Feminist Theory – The Development Of The Discourse Of Feminism Sample Paper

Feminist theory, it should be mentioned from the beginning of the paper, is not a unified theory. As women experience the social world differently according to class, age or “race”, there exist different feminist standpoints within the feminist tradition i. e. Marxist or Postmodernist feminists and this explains the need to talk of Feminisms in plural.

In general though, feminist theorists in order to explain the marginal position women’s issues hold in the social sciences and why they are merely “added on” in the academic discourse, focus their critique upon traditional scientific approaches existing in the social sciences, offering alternative theories of knowledge. In addition, they attack concepts that originate from the founding fathers of each discipline i. e. Durkheim in Sociology, and which still hold an exceptional position in the social sciences.

For example, feminists believe that the concepts of scientific neutrality, or objectivity, or the belief that we can achieve “pure” knowledge of the social world, have all contributed to the androcentric status of the social sciences. In this essay we will attempt to define what is meant by “conventional epistemologies” focussing primarily upon Sociology, suggesting also that different feminist epistemologies offer different approaches regarding conventional epistemologies.Thus, it is going to be discussed why feminists view as problematic the “scientific” approach that permeates and influences traditional explanations of the social world.

Moreover, we will attempt to explain how feminists, with the introduction of new ways of investigating society that is, the introduction of new subject-areas in social research, the placing of the researcher along with the research in the centre of research analysis, or the emphasis of the importance of locating experience and emotions in the research, challenge conventional epistemologies.

Finally, in the end we will suggest that feminist epistemologies strongly challenge not only the theoretical basis of conventional epistemologies, but its application to the methods of investigating the social world as well, offering feminist versions of traditional theories. Feminists criticised traditional social science, suggesting that it offers a distorted picture of social reality, as it predominantly focuses its attention upon men’s experiences. But before taking this point further, it is pertinent to briefly explain what is meant by “epistemology”.

As L.Stanley and S. Wise suggest 1993, the question of epistemology is fundamental for feminism. They state that an “epistemology” is a framework or theory for specifying the constitution and generation of knowledge about the social world; that is it concerns how to understand the nature of reality: A given epistemological framework specifies not only what “knowledge” is and how to recognise it, but who are “knowers” and by what means someone becomes one, and also the means by which competing knowledge-claims are adjudicated and some rejected in favour of another/others.

However, conventional epistemologies and for the purpose of this paper we will limit our discussion of conventional epistemologies referring to the positivist tradition, exclude in their discussion women.As S. Harding puts forward 1987, “epistemology” answers questions about who can be a “knower” and what tests beliefs must pass in order to be legitimated as knowledge.

Yet, Traditional epistemologies systematically exclude the possibility that women could be “knowers” or agents of knowledge; they claim that the voice of science is a masculine one… age 3. She goes on to suggest that traditional philosophy of science suggest that the origin of scientific problems or hypotheses is irrelevant to the “goodness” of the results of the research.

However, feminist challenges reveal that the questions that are asked in social research, and most significantly those that are not asked, are at least as determinative of the adequacy of our total picture as are any answers we can discover: Defining what is in need of scientific explanation only from the perspective of bourgeois, white men’s experiences leads to partial and ever perverse understandings of social life. page 7 Sociology’s role in the exclusion and silencing of women from this discourse has also been the object of feminist criticism.

D. Smith 1987 states Sociology has been based upon men’s social universe. This renders problematic the attempt to think how women experience the world from their place, given the limited concepts and theoretical schemes available to employ.In addition, Smith repudiates the idea that Sociology can be a science challenging therefore directly positivist ideas concerning the status of this discipline within the social sciences.

She argues that The Sociology I conceive is much more than ideology and at the same time much less than “science”. The governing of our kind of society is done in concepts and symbols. The contribution of Sociology to this is that of working up the conceptual procedures, models and methods by which the immediate and concrete features of experience can be read into the conceptual mode in which the governing is done. age 87. Similarly, M. Millman and R. Kanter 1987 argue that Sociology focuses only on the formal, official action and actors. Thus, it explains the status quo and does not explore much needed social transformations; neither does it encourage a more just humane society.

It is also relevant to mention here that the sociological subject in language has been male -“he” and that language which is used describes experiences purportedly universal, although they are exclusively male.Before turning our attention to the different feminist epistemologies mainly the “feminist empiricist” and the “feminist standpoint” we should explicate how feminists take concepts, as well as research practices dominant in conventional epistemology such as “empiricism” “objectivity” “positivism” and “scientific methodology”, and deconstruct them in order to challenge the hegemony of such epistemologies.

