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Thu Mar 16, 2017, 01:35 PM

Healthcare Drama

Two days ago, I made a post saying that it's not really about price when it comes to healthcare, but about social control.


I don't think my post did what I typed justice and so I think it's time to explore this concept more fully. Our healthcare system is, quite simply, technological. Skilled doctors and nurses using devices and objects designed by others to diagnose and treat disease and injury is the first thing that comes to mind. But then we have companies communicating with each other, hospitals, pharmaceutical companies, and of course insurance companies authorizing payments for these treatments and moving money. With skilled individuals, devices and objects used in medicine, hospitals and insurance companies, and more; it is all indeed a technological system.

Now turn to Bryan Pfafferberger who says that technology can be treated as drama, a system where power is being constructed. Our healthcare system needs to be examined in this light, where it creates the powerful, the powerless, and other differences between groups of people.

Pfaffenberger says there are eleven ways we can see this, and it becomes very apparent that this appears in our healthcare system.

Exclusion - This is where people of the 'wrong' group are denied access to technology and knowledge.
* The tie between being employed and having insurance for the non-upper class is very important here. If you are long-term unemployed, part-time, etc.; then you are of the 'wrong' group. Expanding Medicaid rectified some of this this, but I don't know if that will last much longer now.
* Can also apply to the medical profession itself. It's difficult, not impossible, but difficult for someone who is poor and if they're the first person in their family to go to college, then it's going to be all that much harder for that person to go into medicine.
* There's also the issue of the 'right' to deny gay people medical treatment. http://www.cbsnews.com/news/bill-would-let-michigan-doctors-emts-refuse-to-treat-gay-patients/

Deflection - Diverting attention away from the machinations of the powerful.
* Who knew that the problem with healthcare was that it didn't have tax cuts for the rich? Good thing Trumpcare solves that.
* http://www.slate.com/blogs/the_slatest/2017/03/13/paul_ryan_and_mick_mulvaney_s_defend_trumpcare_s_tax_cuts_for_the_rich.html

Differential incorporation - Different groups may have different experiences of the same technology.
* Calling healthcare reform "Obamacare" vs the "Affordable Care Act"
* http://thegrio.com/2017/01/18/watch-americans-who-love-the-affordable-care-act-but-hate-obamacare/
* http://politicalticker.blogs.cnn.com/2013/09/27/poll-obamacare-vs-affordable-care-act/

Compartmentalization - While access may appear democratic and free, it is constructed to keep some away.
* As Tom Price said, he wants to make sure "every single American has access to affordable coverage", quality coverage... if you can afford it.

Segregation - All the mechanisms that keep people away.
* High costs of treatment and tests.

Centralization - Decisions over who will use technology and how it will be used are centrally managed.
* Take a look at the price of Daraprim, how it's price was hiked by one company and one man in particular, Martin Skhreli. One can also look at the control of this drug and how the whole issue of generic drugs and patents.
* Also here would be a treatment being denied because it's "experimental", deeming something this probably wasn't mentioned in the doctor-patient relationship that people opposed to healthcare reform like to talk about.

Standardization - Demands for compliance can be so great that they overwhelm autonomy or alternative cultures of usage.
* You will buy your prescription drugs here in the US, getting them cheaper from Canada is frowned upon, no, it's actually illegal.

Polarization - Different iterations of the technology are produced to create social differentiation.
* A rich person being able to go into a hospital and getting elective surgery and saying "put it on my card" vs a poor person needing a life-saving surgery and wrangling with the hospital and insurance companies before, during, and after treatment is exactly this. In fact, I would actually say this creates class distinction rather than the difference between classes doing this.
* Gender also plays a role here. In particular, sexual and reproductive health for men vs women. We've seen demonization of women's health, even reaching to the point where an abortion doctor is assassinated and a Planned Parenthood is attacked by a terrorist. The campaign against Sandra Fluke also counts. Employer permission for birth control. All this even though birth control medication treats a wide variety of conditions. Meanwhile, what regulations and demonization campaigns do we see regarding drugs such as Viagra?

Marginalization - Inferior models for audiences deemed inferior.
* The "war on drugs" definitely goes here. When the people were black and inner city, our media and government officials spoke in terms of militarization, of a "biological underclass", of long prison terms, of Shariah-like executions (Just a side note, funny how nobody calls Bennett a "secret Muslim", why is that?), etc. When the drug users became white and not-so-inner city though, it became a public health crisis. They received medicalization when another group received criminalization, why the different approaches?
* "Affluenza" for Ethan Couch is also a superior treatment for someone because they have money and influence. Has a poor person's poverty ever became a reason why they didn't understand what they were doing was wrong?

Delegation - Morality may be delegated to technology in order to counter perceived moral failings in people.
* Before we had the end of pre-existing conditions and how nearly everyone loves it now, but remember how Republicans were defending it? Calling people who were hit by these it liars, frauds, and cheaters? Here's a more recent example - http://www.patheos.com/blogs/danthropology/2017/02/cnns-rick-santorum-millions-americans-using-pre-existing-conditions-scam-health-care/ But, this is that, being denied because pre-existing conditions aren't bad, they were simply exposing the people who were trying to game the system, even if those gamers were cancer sufferers who investigators found out had athlete's foot or was a devious newborn baby.
* Jason Chaffetz saying the only reason poor people can't afford healthcare is because they went out and bought an iPhone also counts here.
* There's also still a very insidious undercurrent in our country's way of thinking that you get sick because there's something wrong with you as a person. It's not because the rich and powerful live in cleaner environments or have quicker access to medicine, it's apparently because the poor are sinful, right?

Disavowal - Things that are created for people further down the social order are avoided by higher status groups.
* We're told public healthcare is bad... quite often by people who have their healthcare paid for by us. Why don't they want our healthcare if what we have is so great.


This is why they call it the "greatest healthcare system in the world."

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