POLICY: On Social Class and Health Care by the Industry Veteran

A WEEK AGO, the NY Times ran
a front-page article presenting three case histories of people who sustained
MRI’s.  The article by Janny Scott, “Life at the top in America isn’t just
better, it’s longer
,” is part of an ongoing series examining the effects of
social class in the US.  I highly recommend it to all THCB readers as the
real heart and soul of what health care analysis is all about, or at least
should be.It will come as no surprise that Scott finds social class
determines every aspect of each patient’s episode, “from the circumstances of
their heart attacks to the emergency care each received…It shaped their
understanding of their illness, the support they got…[and] their relationships
with their doctors.  It helped define their ability to change their lives
and shaped their odds of getting better.”  In the best traditions of
feature journalism, Scott supplies copious detail to illustrate that the
enormous treatment differences meted out to patients and the commensurate
outcome disparities varied according to social class.Just within the
realm of health care services, the same disparities apply to stroke, cancer,
diabetes, chronic viral infections (HIV, hepatitis C) and a raft of other
episodes and conditions.  Of course, we could examine most of the other
issue areas at the core of contemporary life — education, retirement, child
care, leisure, on and on — and find in these that social class is also at the
root of discrepant life chances and life styles.The Times’s
article also underscores a point that you and I have both made on TCHB several
times, namely that the holy-of-holies under Reagan-Bush-Bush, the omnisciently
unregulated market, is a piss poor way of delivering goods and services that
have such enormous impact upon the length and quality of lives.  Markets
stratify the public into segments, they often require long periods to
self-correct, and they tend to evolve in ways that subvert the very
preconditions for a market.  Some of those market system shortcomings,
within moderate limits, may be acceptable for consumer packaged goods, luxuries
and certain other sectors.  Health care is too important, however, to leave
in the hands of the oligopolists and plutocrats who run markets.

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Jana HillAbby VigneronHarvey S. FreyAbbygadfly Recent comment authors
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Jana Hill
Jana Hill

Does anyone remember when it was called “medical treatment”? Then it turned into “medical care” and quickly morphed into “health care”. Is this really caring for health? Doesn’t this system concern itself with disease and the disease caused by the medical treatment of disease? Doesn’t it exclude the people who really do concern themselves with preserving health?
Is actual care of health covered by insurance? No, only medical treatment is covered. So why do insurers call this “health care”?


//So if you address your complaint to them, they will make sure that it gets taken care of.// I’m going to ask for the benefit of the doubt that I’m not crazy, and I don’t come across as crazy when I ask for help. California politicians and agencies are genuinely non-responsive. In the last two years of writing repeatedly for help, I have only gotten a couple generic responses. These asked for me to provide information so the politician can start a case file. Then nothing happens. Both Feinstein and Boxer have each given me the courtesy of a response… Read more »

Abby Vigneron
Abby Vigneron

It is sort of expensive. I think the basic thrust is that politicians know that they can get voted out. So if you address your complaint to them, they will make sure that it gets taken care of. If you’re crazy though, they may not bother to push on your behalf. The special procedures might reflect the fact that there’s been an additional level of screening before the complaint went forward.


The Governor’s Office doesn’t even respond to my letters, so I need VIP access to the Governor’s Office to get VIP access to the DMHC. :-/
Frankly it really bothers me that a State agency would consider some citizens better than others to the point where they would develop special procedures.

Harvey S. Frey

One way of levelling the field somewhat, is to send your complaint to an important person. DMHC, for example, has a special set of procedures, labelled “VIP procedures”, for handling complaints referred down from the Governor, Director, etc.
Of course, you still need to be educated enough to express yourself fairly rationally.


How do they define class in these articles. In the UK if you’ve got a good university degree, you’re middle class even if you make next to nothing, and that level of education affects what you get. I mean, go into the Radcliffe Infirmary as the wife of the master of an Oxford College who is a trustee of the hospital and you’ll probably get better care than somebody with more money who goes private.


Thank you for articulating these issues. I would like to add that it’s more difficult for poor people to resolve billing problems because bureaucrats seem to assume they won’t be able to get help. A good-looking, well-dressed, “classy” person probably has the resources to have their rights enforced. And I can vouch personally for the way poverty shapes health problems and visa versa. I have genetic disorder that could be practically invisible at my age, but since I don’t have access to even basic treatment (I need a doctor to prescribe – that scrip pad is such a racket!), I… Read more »