As far as ‘objectivity’ is concerned, positivist methodological approaches claim that ‘objectivity’ is an ideal that is attainable, as we can actually stand “outside” of our social world, and observe it without any preconceptions.As a result, the aim of the social scientist is to be detached from the research subject, excluding from the research analysis any discussion of “feelings” or “experiences”.

Stanley and Wise 1993 state that it is the inductivist research methodology which claims that pure, unbiased, objective knowledge can be produced from the scientific mind’s experience of the world. Sydie also suggests that in traditional social science there exists a dichotomy in the sexes where ‘objectivity’ is given as a male attribute and ‘subjectivity’ therefore as a female one: The attributes of science are the attributes of males; the objectivity said to be characteristic of the production of scientific knowledge is specifically identified as a male way of relating to the world women by contrast, are ‘subjective’. Page 207. Sydie also discusses Weber and Durkheim ideas in relation to the issue of “objectivity” in the social sciences, as their ideas still hold an eminent position in modern social theory.

Weber, she argues page 214 sustains that “objectivity” in the social sciences is secured by the fact that once the object of the sociological interest has been selected in terms of values, then values cease to enter into the causal explanations offered regarding the behaviour and events.

If we turn to Durkheim now, we can see that he believed that it is possible for social facts to become visible to the sociologist, as they exist “independent of the individual forms” and can be “recognised by the power of external coercion it exercises over individuals Sydie, page 43.Thus, for Durkheim as Sydie argues the independence of social facts from particular individuals meant also that social facts had to be explained in terms of other social facts and therefore the “objectivity of the observation would be secured in the same manner as the natural sciences” page 43. However, according to many feminist theorists objectivity should not be the primary aim of a social investigation.

Rather, researchers should take into consideration their age class and “race” and consider how these will effect the research process.In addition, it should be recognised that feminist researchers shape the results of their analyses no less than do those of sexist and androcentric researchers. The “objectivist” stance should be avoided as it attempts to make the researcher’s cultural beliefs and practices invisible, while simultaneously skewering the research objects, beliefs and practices to the display board Harding, 1987:9. From the above discussion it is evident that feminist theories do not advocate the positivist methodology which exists in conventional theories of knowledge.

However, we should be cautious here about how we use the term “positivist”. And that because there are various schools of positivism i. e. the new realists, and also because the word “positive” can take different ontological, epistemological and practical forms Bryant, 1985. Johnson et al 1984 offer us a general definition of the term, stating that it refers to the extension of empiricist models of natural science, to the field of human action, by arguing for either a methodological or substantive unity of the two page 32.Its main methodological approaches of research are inductivism and deductivism. The former refers to the idea that knowledge – theory, can be produced by the researcher according to her experience of the world. By the latter term it is meant that theory pre-exists the actual research.

Feminist thinkers have fiercely challenged those concepts found in traditional epistemologies, offering new approaches towards the research praxis. As it has already been mentioned, they place particular emphasis upon the location of the researcher in the research process.In addition, as we shall see, they introduce new subject areas for research, stressing the importance of conducting research on the subject of everyday life experiences. But let us see first how feminist theorists have rejected positivist attitudes.

Stanley and Wise 1990 put forward that all knowledge is partial, results from the conditions of its production, is contextually located and originate from the minds and intellectual practices of theorists and researchers who give voice to it page 39.Therefore, this feminist standpoint dismisses claims of objective knowledge. Stanley and Wise 1993 also attack the method of ethnography in social research, claiming that it is an approach, which is positivist in nature: “Scientific detachment”, “truth”, “non-involvement” all exist as the aims of an ethnography.And despite all the controversies and debates about the place of “values” in ethnographic research, “scientific detachment”, “truth” and “non-involvement”…are still alive and well and frequently to be met.

But what is the alternative approach of the feminist standpoint? First of all, as it has already been mentioned it is the location of women within research. And this is crucial to our understanding of women’s place in the social world. Smith 1987, argues that in order to increase our understanding as women, we need a method from where women are, as subjects, located in the everyday world, not in imaginary spaces constituted by the objectified forms of sociological knowledge.Similarly, for Millman and Kanter 1987 there is the need for research in “local” settings, which are largely populated by women in their daily rounds of life and which have received no serious sociological attention.

Thus, for them the importance of ordinary aspects of our social life becomes more prominent in a feminist perspective, as “women have traditionally been chained to an existence of cleaning up and caring for others” page 33. Another way of challenging conventional methodologies in social research is to encompass “emotions” and “experience” in the research analysis.And that because the employment of emotions in the social investigation challenges dominant notions of the inferior status of emotions as a reliable source of data. Thus, the use of emotion in research does not somewhat fit with the conventional image of the detached, objective social researcher.

