I think a lot of people will agree that this is probably the worst problem in healthcare in the US. The most recent events, Katrina and Rita, give a really good picture of the importance of classes in our society. I'm not from the area, so I don't pay a lot of attention to all the local news. So can somebody give me a couple of good examples of how unequal access to health care is evident during and after the events?

It makes no sense to assert that the response to Katrina and Rita is exemplary of unequal access to healthcare being under socioeconomic control, while simultaneously asking other people to provide you the examples because you haven't researched the topic.

I would suggest that if you are trying to get ideas for a paper you either be completely upfront about it, or crafty enough not to rat yourself out.

Worst problem in healthcare? Of course there is inequality. People who have more money get better health care. Duh. I wouldn't consider this a "problem".

It makes no sense to assert that the response to Katrina and Rita is exemplary of unequal access to healthcare being under socioeconomic control, while simultaneously asking other people to provide you the examples because you haven't researched the topic.

I would suggest that if you are trying to get ideas for a paper you either be completely upfront about it, or crafty enough not to rat yourself out.

What's your problem? You assumed that I'm secretly getting help on writing a paper? How do you know that? Maybe because you probably used the same strategy?

No, I'm not secretly getting help on writing a paper. I'm preparing for my interview. I thought that this is the reason why this forum is set up: to help students better prepared for med school, by discussing all the different issues such as interview, undergrad, ec, MCAT, etc. If you don't like my post, you don't have to reply. But I do appreciate all the people that reply. I think this is one of the best resources for our medical community.

Yeah....I think unequal access to health care is a problem - perhaps not the worst, but a problem nonetheless. As for Louisana and Florida after the hurricanes - not sure about specific examples. Here in California, when we received folks from there who were displaced, we had a terrible time obtaining prescription drug records - pharmacies and physician offices were closed for weeks. But, all pharmacies I am aware of advanced medications without payment because those folks could not access their money either (banks & atms were offline too). In my opinion, economically, those who are stuck in the middle suffer the most - meaning those who do not qualify for public assistance, but also are not employed by companies who offer health insurance. In addition, the population who suffers are those who do not speak or understand English. Although we have a significant number of interpreters in hospitals, many private physicians and pharmacists do not have easy access to interpreters and I often wonder if I am understood when I explain a medication. I, at times, have refused to fill a prescription and found a pharmacy which has a pharmacist who speaks a particular language because I have felt the risk of misunderstanding was too high (usually a child). Unfortunately, this has required the parent to take public transportation farther. At least I knew he/she would be properly instructed to give the correct dose. I think after major disasters like hurricanes, earthquakes, we become the best we can be - there are several pharmacy examples I could cite. However, it is the day to day access which is a problem, IMO

I apologize for the outburst. I assumed that you were writing a paper because that is the common reason for people to pick a solid position on a topic before they have researched it and then ask for others to help. An interviewee typically wants to discuss all aspects of an issue and be able to discuss it candidly, rather than just racking up support for a hypothesis.

Here in California, when we received folks from there who were displaced, we had a terrible time obtaining prescription drug records - pharmacies and physician offices were closed for weeks.Prescription records for the insured could be obtained from the insurance processors. So, those with healthcare insurance had a better chance of getting the records they needed. Most of the nation's uninsured are either young and healthy or elderly and poor. Since the young healthy folks didn't really have a need to retrieve filling info, it was the elderly poor cash paying patients who were most likely to be hurt by inaccessible medical records.

Also, anyone who used national pharmacies with non-site specific databases such as Rite-Aid and Walgreens maintained access to their filling histories.

Prescription records for the insured could be obtained from the insurance processors. So, those with healthcare insurance had a better chance of getting the records they needed. Most of the nation's uninsured are either young and healthy or elderly and poor. Since the young healthy folks didn't really have a need to retrieve filling info, it was the elderly poor cash paying patients who were most likely to be hurt by inaccessible medical records.

Also, anyone who used national pharmacies with non-site specific databases such as Rite-Aid and Walgreens maintained access to their filling histories.

Although the insurance processor idea might have been good, it is/was not feasible. First, they don't have the actual copy of the Rx - they only have drug/qty/days supply...some insurance processors don't have MD info, they definitely don't have dates of first/last/refill - in this state, I could never have obtained a valid Rx from an insurance co. The folks we had emigrate from Louisana (none from Fl) came with NOTHING but their medication bottles. No insurance card, ID#, nothing! They wouldn't even know which company to call for info, even if that had been a possibility. When 9/11 occurred, many insurance records were lost completely. Now, that may be the exception, but that was my experience. Inaccessible medical records are a whole other story and has to do with IT, different state laws on privacy, portability of records, etc....much too long for this. However, Walgreens opened and made accessible on a secure website their prescription records for ALL pharmacies for those folks affected by the Louisana disaster. We made do with alternative strategies for those folks who do not use nationwide databases. Fortunately, healthcare providers are empathetic and rally well in disasters!

