approach to healthcare delivery nearly impossible?

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Defining an Injustice

This past week in our weekly responses we were asked to describe an injustice that had not been brought up in class.  As Dr.Barnidge brought up many students focused on education injustices.  As I took a look back over my class notes I realized that many of the injustices acd discussion centered around those with lower incomes receiving less than areas and people who had higher incomes. This is a very valid point to be debated, as most of public health is focused on increasing the health of the under served, of which is frequently those who are of lower socioeconomic status.

This recent article in the New York Times discusses a different kind of injustice in the health care field.  In this article the New York Times reports on the growing gap between the salaries of male and female doctors.  My knowledge  always had me under the impression that the gap between male and female compensation was decreasing every year, showing that we were indeed making giant steps toward equal compensation.  However, for those of you pursuing a medical career, you may just the opposite, as this article informs us.

I was simply amazed by the growing gap between male and female physicians, jumping from roughly $4000 to over $16000 in less than a decade.  As someone not pursuing a career as a physician I found myself asking if this was truly an injustice?  While in many other contexts I would be appalled at the statistics on the compensation differences between genders, instead I was questioning the validity of such an injustice.  So many times in our discussion of public health injustices we are confronted with fighting for the rights of those who do not have very much.  However, here this article is showing a clear gender injustice, and I was questioning it.

Much of my question revolved around the idea of  how much money physicians were reported to make on average.  In the article, women weighed in around$175,000 while male physicians made around $210,000.  When physicians are making well over $100,000, is a gender compensation gap really an injustice?  I found myself back at the discussion in the classroom, wondering who defines what an injustice is, and when a situation can indeed be deemed an injustice.

I found my personal answer to be affirmative, and I still believe that an injustice is taking place despite the large incomes.  In my mind, the issue is not about the amount being made, but rather the large and increasing difference in salaries between men and women.  I challenge you to do some thinking, and share whether or not you believe this situation is an injustice.

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Treatment as a Function of Location

I came across this article in the New York times and thought it related to areas in our class discussion where we talked about geographic locations defining community and types of prevention.

Mexico’s Universal Health Care

Upon first reading the article I thought it would be just another article about a comparative health system, and the struggles of attaining effective universal healthcare.  Initially, the article does discuss many of the ins and outs of the new health care system in Mexico, and even gives many examples of the successes that the new health care has brought about.  While many of the people told stories of quality care at no cost to the individual, there were some who are still not seeing the health care system as ideal.

One of the problems that the article brought up was something we have mentioned many times in class, that the poorer states are lacking in health care quality.  One of the points we have brought up in class is the idea that communities are sometimes defined by socioeconomic status and usually these are the groups that see more injustices in health care.

It seems that even in Mexico’s universal system these divisions between quality of care based on socioeconomic status are still present.  Another divider and definition of communities in the Mexican health Care system was the idea that, “Mexicans are treated very much a function of where they live.”  In class part of the discussion was the association of communities based on geographic location.

Luckily, in this new health care system the Mexican people are not confined to their geographic locations and are allowed access to the other health centers and better care.  This is one way the article mentioned that they are striving to offer better care to the impoverished.  Of course, barriers to this lie in the ability of those in poverty to actually travel and stay in another state that may offer better care.

Near the end, the article also mentioned that the system is trying to adopt centers that focus on prevention and the rights of patients, which relates to the shifting of care to a primary prevention that we talked about in class when showing the model of the levels of care.

Our first reading, prevention is primary, also talked about the need for prevention in public health.  Currently, the article mentioned more about the Mexican health care system offering tests to citizens to detect different diseases, such as HIV, which accounts for a level of secondary prevention.  The mobile centers mentioned at the end of the article show the shifting toward primary prevention, and the recognition for the need of primary prevention.  However, they did mention while this is acknowledged as the plan, it is never known exactly who these plans will turn into a reality.

I believe that from the facts presented, the overall improvement of health care for the majority of the Mexican people has been successful.  I also believe that it is important that the government has realized they still have many improvements to their new system, and are working towards solutions.  Even though the care for the impoverished is still marginalized it is seeing overall improvement, which I think can continue to grow into a great system.

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