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US Health Care Crisis: Implications for Education, Medical Praxis, and Democracy

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US Health Care Crisis: Implications for Education, Medical Praxis, and Democracy Georgia Southern University Digital Commons@Georgia Southern Electronic Theses and Dissertations Graduate Studies, Jack N. Averitt College of Spring 2007 US Health Care Crisis: Implications for Education, Medical Praxis, and Democracy Michael W. Kleinpeter Follow this and additional works at: https://digitalcommons.georgiasouthern.edu/etd Recommended Citation Kleinpeter, Michael W., "US Health Care Crisis: Implications for Education, Medical Praxis, and Democracy" (2007). Electronic Theses and Dissertations. 503. https://digitalcommons.georgiasouthern.edu/etd/503 This dissertation (open access) is brought to you for free and open access by the Graduate Studies, Jack N. Averitt College of at Digital Commons@Georgia Southern. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons@Georgia Southern. For more information, please contact [email protected]. THE US HEALTH CARE CRISIS: IMPLICATIONS FOR EDUCATION, MEDICAL PRAXIS, AND DEMOCRACY by MICHAEL KLEINPETER (Under the Direction of Rosemarie Stallworth-Clark) ABSTRACT This theoretical inquiry sought to critically analyze the various ideological and political aspects of the culture of health care reform in the United States (US) and to investigate the underlying ideologies, values, and purposes of medical practice in a changing democratic society. Using Michel Foucault’s cultural studies approach as the theoretical framework for the study, agent and client relationships within the US health care system were examined in efforts to describe the articulation between the health care crisis and the government’s social responsibility to prevent the imminent bankruptcy of its health care system. State and national data were collected from governmental web sites of the Department of Health and Human Services, the Center for Disease Control and Prevention, and the Center for Medicare and Medicaid Services. This data describes the percentage of the uninsured population in both Georgia and US; total health care costs of the private and public sector in the US; total health care costs in both Georgia and the US; breakdown of health care costs in Georgia; breakdown of health care costs in US; and the Medicare allowables for five random current procedural terminology (CPT) codes. Socioeconomic trends in the US indicate a health care crisis. This study revealed the numbers of uninsured citizens in this country are steadily increasing and the economic impact on these individuals, as well as the rest of the country, is devastating. Literally every hospital in the US is subsidized by the federal and/or state government for indigent and charity care. Therefore, the tax payers ultimately pay for medical care for these individuals. All in all, there is a tremendous financial and health strain to the entire nation because of the uninsured problem in the US. Implications of this study included the following: the health care industry must to do a better job of educating patients on health care issues; catastrophic insurance can provide a useful solution to protect patients from rising costs; patients must begin to think preventive instead of curative; tax deductions should be extended to individuals to pay for health insurance; and a nationwide information system should be implemented. INDEX WORDS: US, Medical praxis, Democratic society, Medical ethics, Michel Foucault, Health insurance, Medicare, Medicaid, Cultural studies THE US HEALTH CARE CRISIS: IMPLICATIONS FOR EDUCATION, MEDICAL PRAXIS, AND DEMOCRACY by MICHAEL KLEINPETER B.A., Armstrong Atlantic State University, 1996 M.H.S.A., Armstrong Atlantic State University, 1999 A Dissertation Submitted to the Graduate Faculty of Georgia Southern University in Partial Fulfillment of the Requirements for the Degree DOCTOR OF EDUCATION STATESBORO, GEORGIA 2007 © 2007 Michael Kleinpeter All Rights Reserved iv THE US HEALTH CARE CRISIS: IMPLICATIONS FOR EDUCATION, MEDICAL PRAXIS, AND DEMOCRACY by MICHAEL KLEINPETER Major Professor: Rosemarie Stallworth-Clark Committee: Ming Fang He Stephen Jenkins Joseph Crosby Electronic Version Approved: May 2007 v DEDICATION This dissertation is dedicated to my supportive family who have encouraged me throughout this long journey. It would have been impossible to finish without the love and sacrifice of my wife, Ruth, and son, Carter. There is not a day that goes by that I do not thank God for you. I would also like to thank my parents who have given me the love, support, and tools throughout my life to succeed in many different areas. I truly feel blessed and recognize the difference that strong parenting makes in the lives of children. vi ACKNOWLEDGEMENTS I would like to thank my committee members for the invaluable guidance, insight, and encouragement they provided during the dissertation process. Dr. Rosemarie Stallworth-Clark, my chairperson, constantly encouraged me and provided the support and time needed to finish my dissertation. The sacrifice of her personal time and emphasis on perfection are greatly appreciated. Dr. Ming Fang He gave me encouragement and thoughtful feedback throughout my entire doctoral studies program and her dedication to the field is both uplifting and inspiring. I was fortunate to have taken two statistics classes with Dr. Stephen Jenkins, and his time and feedback with my dissertation research has been a tremendous asset. In addition, I would like to thank Dr. Joseph Crosby for his time and mentoring during my studies and my career. Lastly, I would like to thank the Southeastern Orthopedic Center for supporting me throughout my course work and dissertation, both financially, and with my time. vii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS.............................................................................................. vii LIST OF TABLES............................................................................................................. xi CHAPTER 1 INTRODUCTION .............................................................................................1 A. Cultural Studies and the Rationale for Theoretical Inquiry ....................5 B. Michel Foucault and the Culture of Health Care ....................................6 i. Genealogical and Ethical Analysis -------------------------------------- 6 ii. Architectural Design and Functional Spaces--------------------------- 8 iii. Different Interpretations -------------------------------------------------- 9 iv. Agents and Clients………………………………………………... 10 C. Statement of the Problem ......................................................................11 D. The Purpose of the Study ......................................................................12 E. Research Questions ...............................................................................13 F. Significance of the Study ......................................................................13 G. Assumptions and Limitations................................................................15 H. Definition of Terms ...............................................................................16 I. Summary ...............................................................................................16 2 REVIEW OF LITERATURE ..........................................................................18 A. Scope of Literature Review...................................................................18 B. Cultural Studies.....................................................................................18 C. The History of US Health Care………………………… .....................23 viii i. The Health Insurance Industry .........................................................24 ii. Medical Education’s Influence on Health Care ...............................28 iii. Post-World War II Medicine...........................................................31 iv. The Making of Medicare.................................................................35 D. Canada: A Neighboring Health Care System.......................................48 E. Culture’s Impact on Health Care...........................................................54 i. The Baby Boomer Effect..................................................................54 ii. The Pharmaceutical Industry............................................................56 iii. The Uninsured Population ..............................................................58 F. Summary ...............................................................................................64 3 THEORETICAL FRAMEWORK...................................................................66 A. Michel Foucault’s Genealogical and Ethical Analysis..........................66 i. Michel Foucault’s Hierarchical Observation ...................................69 ii. Michel Foucault’s Normalizing Judgment.......................................70 iii. Michel Foucault’s Examination .......................................................71 B. Data Collection Procedures and Descriptive Analysis..........................74 C. US Health Care versus 23 Other Countries...........................................84 D. Summary ...............................................................................................85 4 CRITICAL ANALYSIS ..................................................................................86 A. US Health Care through the Lens of Michel Foucault..........................88 B. Data Analyses........................................................................................90
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