Stanley and Wise 1993 state that their own feminist epistemology does include emotionality. They view emotionality as the product of a culture and therefore open to “rational” analysis as much as any other culturally inscribed behavioural forms.Moreover, they argue that emotions are vital to systematic knowledge of the social world and that “any epistemology which fails to recognise this is deeply flawed” page 193. As mentioned before, feminist criticism is not unified and consists of different epistemologies some more marginal than others i. e. black feminist or lesbian epistemologies. One thing that has in common though, is the belief that social sciences should have a new purpose. That is, to use women and their experiences as new empirical and theoretical resources.

If we are to look at feminist empiricist, we can see that this epistemology advocates a stricter adherence to the existing methodological norms of the scientific inquiry, in order to eliminate sexist and androcentric biases. What is responsible therefore for biases in social research according to this standpoint, is the misuse of existing research methods Harding, 1987. Also, what we can deduce is that feminist empiricists do not see anything fundamentally wrong with dominant, conventional methodologies in social science. It is merely the case of conducting the research better.

The “feminist standpoint” position on the other hand, claim that their research findings offer a more complete and less distorted picture of social life. And this because knowledge is supposed to be based on experience and feminist standpoint theorists argue that their experience is more complete because it originates from the struggles against their male oppressors Harding, 1987. Yet, Stanley and Wise 1990 are against both these feminist epistemologies, as “they still accept the existence of a “true reality” and the methods of science as a means to establish it” page 42.Considering now another feminist epistemology the lesbian one we can see how diverge feminist epistemologies are.

The starting point of this epistemology is that “women” is a social category defined in terms of economic, physical or other dependency on men Stanley and Wise, 1990. As a result, they view women as a politically and socially constructed class. It is evident therefore how this epistemology challenges conventional theorising on women, in the social sciences.What is ambiguous about feminist epistemologies is whether they wish not only to challenge conventional ones but also lose their marginal status and substitute conventional epistemologies with feminist ones as well.

For some feminists feminist theories of knowledge are best kept in the margins in order to avoid temptations of assimilation Stanley and Wise, 1990. Thus, according to Miles quoted in Sydie feminism is not simply about substituting a female understanding for the current male viewpoint.In addition, feminism is the viewpoint of outsiders to power, who have therefore a more accurate view of reality because they have no stake in mystifying that reality page 214. On the other hand, it can be argued that feminism is primarily a political movement for the emancipation of women, and as such, the predominance of its theory in the social sciences could ameliorate women’s position in society mainly through social research.

Smith quoted in Sydie is in fact in favour of creating a Sociology for women, instead of women.This will result in initiating a discourse among women that “transcends the traditional academic and knowledge boundaries” page 216. As a result, what has been argued in this paper is that there exists a twofold challenge of traditional epistemologies of the social sciences. That is, feminists challenge dominant ideologies located in the social world i. e. sexism as well as dominant methods of investigating it. Finally, despite the tensions within feminist epistemology feminism has managed to expose what dominant models of viewing and researching the world have overlooked.

Managing Change With The Healthcare Issues

I consider the question of the managing change with the healthcare issues in a way of curtain problems and they’re solutions. First of all, let’s see some current issues in the USA health care system today. New diagnostic and treatment procedures flourish in the United States.

Our medical schools are of the best, our physicians of the first rank. And why not, since we spend some 15 percent of our GDP on health care?Few would argue that there’s a better place to get sick than in the United States if you can penetrate the system. Our system is the problem, and it’s only going to get worse. At dinner party, if you listen to people on the subway, if you talk with physicians, and if you talk with leaders of small business and big business, they’re all very unhappy and confused.

Private insurance companies are happy about current trends, if not happy about where we are. In the present, they’re making money.Drug companies were happier six months ago. They think they’ve been taken aback by the bad press that they’ve been getting, and they’re searching for how they can do better.

But by and large, until relatively recently, I think they were feeling again comfortable. The more-affluent people that are also fully insured. While they grouse about the paperwork, they have reasonable ways of accessing the tremendous advances that have taken place in the biomedical sciences, which are increasingly translated into better diagnostic care, therapy, drugs.I use the word “access” advisedly, because it isn’t always easy for them either to get to the right places because of the bureaucratic constraints, because of the third-party payers who say you’ve got to have your primary-care physician refer you before you can see a specialist.

But when they do gain access to the system, this group feels reasonably satisfied.National medical errors database hits one million records milestone. Medmarkx, nongovernmental database of medication errors, has received over one million medication error records to date, the U.S. Pharmacopoeia USP announced recently.

Medmarx is an anonymous, Internet-based program used by hospitals and other healthcare organizations to report track and analyze medication errors. Since the program began in 1998, more than 900 HCOs have contributed data to use an historical review of Medmarx data reveals that approximately 46 percent of the medication errors reported reached the patient; 98 percent of the reported errors did not result in harm. JCAHO Creates IT Panel.

The Joint Commission on Accreditation of Healthcare Organizations has created an advisory panel to recommend ways the Oakbrook Terrace, Ill.-based organization can use its accreditation process to increase the role of IT in healthcare. The panel will conduct a benchmark survey on the existing state of IT adoption in healthcare, and track progress annually. The 39-member panel, chaired by William Jessee, M. D., president and CEO of MGMA, includes provider representatives and reps from health insurers, academia, think tanks, IT vendors and government agencies.

The Council of Smaller Enterprises is putting its considerable weight behind a push by the National Small Business Association for health care reform on a national level. The National Small Business Association, of which COSE is a member, has developed three ideas it plans to take to the federal government as ways to reform the ailing health care system, said William Lindsay III, immediate past chairman of the association, during a recent visit to Cleveland.

Those ideas are fair sharing of costs, empowering and focusing on the individual, and reducing costs while improving quality. “The fundamental problem in America is the cost of health care and the cost of insurance,” he said. “We’ve got to get everybody insured.”The Washington, D. C.-based association already has begun to lobby lawmakers to adopt the three basic principles, and they’ve been receptive so far, Mr. Lindsay said. For its part, COSE soon will lobby Ohio lawmakers on the same issues, said COSE president Jeanne Coughlin.

Under the association’s proposal, all Americans would be required to obtain basic health care coverage, a package that would be designed and mandated by the federal government, Mr. Lindsay said. The basic package would cost the same for anyone in a given market, regardless of their health condition, he said.For that proposal to work, insurance companies would need to accept everyone into one insurance pool, which would spread costs broadly and reduce uncompensated care, Mr. Lindsay said. If companies provide health care coverage above the basic federal level, they would need to pay taxes on the money spent on those benefits, he said.

Those additional tax dollars then would be set aside for health insurance subsidies for people who don’t qualify for Medicaid but can’t afford their own insurance.It is ironic that Mrs. Jeannie Lacombe received so much attention after her death; she didn’t receive much of it immediately beforehand. On the morning of February 1, the Montrealer suffered chest pains and went to the nearest hospital emergency room. Four hours later, a physician finally looked at the 66-year-old woman, who lay on a stretcher in the hallway. She was dead.

On that early February morning, Maisonneuve-Rosemont Hospital was crowded with 63 patients in a ward designed for 34. Only three of Montreal’s 24 emergency rooms were not overflowing with double or triple their capacity. The problem isn’t confined to Montreal.Two weeks later, in Toronto, a five-year-old boy died in an ER five hours after arriving, without having seen a physician.

At times this February, Toronto nurses have fought with ambulance attendants over the stretchers patients were brought in on. A Toronto Ambulance official commented last week that the hospitals have been refusing ambulance patients more often, and for longer periods, than at any time in the last 27 years. In Winnipeg, hospitals have been routinely on “redirect,” meaning that they accept only critical patients, and “critical care bypass,” meaning they are too crowded even for those. In Calgary, a physician arrived for work at Rocky View Hospital oneday to find emergency patients lined up in the parking lot.

The ER and the foyer were already filled. “I have never seen anything like that in all the years I have been practising,” he says. Calgary’s regional health authority openly contemplated cancelling all elective surgeries, and near month’s end, health officials in Edmonton did so.Somehow, in the “best healthcare system in the world,” patients are waiting hours to be examined.

The sickest lie on stretchers for days, awaiting admission. Some argue that a combination of winter storms and flu have placed an unusually great strain on the system.These two factors surely contributed, but how did Medicare erode to the point where minor stresses can wreak such havoc? And is ER overcrowding such an isolated phenomenon? Last year at this time, with neither flu nor ice storm, Montreal’s emergency wards were filled to 155% capacity. And the problems with Canada’s emergency rooms are only the tip of the iceberg.

In truth, Medicare has been languishing for years. Consider the plight of Jim Cullen of Winnipeg. Mr. Cullen has a potentially life-threatening abdominal aneurysm. He could bleed to death without warning unless the aneurysm is surgically repaired. Mr. Cullen has waited five long months for that surgery. Despite his optimism, he wonders every day: “How long will that artery wall hold out? ” But because of the ER crisis, Mr. Cullen’s surgery is on hold indefinitely. Once Canada’s pride and joy, Medicare is marked by long waiting lists for life-saving surgeries, inaccessible diagnostic equipment, dwindling standards of hospital care, and an exodus of good physicians. Meanwhile, Canada’s population is aging.Over the next 40 years, the percentage of senior citizens will double.

More seniors require more services; if we can’t meet today’s demand, how will we meet tomorrow’s? To improve Medicare, Canadians must first answer one question: what ails the system? Some-opposition politicians, professional associations, and public-sector unions-argue that the system is simply under funded. Others-cabinet ministers, economists, and policy experts-maintain that the system has enough money: we just have to spend it better through greater government control.If Medicare is under funded, people should pay more into the system. But according to a study by the Fraser Institute, working Canadians already spend 21 cents of every dollar they earn paying for Medicare.

How much more do we need to spend? How much higher must taxes rise? The aging of the baby boomers will almost certainly bankrupt us: the Canadian Actuarial Society estimates that taxes will need to rise to an average of 94% of income in the next 40 years to sustain the system. If greater control is needed, governments must take a larger role in the healthcare system.This has been the trend over the past two decades, but has any government ever managed to browbeat part of the economy into efficiency? Governments are increasingly involved in hospital decision-making, but if Moscow central planning didn’t work in Moscow, what makes us think it will work in Victoria, Edmonton or Toronto? When healthcare is “free,” people do not hesitate to use the system. They request too many tests.

They stay in hospitals too long. They consult too many physicians. The costs add up.Millions of Canadians suffer from problems such as insomnia, back pain, chronic fatigue, severe headaches, and arthritis: there is a great potential for them to spend vast resources to little proven benefit.

In 1977, a joint Ontario government-medical association committee reviewed patients’ use of the system and concluded that “demand for medical care appears infinite. ” Canadians assume that in a “free” system there are no tough decisions to be made. If the doctor suggests that you need an X-ray, you get one.But while you don”t need to think about the cost of the X-ray, the folks at the Ministry of Health do.

You don”t worry about the cost of visiting walk-in clinics, or lengthy hospital stays, but these costs still add up. According to the Ontario Task Force on the Use and Provision of Medical Services, Ontario physicians billed $200 million in 1990 alone for “treating” the common cold. In Canada, the provinces have achieved cost control by restricting access to health services. They have downsized medical schools, restricted access to specialists, and reduced the availability of diagnostic equipment.

In many ways, Canada has opted for the old Soviet method of rationing-everything is free, and nothing is readily available. And so Canadians must line up for tests. For surgery. For the basic healthcare they need. Provinces have been busily “reforming” health care, but what are the long-term results? Patients are discharged earlier from hospitals, often too early. Patients wait for treatment; some develop complications. Hospital beds are closed, reducing doctors’ ability to admit patients. All these factors played a role in the ER crisis this February.

To make matters worse, bureaucrats have developed elaborate spending controls, reducing the system’s ability to react. Canadians have assumed that if we make health care “free” and pay the consequent high taxes, no one will ever need to worry about getting quality care when they need it. It seems that this assumption is false. Making health care “free” means everyone must worry about getting quality care.

And yet the so-called experts continue to try to make Medicare work-against the odds, against human nature. This dooms us to longer waiting lists and more horror stories.Isn’t it time we had a meaningful public discussion about health care? Lives are at stake. Most Americans are insured through their jobs.

Employers used to buy the insurance from a third party, typically the local Blue Cross/Blue Shield not-for-profit plan. Recently the Blues have lost ground to more aggressive for-profit insurers. But their strongest competitor is now employers themselves, stung by rising health-care costs and the state authorities’ burdensome regulation of the insurance industry. Federal law allows employers who “self-insure” usually through an arm’s-length intermediary to escape state regulation.

Over half of America’s biggest employers have now made the switch, in effect paying their workers’ medical bills themselves. The other main insurer in America is the government. The old and the disabled are covered by a federal programme, Medicare. Medicare, which will spend about $110 billion this year roughly twice the cost of Britain’s NHS, is divided into two parts: the first pays for most hospital care out of payroll taxes; the second pays for doctors’ fees out of general taxation and a premium paid by the patient.

Medicaid, a state-federal programme that will cost nearly $90 billion this year, pays all the medical bills of the poor, including those for long-term care. Retired and serving soldiers are covered by the Veterans’ Administration, which has a network of inefficient hospitals, and by a special programme with the colourful acronym champus. This patchwork quilt see chart 4 on next page has two gaping holes. One is that it leaves a large and growing number of people currently around 35m without any insurance at all.

The plight of the uninsured is bad, but not as bad as it sounds: most get care from hospitals that are, in theory, not allowed to turn anyone away. Figures from the census bureau and the American Hospital Association suggest that overall spending on the uninsured is comparable to spending on the insured, though it is unevenly distributed. Uninsured people can be bankrupted by big medical bills. And the bills they cannot or will not pay are a time-bomb passed among others involved in the system.

The hospitals try to pass it to the insured in higher premiums; insurers try to pass it back in lower hospital profits, or to offload it on to state and local governments. The other flaw in the American way is caused by costs that are spinning out of control. At over $600 billion, the cost of health care in America now absorbs 12% of GDP. And whereas in other countries it has roughly stabilised, in America the share has been rising throughout the 1980s.

Employers have reacted by trimming the health benefits they offer, especially undertakings to cover staff who have retired.Those undertakings will knock a $200 billion hole in profits when they have to be shown in company accounts from next year. One result is that in four-fifths of labour disputes in the past two years, the main fight has been over health benefits. Foreigners like to blame the tribulations of American health care on excessive reliance on the free market.

In fact, government policy has played a big part. Instead of improving equity, well-intentioned state regulation of the insurance market has made insurance all but impossible for small employers to buy.Two-thirds of the uninsured work, many for employers who would like to offer insurance if they could find it. The other third ought to have Medicaid cover, but budget cuts and a diversion of cash into long-term care for poor, old people mean that the programme now covers only 40% of those below the federal poverty line.

As for costs of treatment, the biggest source of inflation has been reliance on expensive fee for-service medicine that gives doctors and hospitals an incentive to treat people in the most expensive possible ways. This might look like a market fault.But another prime contributor is the government’s decision to exempt employer-paid insurance premiums from federal and state income taxes amounting to an annual subsidy of nearly $60 billion. It is bad enough that this subsidy is biased to the better-off; worse, it destroys any incentive for employees to choose cheaper insurance.

The government is also partly to blame for a legal system that has produced astronomical awards to patients in malpractice suits. These feed straight into the costs of health care through malpractice insurance taken out by doctors.High premiums and the fear of being sued have also made some types of care hard to get try finding an obstetrician in Florida to deliver a baby. Even more expensively, they encourage doctors to practise defensive medicine such as ordering unnecessary tests.

Not everything about American health care is bad. Its quality is widely thought to be high which is why one opinion poll had 90% of respondents favouring “major changes” in the system, but over half satisfied with their own care.There is plenty of choice of doctors and hospitals: European indifference to patients is rare in America. America has made the biggest progress in developing quality assessment and output measures for health.

It remains the world leader in innovation, experiment and new technology, both in medical care and in different ways of delivering and paying for it. In 1915 a labour pressure group looked forward to national health insurance as the “next great step in social legislation”. Truman tried and failed to introduce it in 1948.In the mid-1960s Johnson managed to push through Medicare and Medicaid.

Richard Nixon encouraged the spread of HMOS in which patients pay a fixed fee to cover all their health care and managed care. But when he suggested a national health programme based on a mandate for employers to provide health insurance for their workers, it died partly because Democrats like Edward Kennedy wanted government insurance instead. Ironically Senator Kennedy now supports something like the Nixon plan, but it is opposed by George Bush.

Some want to ban “experience rating” skimming the cream of insurance risks and insist on community rating. Others want to encourage the small-employer insurance market, perhaps by pooling risks. A third idea is an “all-payer” system such as Maryland’s, under which all insurers agree to pay the same price to hospitals  an attempt to create the monophony power among purchasers that is common in most other countries. But the insurance market already suffers from too much regulation.

And an all-payer system could stop the move towards cheaper selective contracts with providers.Medicaid expansion to cover more of the uninsured. This might include letting people above the poverty line, but who cannot otherwise find insurance, buy into the public programme. An alternative is to expand Medicare to cover the whole population.

But in deficit-ridden, taxophobic America, neither the federal nor any state government is in a position to take on a new spending commitment that could add up to $250 billion a year even if it saves more in private spending. State governors have repeatedly asked Congress to stop expanding the coverage of Medicaid. Price and volume controls.The most successful of these has been Medicare’s prospective budgeting for hospitals, where payments are based not on the costs incurred but on fixed prices per case known in the jargon as diagnosis-related groups, or DRGS.