Worst problem in healthcare? Of course there is inequality. People who have more money get better health care. Duh. I wouldn't consider this a "problem". :horns: inequality will always manifest itself no matter what the powers that be try to craft

:horns: inequality will always manifest itself no matter what the powers that be try to craft

Clever point, but inequality is not an on-off switch. Saying you can't get rid of it is no way an argument against trying to minimize it. This is tantamount to saying we are all going to die anyway, so we might as well just jump off a bridge.

touche

in moderation the attempt to achieve equality is noble, but it starts to cross the line when in that quest society as a whole starts to suffer. overzealous equality seeking inevitably stifles the most able members of a group. from a statistical point of view, forcing equality may not matter if ability followed a normal distribution. but i believe it is highly skewed to the right (a la wealth/income) and thus equality attempts have the potential to hurt those at the far right much more. dunno...just some pondering, i like stats

to relate it to healthcare, its basically US medicine vs socialized medicine, where we have the best docs even if other countries can cite superior average societal statistics. thats why all the foreign kings and princes come here to have their life saving heart surgeries, not canada. and forcing more equality into US healthcare may come at that cost. so equality is good in theory, but eventually the lack of it is something people just have to accept. incessantly pushing for it could lead to overall detriment.

i brought up inequality in one of my interviews. sort of like a glass thats half full, and that maybe we should try to fill the other half. the interviewer astutely pointed out that its more like 85 or 90% full, and should we risk tipping it?

Equality is nice, but who is supposed to pay for it?

Society? I think not. Trying to raise taxes is a death sentence to any politician.

Example: California tried a few elections ago to put a tax on phone calls (I don't remember the exact specifics) to specifically pay for uninsured patients in EMS (including EMP compensation). Yea, it didn't pass...

Doctors? Why should they provide a service for free? Isn't this one of the reasons that people don't go into trauma surgery is because of the problematic payor base?

Hospitals? They'll just pass it on to other patients (unfair to the other patient, why should they pay for your health care when they are sick too?). Furthermore, why should hospitals pay for it?

Now I know someone else is going to say, "But the doctors, insurance companies, and hospitals are filthy rich, they can take a free patient or two!" The problem is that we aren't talking about a free patient or two. It gets worse if it is goverment ran without strict limits on eligibility. If it is basied off of need then people will make it a habit of trying to be the neediest so that they get the most "free" money and services.

Furthermore, the goverment can not tamper with the market. Once you start playing around with set prices is when you start having a problem like Canada. Lots of patients but not enough money allowed in the system to treat them all.


If you want a good book about thinks like this, I'll suggest Atlas Shrugged. Ayn Rand might be a little on the crazy side of things (feel free to skip the 10 page speech at the end, as well as some of the more, shall we say, personal, scenes of the book), but parts about socitial obligations and "brother-love" are pretty good.

capitalism the unknown ideal is also good, basically the nonfiction version of that book. haha yeah i did skip that speech...parts of the book are repetitive but overall its highly influential and thought provoking

Although the insurance processor idea might have been good, it is/was not feasible. First, they don't have the actual copy of the Rx - they only have drug/qty/days supply...some insurance processors don't have MD info, they definitely don't have dates of first/last/refill - in this state, I could never have obtained a valid Rx from an insurance co. The folks we had emigrate from Louisana (none from Fl) came with NOTHING but their medication bottles. No insurance card, ID#, nothing! They wouldn't even know which company to call for info, even if that had been a possibility. When 9/11 occurred, many insurance records were lost completely. Now, that may be the exception, but that was my experience. Inaccessible medical records are a whole other story and has to do with IT, different state laws on privacy, portability of records, etc....much too long for this. However, Walgreens opened and made accessible on a secure website their prescription records for ALL pharmacies for those folks affected by the Louisana disaster. We made do with alternative strategies for those folks who do not use nationwide databases. Fortunately, healthcare providers are empathetic and rally well in disasters!I did not mean to imply that we would get an actual prescription from the insurance processor, but that we could get a record of recent prescriptions and construct a medication list. We coordinated with a local clinic to get prescriptions written out or called in. In a couple of states (Alabama was one, per bbmuffin) there was temporary prescriptive authority given to pharmacists.

I did not mean to imply that we would get an actual prescription from the insurance processor, but that we could get a record of recent prescriptions and construct a medication list. We coordinated with a local clinic to get prescriptions written out or called in. In a couple of states (Alabama was one, per bbmuffin) there was temporary prescriptive authority given to pharmacists.

Actually, in CA we have permanent emergency dispensing guidelines pharmacists use for just these scenarios and many of us (pharmacists) did actually generate prescriptions from labeled medication vials or other sources, not from actual prescriptions or valid copies. But...this is seems like a hijack of the thread.....sorry to digress.....

Actually, in CA we have permanent emergency dispensing guidelines pharmacists use for just these scenarios and many of us (pharmacists) did actually generate prescriptions from labeled medication vials or other sources, not from actual prescriptions or valid copies. But...this is seems like a hijack of the thread.....sorry to digress.....Then, the proposal I didn't make was valid in your state! :p :laugh: