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American Healthcare from a Sociological Perspective: Who Gets to Be a Doctor, Who Gets to See a Doctor?

Excellent sample paper by K. Nelson. Fall 2010.

"You are special and you can do anything or be anything that you choose." I have had numerous conversations with friends who also grew up hearing something along those lines from their parents; those of us in our mid-twenties might as well be referred to as "Generation Unique." But to what extent can one take credit for being unique if our ideas and behaviors are heavily influenced by something as arbitrary as social location? Social location is described by James Henslin as "the corners of life that people occupy because of where they are in society." (1) Gender, age, race, nationality, education, and economics all play a role in determining where a person exists socially. For the most part, those factors are not under the control of the individual who is influenced by them, which is why I consider social location to be fairly arbitrary. For example, one cannot control their skin color but many of their experiences, positive and negative, will be directly related to having skin of a certain color. A person's perception of the world, while unique, is more a product of experience rather than a creation stemming from within the individual.

Relating to a social group and self defining based on observations of what it looks like and means to be a "insert social descriptor here" is powerful. One only needs to look at a group of teenagers to witness a period of rapid self-definition based on social influences of friends and media sources, which, unfortunately, are often negative in nature. This can happen more subtly throughout life, sometimes even before a person identifies with a group. When I was a toddler, my mom always received compliments on how pretty my eyes were. She was frustrated that comments about me were mainly based on external qualities rather than anything to do with my person so she started replying, "yes, and she's good at math too." As a 3 year old, I adopted the response, though mine came out as "I'm good at MAFF too." I had no idea what math was but I'd gotten the sense that it was positive to be good at it and I certainly believed that I was. Upon encountering math in school, I excelled, which I attribute to my early self-definition as being good at math.

It is possible to better understand the influences that play into an individual's ideas and behaviors by using a "sociological perspective." Emile Durkheim, the world's first sociology professor, stressed the importance of researching patterns within societies in order to better understand individual behavior. He believed that "Human behavior cannot be understood only in terms of the individual; we must always examine the social forces that affect people's lives" (1). The very existence of trends and patterns within groups supports the argument that individuals are affected by the groups they belong to.

It is important to consider the history behind the development of different groups. According to C. Wright Mills, "the sociological imagination [perspective] enables us to grasp the connection between history and biography" (1). Taking the historical context into account allows for a much broader understanding of what has gone into creating our current environment. Sociological perspectives are also helpful in evaluating why certain societal institutions are valued and maintained.

In "Body Ritual among the Nacerima," Horace Miner provides insight to how Nacerima society, which is actually American society, is strongly affected by our perception of the body and physical health. Miner examines the rituals of the body and the institutions surrounding health maintenance. I would like to further explore how our current healthcare system is maintained by social perceptions as well as how the system we've created affects American behavior as individual citizens and as a society.

Miner touches upon the social reverence that is granted to healthcare providers, specifically doctors, and the monetary rewards associated with being a doctor. As a society, most of us recognize access to the services a doctor provides as desirable, yet we make it difficult to become a doctor so accessibility is limited and expensive. This creates an attitude of eliteness surrounding both the services and the service provider. I would argue that for most people, social acknowledgement provides greater motivation to become a doctor than money provides. This argument is based off of Henslin's description of symbolic interactionists, who "analyze how our behaviors depend on the ways we define ourselves and others. They study face-to-face interaction, examining how people make sense of life and their place in it" (1). As I consider career paths, I do not want to be socially defined by what I do for a living but my awareness of how certain jobs are valued often plays into evaluating my options. Americans generally view being a doctor as a worthy profession, accessible to ambitious, intelligent people.

Views on who should have the right to access those ambitious, intelligent doctors and the services which they provide can vary drastically throughout American society. Is access to healthcare a universal human right? In a society that highly values physical health, should everyone have equal opportunity to maintain optimal health? How much of the responsibility to provide healthcare to its citizens lies with the governing body of a society as opposed to the individual citizen? These are all questions that Americans are currently struggling with as we consider a major overhaul of our current healthcare system.

The issues surrounding healthcare in the United States are coming to head as a major class conflict, which tends to be much more complex than Marx's observations of the bourgeoise and the masses of laborers. Support for providing universal healthcare comes from people who are poor, wealthy and somewhere in between, as does opposition to providing universal healthcare. Disregarding arguments about economic feasibility of a program overhaul, the main issue revolves around whether or not access to healthcare is an inherent human right.

Early sociologist, Herbert Spencer believed that societies evolve and benefit from allowing less capable members to die out. His views are called "Social Darwinism" and are no longer given much credit but could be applied to the healthcare debate. While even the most staunch opposition to universal healthcare might be reluctant to be associated with anti-gay slogans such as "AIDS Cures Homosexuality," there is an underlying feeling that some people are more deserving of healthcare than others. Consider the allowances that are made in order to provide coverage for children. It is not that children are more sick than adults, but that they are viewed as innocents. By designating innocents within a society, it is implied that those not in that category must prove their worth; not proving one's worth (i.e. securing a job that provides benefits) will result in lack of whatever is automatically granted to the innocents. It is common an American to attribute hard work and solid decision making to those who have and laziness or stupidity to the "have-nots." This attitude may be a result of the American story of being able to transgress class. But upon looking at how trends in healthcare access show up across class lines, it becomes harder to blame the individual. A 2009 report on healthcare disparities based on gender showed that compared with 59 percent of working-age men, 70 percent of working-age women are uninsured, underinsured, have medical debt or bill problems, or chose to not access need care due to cost (2). There is also evidence the women are charged more for identical health plans (3).

Scarcity of resources plays a significant role in determining who deserves what in a society and certainly plays into the debate surrounding healthcare. The "quality versus quantity" argument is one of the most prominent questions in the media. I find the sociological perspective of conflict theory to be very useful in examining the current institutions we have in place with American healthcare and why there is a need for change within the system. Henslin attributes the origin of conflict theory to Karl Marx and writes that "conflict theorists stress that society is composed of groups that are competing with one another for scarce resources" (1). If the number of healthcare practitioners, clinics and hospital as well as the inability to pay for services provided remains at the current state, we encounter scarcity issues. If these issues were reduced, the question of who deserves to access healthcare could be eliminated.

Select groups profit from maintaining the current healthcare system and wield significant influence with the policy makers who have the capacity to create change. I held high hopes for changes in healthcare when Obama was elected two years ago and I have witnessed small changes within the healthcare over the past few years. However, social activism is stimulated by conflict and frustration with the status quo--I can only hope that the true revolution is still brewing.

Henslin, James M. 2009. Essentials of Sociology A down-to-Earth Approach. Allyn and Bacon: Boston MA
"High Health Costs Hit Women Hardest" Julie Steenhuysen. Reuters. 05/11/2009
"Women Buying Health Policies Pay a Penalty" Robert Pear. NY Times. 10/29/2008.
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