Qualifying exam - DONE!

Today I just turned in my qualifying exam.  It feels pretty darn good.  My preparation over the last few months, despite turning me into a hermit, really paid off.  Technically my "readers" have until the end of the summer to grade it (pass/fail/honors), so it might be a few weeks before I find out if I pass.  But I feel pretty good about it.  I am really fortunate that my friend, Emily, let me stay at her place to take the 3-day exam. It really helped me to focus to not have to worry about the dog or the laundry or cleaning my house and I am so thankful to her for it! 

My area of expertise is in Medical Sociology, so it was really timely that the Supreme Court ruling on the individual mandate of the health reform bill came out while I was taking the exam so I could comment on that.  So you want my take on it as a PhD-level medical sociologist?  Well, it's complicated for sure.

It's no surprise that the individual mandate was the part that received so much media attention, because Americans really value their independence, freedom, and personal liberties to do as they please with their hard earned money.  Americans like having choices.  But the healthcare reform bill (PPACA) puts the squeeze on insurance companies by requiring them to accept everyone regardless of preexisting medical conditions, and to provide unlimited lifetime spending on health care services.  So requiring healthy people who otherwise wouldn't rationally pay for health insurance to now purchase it helps to subsidize the more expensive, more sickly people.  If there's not some kind of subsidizing or "redistribution," insurance doesn't work.

Insurance companies have historically enjoyed substantial profits from their cut of transactions in health care services, and PPACA limits those, to some extent.  So shoveling in more money from coverage of healthy people (under age 26, plus anyone who wouldn't otherwise choose to purchase health insurance) really helps to keep insurance companies profitable (albeit, limited to 20% under the act, with some exemptions).

For a great read on health reform, check out Howard Watizkin's Medicine and Public Health at the End of Empire.  Really the only last chapter is where he digs into PPACA, but the rest of it kind of sets up the argument.  What I loved about this book is that despite how much of the book focused on overthrows of capitalism as an evil beast, the final chapter presents a liberal criticism of PPACA.  You can get conservative criticisms by the truckload, but it's really unique to see something written from the left that is not supportive of the act.  Essentially, he argues that PPACA will continue to serve the interests of the "transnational ruling class" (read - the 1% but on a global scale), and the whole system will implode from continually expanding costs that focus on expensive technology.  So that view may be extreme, but it's really interesting to see an analysis of PPACA that doesn't focus on individual liberties.

So personally I'm not going to argue that PPACA is good or bad.  It's got a mix of good and bad.  You've got more people covered (but still not everyone - Waitzkin argues it'll only cover half of the currently uninsured at best), but not much of a cap on escalating costs of high tech medicine that has a poor return on quality of life.  I'm also not sure if it's going in the right direction, because that all depends on what the desired outcome is - cost, quality, access, coverage.  Pretty much all PPACA addresses is coverage (and to some extent, quality, but that's a whole can of worms in itself).  But we'll see where it goes from there.

Push Girls

I just watched the first episode of "Push Girls," a documentary about four women who happen use wheelchairs to get around. It's so rare that anyone on television is in a wheelchair, nevermind a whole show!  These are some truly inspiring women.


Here's where you can watch it online http://www.sundancechannel.com/push-girls/

Having just finished reading the section of my qualifying exam material that deals with stigma, I definitely noticed the lack of research that has been done on physical disability.  Nearly all of it centers on mental illness.  Here's a few takeaway points I think are important when it comes to stigma:

1. People with a disability or illness do not immediately consider themselves "a disabled person" as their primary identity.  If it's a new issue for them, their whole existence prior to the diagnosis does not suddenly erase everything about them.  And even if the person was born with the stigmatizing condition, it still is not how they define themselves.  This is why it's better to say "a person with a disability" rather than "a disabled person," to emphasize the importance of the person over their physical (or mental) condition.
2. People with a stigmatizing condition know they have the condition, and know that other people notice it.  Sometimes this makes them nervous that the other people will treat them badly if there are negative stereotypes about their condition (this is called stereotype threat), and this can make them act in ways that actually confirm the negative stereotype they are trying to avoid.
3. Problems that people see as character flaws, like substance abuse, are stigmatizing and make people want to avoid those people.  But problems that are blameless, like being paralyzed from an accident, are still stigmatized, albeit to a lesser extent. 
4. Discrimination can be supported as a cultural institution.  For example, in the show, one of the women is looking to get back into modeling and finds that all of the modeling agencies she tries to work with have never represented someone in a wheelchair before.  One even told her that their building was handicap accessible with a staircase.  Thus the culture of the modeling industry systematically excludes people who use wheelchairs to get around.
5. Not all people who have a stigmatizing condition are upset about it.  The main thrust of the "disability rights movement" is to enable people with disabilities to be self-sufficient (see related article here) and not dependent on medical professionals or caregivers.

Anyway, check out the show!  It addresses so many sociological issues besides just stigma.