This has been copied by many private insurers. The average patient now stays in hospital for a shorter period in America than in any other country, and a recent Rand Corporation study confirmed that the quality of patient care has not been affected. A new set of Medicare price and volume controls on doctors comes into force next year.But though such controls might hold down spending in one place, bills have a nasty habit of popping up somewhere else as providers fight to maintain incomes.

Alain Enthoven of Stanford University has put forward the most sophisticated single reform plan. TO encourage managed care of which more below he would cap the tax exemption for health insurance at the cheapest insurance policy available. He would create state insurance pools under healthcare “sponsors” for those who cannot get coverage. Employers who did not give their workers insurance would have to contribute to a state pool an idea known as “play-or-pay”.

Congress’s Pepper commission, which reported in 1990, also wanted a play-or-pay plan. But such employer mandates would increase business costs, and without firm cost controls they might lead to more overall spend on health care.  The Heritage Foundation, a right-wing think-tank based in Washington, DC, is touting a plan that would replace the employee-tax exemption by a tax credit to help people buy their own health insurance.

The government would require everyone to take out “catastrophic” health insurance a long-stop protection against the biggest medical bills.Potting the burden on individuals sounds attractive, but it would make it harder to avoid adverse selection by both insurer and insured. As a variant, a government commission headed by Deborah Steelman has been considering replacing both Medicare and Medicaid with catastrophic coverage for all. More patient charges or what are known in the jargon as “co-payments”.

But these are already high, in both the private and the public sectors on some estimates, old people now pay as much out of their own pockets for health care as they did before Medicare. And if they are pushed too far, people simply take out extra private insurance. Managed care in HMOS or PPOS preferred-provider organisations that offer more choice of doctor and hospital than most HMOS. This still looks the most promising option.

About 70m Americans now belong to a managed-care plan. Some plans do little more than insist on second opinions before surgery. But the best of them offer patients all the care they need for an annual prepayment, reversing fee-for-service medicine’s incentive to excessive treatment. HMOS have been touted as the answer for American health care since Paul Ellwood, a health economist, coined the phrase in 1972.

But after a one-off cut in costs, their spending growth has since matched the inflation of the fee for-service sector. Many HMOS have lost money; some have gone bust. No wonder Bob Evans of the University of British Columbia says that “HMOS are the future; always have been and always will be. ” Is America ready to make any changes to its chaotic system at all? One day, it must: the uninsured are a growing embarrassment; spending cannot rise for ever; growing paperwork will become intolerable; increasing interference in doctors’ clinical judgments will provoke revolt.

But the short-term prospects for reform are poor. The White House appears to think that any change would be politically riskier than letting the system bumble along as it is. As for the Democrat-controlled Congress, it was badly burnt when it expanded Medicare to cover catastrophic health-care costs in 1988, only to be forced to retract it in 1989 when the better-off elderly objected to paying extra taxes. In recent months the Democrats, especially in the Senate, have gingerly begun to discuss changes in health care.

Some hope to make a version of national health insurance a big issue in the 1992 election campaign.The biggest problem for Republicans and Democrats alike is the mulish conservatism of America’s powerful interest groups. John Ring, president of the American Medical Association, says his organisation is firmly against national health insurance, or any plan that involves a single payer. It might horrors reduce doctors’ incomes from their present average of $150,000 a year.

Conformity As A Way Of Behaviour

Conformity is defined by David Myers 1999 as ‘a change in behaviour or belief as a results of real or imagined group pressure’ But Zimbardo defines it as a ‘tendency for people to adopt the behaviour, attitudes and values of other members of a group’Different people maybe agree with one definition more so than with the other but it is generally thought as the act of going along with conforming to the social norms that their groups and societies have evolved.Minority social influence is when small minorities, or even dissenters, have influenced majority opinion. These people maybe dismissed initially by the majority as eccentrics or extremists.

However, under certain circumstances, these small groups or individual can eventually become very influential.Obedience is a type of social influence where somebody acts in response to a direct order from another person Cardwell 1996. Obedience may sometimes be destructive, as when people comply with the orders of a malevolent authority. Milgram comments on the happenings from 1939 – 1945 in Germany; a perfect example of obedience.

Where people were slaughtered on command, gas chambers were built, death camps were guarded, etc. These policies originated in the mind of a single man but they were carried out by millions who followed his orders.b Outline the procedures and conclusions of one study of obedienceMilgram carried out several studies of obedience but his original was the most shocking.Milgram got 40 male participants by paying them $4. 50, to take part, in 1960. The men thought that they were taking part in a study to do with learning and memory, and in what way punishment was involved.It took place in a university in the USA. The experimenter wore a grey lab-coat to reinforce his authority.

