Health Care, Ideological Barriers to Change

Health Care Reform

Many argue that the only way the United States can achieve substantial improvements in health care quality is through the development of national health insurance (NHI). Successful adoption of NHI would establish the right to health care. Despite high levels of support for some sort of NHI among the public, previous efforts to institute NHI failed. Historically, [Page 434]labor unions and physician opposition, concretized in the lobbying efforts of the American Medical Association, helped undermine early reform efforts. Conservative political opposition, frequently aligned with the Republican Party, also rejects the notion that health care is a right, preferring to treat health care like other goods and services optimally provided through competitive markets. In support of this perspective, the American Medical Association, conservatives, and other opponents have been successful in mobilizing “myths” about the quality of the U.S. health care system as rhetorical devices to persuade policymakers that NHI is simply not a politically feasible option. These myths play upon commonsense beliefs about the U.S. health care system, including generalized beliefs that U.S. health care is “the best in the world,” any existing problems are “not that bad,” and the best solutions to any problems lie in privatization and the market. The dominance of such ideologies has led to the failure of significant reform attempts, ensuring that the current system of health care rationing, according to ability to pay rather than clinical need, continues.

Health Care Access and Quality

A growing body of evidence suggests that even with the adoption of reforms such as NHI, inequities in the delivery of health care will persist. Some argue that a major problem overlooked by most reform efforts is the chronic undersupply of minority and female physicians. Regardless of good intentions, a health care delivery system reliant upon physicians who are, by and large, white, upper-class, able-bodied, and heterosexual males will inevitably yield poorer health care outcomes for patients who fall outside these categories. Others argue that even if a ready supply of physicians outside these privileged groups existed, inequities sustained by the existing system of medical beliefs remain unaddressed. These barriers stem from the nature of medical training and the ways in which medical knowledge is applied within health care delivery. Medical professionals are trained to complete the process of diagnosis and treatment by taking symptoms presented by a patient and using them as clues to construct a diagnosis for which they can then prescribe treatment. Thus, patients who receive the best care are those who can most skillfully cooperate in the construction of these standardized medical narratives. Patients who are unfamiliar with the appropriate medical terms and phrases, whose cases are complicated, or who attempt to present alternative narratives to the standard medical ones are less likely to receive good care.

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