Category Archives: United States healthcare system

Welcome new citizens to Life, Liberty and the Pursuit of Health Care

Recently I attended a Naturalization Ceremony, my first ever. Forty people from 15 different countries met all the requirements to become citizens of the United States.

The ceremony was solemn but joyful with a local high school choir singing “Music to My Soul” as the whole audience clapped along. The Oath of Allegiance that I’m sharing with you here is sobering . Judge Michael said that we natural born citizens should take it to heart also.

Naturalization Ceremony
front page of the program
Oath of Allegiance
the oath of allegiance

In honor of my new fellow citizens, I’m sharing a post I wrote about the American healthcare system-not perfect, but one we can “support and defend” with pride.

Every year on July 4th we celebrate Independence Day- the day the original 13 American colonies established an independent country.

They subsequently established a government, military, educational system, highway system, public works, and a healthcare system.

We Americans may pride ourselves on not having “socialized” medicine or “national healthcare”, but we do have  a health care system that is a combination of public and private funding and administration. And even private healthcare must comply with a myriad of local, state, and federal laws and regulations.

I believe we have one of the best healthcare systems in the world  because of the people who work in healthcare- the people who devote years to education and training and who work tirelessly 365 days a year, 24 hours a day to make and keep us well.  Their commitment, compassion, dedication and competence benefits all of us and deserves our gratitude.

Statue of Liberty
Lady Liberty lifting her torch in New York harbor

According to recent statistics, the United States government accounts for-

40% of healthcare  spending

$1.3 trillion /year

Covering 100 million individuals

Through 4 federal agencies

Department of Health and Human Services 

Department of Defense

Veterans Administration

Department  of Homeland Security

(JAMA (Journal of the American Medical Association), June 21, 2016)

Healthcare for active duty military and veterans

During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic a Veterans Administration clinic (photo by Dr. Aletha
American soldiers serving in Afghanistan American soldiers serving in Afghanistan

Healthcare for civilians

Under President Barack Obama, Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens. Newly elected President Donald Trump vowed to “repeal and replace” this law while some changes have been made, it is still in force.

Two other government healthcare programs- Medicare and Medicaid are over 50 years old.

Medicaid provides insurance coverage for adults and children who are unemployed or low income.

Medicare covers disabled children and adults  and persons 65 years and older.

The numbers are rather staggering.

  • Together these programs cover at least 30% of Americans.
  • Together they comprise 25% of all federal spending.
  • Together they pay 40% of total U.S. health care spending.

An infographic from the Kaiser Family Foundation and JAMA explains this further.

You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.

  • Anyone can become disabled from a serious illness or freak accident.
  • You or your spouse may lose your job and your employer sponsored health insurance.
  • Your child may have a disability that will prevent them from working when they grow up.
  • We may all live long enough to qualify for Medicare on the basis of age alone.  Your parents or grandparents are near or already at Medicare age.
ELDERLY COUPLE -189282_1280
Senior adults age 65 and older use Medicare.

It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an  easy to understand book.  

Government healthcare administration –The United States Department of Health and Human Services (HHS)

Several government agencies regulate, monitor,  promote and/or support both public and private healthcare (most but not all of these are under HHS.) 

Food and Drug Administration- FDA

Centers for Disease Control and Prevention- CDC

National Institutes of Health- NIH

Occupational Safety and Health administration-OSHA

Drug Enforcement Agency-DEA

medication capsules
The FDA regulates the development and sale of medications and medical devices and the DEA regulates dangerous and controlled drugs.

Important Federal Healthcare Laws

The Affordable Care Act- ACA

Health Insurance Portability and Accountability Act-HIPPA

Emergency Medical Treatment and Labor Act- EMTALA

Health Information Technology  for Economic and Clinical Health- HITECH

Americans with Disabilities Act-ADA

Family Medical Leave Act-FMLA

Liberty Bell -replica
replica of the Liberty Bell at Disney World, Florida

The origin of United States healthcare

In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the Pursuit of Happiness” and to promote “Safety and Happiness” . 

In the Constitution they vowed to “promote the general Welfare” .

I wonder if they envisioned their new government would spend so much time and money providing and regulating health care –

most of which was not available or even imagined at that time? 

Let’s celebrate!

woman holding a sprakler
Let’s celebrate ! This photo and featured image from stock photo site- Lightstock.com (affiliate)

Dr. Aletha 

a woman in a red, white, and blue shirt
Me, a few years ago, showing my patriotic spirit by posing in red, white, and blue
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Discover women physicians, the future of medicine

Why celebrate women physicians?

In 1860 the United States had 200 women physicians.

By 1900, there were 7000.

Since 1975, the number of female physicians has grown more than six-fold, from 35,626 to 333,294 in 2013. Women physicians comprise 35% of actively practicing physicians. Follow this link for a detailed timeline of

A PROFILE & HISTORY OF WOMEN IN MEDICINE

Last year, for the first time since Elizabeth Blackwell was the first woman  in the U.S. admitted to medical school in 1849, more women than men entered U.S. medical schools and approximately half of all medical students are now female. This trend will likely continue, as fewer men are applying to medical school and more women are.

class reunion
My medical school graduating class of 1978  at our 30th reunion; the original class was larger, 150 students, but the percentage of women was the same as in this photo. (I’m in the pink dress)

(This post contains commission earning affiliate links to help fund this blog)

Why are more women entering medicine?