The participant was introduced to someone else and it was ‘randomly’ chosen who would be the ‘teacher’ and who would be the ‘learner’. It was arranged so that the participant was always the teacher.The learner was asked questions and everytime he got one wrong the participants job was to shock him. The shocks ranged from 15volts to 450volts, the voltage increased with 15volts every time the learner got a wrong answer.

The learner was not really being shocked. The teacher was told that the shocks were painful but not dangerous, even though the 450volts button was labelled ‘Danger: severe shock XXXConclusions included that obedience levels could be manipulated by controlling the situational variables, for example when the experiment was tried in seedy offices in a nearby town 47.5% of the participants obeyed.When participants were unsure of what the consequences were they tended to obey, when the participants were forced to see as well as hear the consequences of their actions, they were less likely to obey.

When they were less closely supervised, when they were given support from other ‘teacher’, and when the experimenter instructed from another room obedience levels also declined, however when some one flipped the switches for him obedience levels soared.c Describe two psychological processes that might be involved in obedience.One of these Psychological processes in Gradual Commitment. This means that the participants were sucked gradually into the experiment, slowly giving greater and greater levels of shock.

They found it difficult to decide when to disengage from the procedure because each voltage increment was fairly small. This is explained by the desire to appear consistent. There is the possibility that participants felt ‘contracted’ to help out with the study. They saw themselves as helpful individuals lending a hand to scientific research, but by refusing to comply they might have to re-evaluate this flattering self-perception.

Another psychological process we can refer to is the use of buffers. In this case the word is referring to any aspects of the situation that protected people from having to confront their actions.Along with other factors buffers helped people, reducing the strain of obeying immoral or unethical comments, and so facilitating obedience.In the original Milgram study, the ‘learner’ and ‘teacher’ were in different rooms, the participant did not have to see the learner so he did not have to witness the consequences of his actions.

‘Not only does research into the psychology of obedience have little application to the horrors seen in wartime, but the abuse of the human participants in such research must also be ethically unjustifiable’To what extent might we justify obedience research such as that carried out by Milgram and others?Critics of Milgram have accused him of deception and subjecting the participants in his obedience studies to psychological harm. Others have defended his actions by referring to the importance of his findings and to the extensive debriefing and follow up procedures he employed.Orne and Holland are two of which had many arguments against Milgram’s study. They thought that the situation within Milgram’s laboratory bore little resemblance to real-life situations where obedience is needed.

But there are several studies that indicate otherwise. For example Hofling et al 1966, which showed that blind obedience could occur just as readily in real life.They arranged for nurse participants to get a call from a ‘doctor’, someone that they wouldn’t recognise, and were told to give a patient 20 miligrams of a drug called astroten, so that it would take effect before he arrived. By obeying what this stranger told her to do she would be breaking four hospital rules; giving twice the maximum dose for that drug, giving a drug not on the ward stock for that day,taking a telephone instruction from an unfamiliar person,acting without a signed order from a doctor.

Despite this, 95% of the nurses started to give the patients the medication. When asked about it later they all said that they had asked to do that sort of thing before and doctors got annoyed if they didn’t do it.Rank and Jacobson repeated this experiment adjusting a few things; the nurses were told to give an overdose of a common drug, valium, they were allowed to interact and the Doctor on the phone gave the name of a real doctor who worked at the hospital. Only two out of 18 nurses started to give the drug.

Rank and Jacobson concluded that ‘nurses aware of the toxic effects of a drug and allowed to interact naturally will not administer a medication overdose merely because a physician orders it.’Baumrind 1964 brought up the argument that the Milgram study was unethical; the participants could not give informed consent to be part of the experiment because the true nature of it was not to be revealed, they were deceived and it is possible that they may suffer long-term psychological damage, because of the lethal shocks that they were willing to give to people. They would also probably not trust psychologists or people of authority in the future.

On the other hand when Milgram collected questionnaires that he had given out after the experiment he found that 84% were glad they had been involved and claimed it had been an enriching and instructive experience, 74% said they had learned something of personal importance, only 1.3% reported negative feelings. Further more, a year after the study took place a psychiatrist interviewed the participants and no psychological damage was reported.

After each experiment Milgram explained to the participant the true nature behind the study. He explained to obedient participants that they were normal, as the majority of people conformed and he explained to the disobedient participants that they’re behaviour was socially desirable because they stood up against a malevolent authority figure, telling them to do something that they felt was wrong.When the study was carried out there were no ethical guidelines to be followed so Milgram, it seems, did his best to protect his participants from harm.