Medicine in the modern era has been defined by incredible discoveries and miraculous cures. Vaccinations, antibiotics, as well as new diagnostic technologies now allow physicians and other medical professionals to eradicate disease more easily than any other time in human history. We have new understandings of how diseases and viruses operate, from the common cold through complex cancers. However, as with many other aspects of our modern culture, medicine is not perfect. In the United States especially, costs have skyrocketed while results lag behind. In 2013, we spent $2.9 trillion on healthcare alone, and these costs increase every year. (1) Before long, it is quite possible that our economy will be literally bankrupted as a result of this wild spending, and arguments abound as to what the best solution to this problem may be. While the issues at hand may seem complex, and many people may claim to have the correct answer, the truth of the matter is that there is no clear cut solution to our problem at hand. Medicine and healthcare are extremely personal, intimate topics. When political decisions literally affect people’s lives it is no wonder that tensions and emotions alike flare up at every debate. Undeniably a complex issue, I believe we have a duty to at the very least understand this archive and out relationship with it whether one agrees with it or not. In this paper, I will try to examine both the specific causes of our healthcare crisis, as well as the current state of healthcare itself. Finally, I will evaluate our culture’s relationship with this issue, and how the technologies it represents shape the world around us.
One major source of cost for healthcare is that of prescription drugs. Many people are shocked at the idea of spending thousands of dollars on a single pill, however this a very real aspect of modern healthcare. As a result, many are often quick to point to large pharmaceutical companies as major drivers for these ridiculous costs. This may be true to an extent, but not so much as people might assume. One of the major reasons that medicines often have such high costs is not their actual manufacturing, the the research and development (R and D) that must go into each medicine before it can be sold. This process often takes years, and after a drug has been successfully created it must still pass the regulations and testing of the FDA, which again can take years. Add all this time together and it is not unreasonable to expect a single drug to cost a company billions of dollars to create, while taking up to a decade to even go to market. Hospitals are another often blamed culprit for the skyrocketing costs of healthcare. We have all heard the stories of people going to the emergency room for a look at an annoying cough, only to be slapped with a bill in the thousands of dollars. this aspect comes down mostly to an administrative issue, as well as a centralization problem in all hospitals. On top of this, the emergency room has in itself become known as an almost “ground zero” for the issues plaguing American healthcare. The ER is supposed to be used, clearly, as a place to go when you are faced with a true medical emergency. They are required and regulated to maintain enough professional personnel, diagnostic equipment, and supplies to handle any and every health problem which it may encounter. As a result, in my example of the thousand dollar bill for an annoying cough, the reason was not the visit itself but the resources needed to make that visit possible. Truly, however, all parts of the American hospital cost exponential amounts of money simply because are system lacks the organization to manage it as efficiently as we need it to.
As a system in this country, many would argue that the healthcare system itself is inherently flawed. One of the main arguments behind this reasoning is that private insurance companies, which in the past dominated the healthcare market, have the ability to determine which hospitals and which physicians they are willing to pay. In addition to this, often times they will simply refuse to pay for certain procedures. For many people who never purchased health insurance, the situation was even worse for both the patient as well as the system as a whole. This relationship held between the individual and this system can be illustrated in the following example: if a pregnant woman in labor was to walk into a hospital uninsured, what would the hospital do? Of course, they would have to care for the woman. It is in fact a law that they MUST care for this woman. (2) However, because this woman has no insurance it is very likely as well that she doesn’t have nearly enough money to even come close to paying the thousands of dollars needed by the hospital and its staff to carry out the procedure, in which case Medicare covers the cost. However, Medicare will likely not come close to covering the full amount needed. So then, who is responsible? In this case and in most cases, it is the hospital which must “foot the bill” so to speak. The hospital must pay for everything involved with the procedure, and cover the cost elsewhere. But where else can money come from? In truth, it comes from those people who DO have insurance. In order to cover the costs of those people without quality insurance, or any insurance at all, they must hike up all prices across the board. This reasoning is one of the main driving forces behind the Affordable Care Act. There is a paradox in this country that people without insurance are driving up insurance prices, which in turn forces less people to be able to afford and purchase health insurance. By forcing people to purchase cheaper and more flexible insurance from the government, many hoped that this cycle could be broken. In some ways it has. For instance, as of mid-2015, 11 million Americans gained health insurance coverage under the ACA, and the percentage of uninsured Americans dropped from 18% in 2013 to 11.9%. (3,4) While this helps, people fear that it will not be enough. By tackling all of healthcare, the government risks the possibility of bankrupting itself. Unless enough people take advantage of the program it is likely to collapse, the results for the national economy being devastating.
Now that I have given a background for the issue at hand, I’ll now attempt to evaluate the role of healthcare as both an archive of feelings in modern culture and a technology with which we as people have an ongoing and developing relationship. In “An Archive of Feelings,” Ann Cvetkovich related experiences of trauma to her own personal development. She writes that some of our most important personal and interpersonal growth comes as a result not of happiness but instead moments of intense stress or worry. She goes on to write that, “As a name for experiences of socially situated political violence, trauma forges overt connections between politics and emotions.” (5) For Cvetkovich, this trauma stemmed from the politics of lesbian and gay rights, and the toxic political discourse these things promoted. However, I believe and clear connection can be drawn between this topic and the topic of healthcare in America. For instance, both items detail the relationship of the government with our personal lives. In the case of Cvetkovich, the government attempted to strangle in many cases the feminist and gay rights movements, and in others it was often just the culture of the United States itself which attacked her. On the issue of healthcare the government and our culture alike also attempt to control what people can and cannot do; how we can and cannot live. We archive in hospitals, doctors, and nurses many emotions that we are unable to talk even to our own family’s about. Some of the most personal and emotional facets of our lives will take place in whitewashed rooms filled with men and women wearing lab coats. I think that for this reason, the healthcare system is one of the most unique in our current world. Few other places are concurrently so modern and open to the world while remaining secretive and silent for the people it serves. In “Alone Together” Turkle writes that, “We have to love our technology enough to describe it accurately. And we have to love ourselves enough to confront technology’s true effects on us.” (6) I feel that one of the greatest barriers most patients have in the world of medicine and healthcare is the inability to confront not only its abilities, but also its limits. We love the machines and pills that save us, but we hate the financial and emotional costs that they have.
Turkle wrote on technology as if it was a being separate from mankind, but one which we grow closer to each day. It was seen as a tool for our use, something apart yet integral to our daily lives. Medicine is very much similar to this, however I feel that in the near future this line of separation will grow thin. Healthcare as a whole is a monster in our modern world. It is a service which people need for their very survival, however it is something which can bankrupt entire families in the blink of an eye. Medical technology each year grows more and more advanced. Soon, much of modern medicine will become less a tool and more an extension of our own bodies. The consequences of these developments are some which humanity has never faced before, however there are facts on the table which cannot be denied: Our nation needs healthcare. We need it, and we need to change it before it is too late. It is something which impacts each and every person in our country and the world, and before we can reap its benefits we must come to learn how to control its consequences. Truly it is a problem which needs solving today, despite its true consequences not being felt until tomorrow.
2) 42 U.S. Code § 1395dd – Examination and treatment for emergency medical conditions and women in labor
3) Jenna Levy. “In U.S., Uninsured Rate Dips to 11.9% in First Quarter”. Gallup Polling.PMID 041815
4) Alonso-Zaldivar, Ricardo. “Number of Uninsured Fell by More Than 11 Million Since Passage of Obamacare, CDC Reports.” Huffington Post.
5) Cvetkovich, Ann. “An Archive of Feelings.” 2003.
6) Turkle, Sherry, “Alone Together.” Basic Books 2011.