In general women still lag in entering the STEM fields– science, technology, engineering, math. But I think the most important factor spurring  more women to enter medicine is the powerful example set by previous women physicians who have paved the way for us who entered medicine later.

DISCOVER WOMEN PHYSICIANS-WWW.WATERCRESSWORDS.COM, EXPLORING THE HEART OF HEALTH

Dr. Elizabeth Blackwell

The first woman graduate of a United States medical school was born in Bristol England in 1821. (thank you, UK readers). Elizabeth Blackwell came to this country as a child and originally had no interest in medicine. But when a dying friend told her, “I would have been spared suffering if a woman had been my doctor”, she found her calling.

She was denied admission to multiple medical schools. The Geneva Medical College of New York submitted her application to the student body for a vote, and, as a joke, they voted to admit her. Well, the joke was on them as she enrolled, completed medical school and graduated in 1849.

Read more detail about How Elizabeth Blackwell became the first woman doctor in the United States

The First Woman Doctor
The First Woman Doctor

With her sister, Emily Blackwell , who also  graduated from medical school, and a German physician, Marie Zakrzewska, they opened and ran the New York Infirmary for Women and Children in 1857.

Dr. Emily Blackwell  managed the Infirmary for 40 years. Dr. Marie Zakrzewska moved to Boston where she founded the New England Hospital for Women and Children, which trained  women physicians and cared for the poor.

Due to failing health, Dr. Elizabeth Blackwell retired from practice in the 1870s.

The Physicians Mom Group (PMG) declared Dr. Blackwell’s birthday February 3 as National Women Physicians Day. This day celebrates all the significant contributions that women physicians make daily, none of which would have been possible without Elizabeth Blackwell.

Dr. Blackwell embodied the ABC characteristics of extraordinary women physicians-

Attentive, Brave, Compassionate

Women physician members of CMDA providing medical care in Ecuador

Dr.Rebecca Lee Crumpler

Prior to founding her hospital, Dr.Zakrzewska served as professor at the New England Female Medical College. That school produced another notable women physician, Dr. Rebecca Lee Crumpler.

Dr. Crumpler graduated in 1864, becoming the first African-American woman to earn the M.D. in the United States.  After practicing in Boston, she moved to Virginia where she and other black physicians cared for freed slaves, who otherwise would have had no access to medical care. In 1883 Dr. Crumpler wrote a book of medical advice for women and children, titled A Book of Medical Discourses, one of the earliest medical publications by an African American.

Dr. Virginia Apgar

More recently, a woman physician’s work has impacted the lives of countless babies and their families. If you have had a baby, or been born within the past 60 years, you benefited from the work of Virginia Apgar, M.D.

She was neither an obstetrician or a pediatrician, but an anesthesiologist. As she observed deliveries of infants she proposed a scale to rate how well a newborn was adapting to life outside the mother.

crying baby
courtesy Pixabay

She considered 5 factors:

And assigned each a score- 0, 1, or 2, at 1 minute of age, and again at 5 minutes.

So a newborn had a potential score as low as 0 and as high as 10.

The higher the score, referred to as the Apgar score, the more likely the baby was healthy and would do well. The lower the score meant the baby was in trouble, and needed intensive medical attention.

  1. heart rate
  2. respiratory (breathing) rate,
  3. muscle tone,
  4. reflexes, and
  5. color-pink (warm) or blue(cold)

After testing the use of the rating scale over several years, doctors starting using it routinely; so for the past 50-60 years almost all babies have been “graded” with an Apgar score at birth. The Apgar score  is used widely throughout the world.

Dr. Apgar, who played violin and cello in her college orchestra, was appointed the first full professor of medicine at Columbia University and also was a director for the March of Dimes.

Dr. Laurel Salton Clark

More recently, Dr. Laurel Clark served her country as a flight surgeon with the U.S. Navy. She along with her husband Dr. Jonathon Clark joined NASA as astronauts.

Clark made her first space flight on Space Shuttle Columbia during STS-107 as a mission specialist. The extended-duration mission was dedicated to scientific research. The STS-107 crew successfully conducted more than 80 experiments.

Independence, a space shuttle replica, on display at NASA in Houston, TX
The space shuttle replica Independence on display at Space Center Houston; photo by Raymond Oglesby during our visit to the center a few years ago

On February 1, 2003  Clark and the STS-107 crew perished during re-entry as Columbia broke up over Texas en route to a landing in Florida. She amassed 15 days, 22 hours and 20 minutes in space.

During a memorial service at Johnson Space Center in Houston, Texas, on Feb. 4, 2003, President George W. Bush emphasized Clark’s love for her family and her work.

“Laurel Salton Clark was a physician and a flight surgeon who loved adventure, loved her work, loved her husband and her son,” he said.
A friend who heard Laurel speaking to Mission Control said there was a smile in her voice. Laurel conducted some of the experiments as Columbia orbited the Earth and described seeing new life emerged from a tiny cocoon. ‘Life,’ she said, ‘continues in a lot of places and life is a magical thing.'”

In this emotional interview, Dr. Jonathon Clark remembers his wife, who “sacrificed her life for space research.”

Please see these related posts about women physicians who are Changing the Face of Medicine

The surprising new doctors caring for you

Meet the Army Surgeon General 

Thanks to the American Medical Association for this post’s featured image.

Thank you for joining me to celebrate women physicians. If you haven’t met me already, please visit my bio page here-

Meet Dr. Aletha 

Please continue to follow this blog as we explore

and share the HEART of health

stethoscope with a heart