End of Course Reflection

While conducting research for the final paper for this class, I learned a lot of interesting things about the Crimean and Civil Wars that I did not know about before. I did not know much about the Crimean War especially, and I was appalled after doing the research about the conditions that the injured and sick British soldiers had to go through in the hospitals. I learned a lot about Civil War hospitals while reading the first book for this course, and after this paper I was able to tell the differences and similarities between the two wars and how they treated their soldiers. The main thing I took away from all the research I did for this final paper was that there were many similarities between the hospitals of both the wars; however, the Civil War doctors had an example to help improve their hospitals a lot quicker thanks to Florence Nightingale. I am glad I picked such a historic topic as this, and I am also glad that I learned a whole lot on the history of health care in the United States and around the world.

Brasfield Chapters 6-10

With our current system of national health care, there are many problems that need to be addressed if this current model is going to survive. Some people say that the current model should just be thrown out and we should start over from scratch in order to solve some of the new problems that are being discovered almost every day. I think the old system needs to be adjusted but not completely thrown out. It has served our nation well for the past couple of decades, and I believe it can be tinkered with enough to help iron out the problems that we are encountering right now. One of the main problems that needs to be solved, in my opinion and a lot of people around the country, is cost control. As stated in this book, the United States spends the most of any developed nation on health care, yet receives the least from what we spend. That needs to change if national health care is going to continue to exist in our country the way it is now. And if a good solution is not figured out for cost control, then I believe the system is too flawed to be changed enough to be saved and needs to be thrown out. Cost control could help solve many of the problems we are trying to address right now, but so far a good solution has not been offered in order to fix it. That needs to be solved sooner rather than later, and I believe one of the only ways to do that is to gather the top officials from every major medical care sector in the same room as some of the political parties' top officials and make them stay there until a solution is agreed to. That is the only way we as a nation will not go bankrupt from health care spending, and that is the main problem that needs to be addressed as soon as possible.

Brasfield Chapters 3-5

In these chapters, the author mainly talked about subjects that had already been covered in the books we have read in the past. The author went over the enactment of Medicare and Medicaid, and how both of these health care plans have changed over the years. It also mentions again the resistance against these health plans that the government were forced to deal with. Many items have been added on in order to improve both Medicare and Medicaid, but overall, both of these plans have remained largely intact. This book also goes over the predicaments that both these health plans face, and what the future might hold in regards to what health care might look like for people in the United States in the next decade. She lists several options of what might happen, and the intended and unintended consequences of each of those solutions. One of the main problems for the future of health care is the rising costs that are draining federal resources and forcing them to raise taxes and/or premiums. The citizens do not like the new raises, but that is the only way that health care will remain the way it is. The author also offers some solutions to these problems, but nothing is for certain and health care might look very different in ten years than it does today.

Brasfield Chapters 1-2

The thing that stuck out to me the most when I read these two chapters was the numbers that she described relating to the amount of money Americans spend on health care each year. This amount totals in the trillions, and continues to rise each year that the same policy is in place. Experts have predicted that health care costs will continue to rise through research and what has happened in the past. If they continue to rise the way they have the past couple of decades, health care costs could become uncontrollable and need to be managed through a bill introduced in Congress. If not, health care costs could conceivably cause the country to bankrupt while attempting to keep up with the rising amount of costs. Americans will not like to be taxed more to pay for the costs, so Congress and the President will have to intervene with a bill that will not cause too many people to be unhappy while at the same time controlling some of the costs.
The author also mentions that the number of employee-based insurance will also decrease, while at the same time offering some predictions of what might happen in the future if current trends continue. The future predictions will not be well-liked by most Americans, maybe causing major changes in the current system. With all of that said, the main focus needs to be in controlling the cost, while at the same time making sure that most Americans still possess affordable health insurance.

Altman Part 4 and Epilogue

When Barack Obama was elected President in 2008, he promised to pass a comprehensive health care reform law that expanded the current health care system to include most uninsured Americans. That was his goal from the moment he took office, and it was one of the first bill he immediately began working on with Congress. However, not only did he have to make compromises with the members of Congress who opposed his plan, he also had to convince the doctors, the insurance companies, the hospitals, and even ordinary Americans that the reform was needed. With almost all the Republicans condemning the bill, it was hard for Obama to begin his plan, and he probably would not have succeeded without the help of many members of his own party. They were able to convince enough people that the reform would be beneficial to side-step the votes of the Republicans and still get the bill passed into law. Along with compromises and deals that the Democratic Party was able to make with the doctors, hospitals, and insurance companies, the bill seemed sure to be signed before the Christmas break. However, during the summer, the public erupted into near-riots, with lies going around (some spread by Republican Congressmen), that the new law would allow Congress to decide whether some people lived or died. Despite this setback, the Obama administration was able to pass the law, although with many amendments that had been added by its own members and by other organizations that they needed. The administration has been lauded for passing into law the most comprehensive health care reform bill in American history.

Altman Part 2

The part of this section of the book that got to me was how many presidents and members of the U.S. legislative branch attempted to get national health reform passed but failed due to many different circumstances. Many failed due to the power struggle in the legislative branch, where there was frequently never a party in control of both the House of Representatives and the Senate during any one presidency. Others failed due to the general public's unwillingness to trust anything that gave the federal government more power than they thought it should have. Many different leaders in Congress tried to pass health care legislation, but almost every one failed. Each time, the new proposal was shot down by a party, group of legislators, or even individuals who felt that some part was unfair. Bit by bit, more legislation was eventually passed through Congress, however, and that finally culminated in the 1990s with the passage of the MMA. This bill was the first major expansion of Medicare since its induction in 1965. It gave more health care benefits to the old, especially those in poverty, by helping them out with the expenses of prescription drugs that they tended to buy frequently. Prescription drugs had never been insured before, and this technique was revolutionary in the United States especially. It also provided insurance to millions of children who lived in families that were under the poverty line, enabling them to get benefits that they had never before been able to obtain. These ideas took many years to pass, with many representatives aggressively opposing them. It took may powerful people in the government for these bills to pass into law, but when they finally were, they were immensely successful. Poverty rates of both children and the elderly have both decreased, and the budget that was set for them has continued to shrink due to continued coverage. No one predicted how successful they have been, and they have been and continue to be an integral part of the national health care system of the country.

Paper Topic

Crimean War medicine and the effects on people from both sides

Altman Part 1

President Nixon was one of the first of his time to attempt to introduce comprehensive national health insurance reform. His stance on the issue was against what many thought the kind of person he was, but he still attempted to introduce it. At the time everyone in Congress had their own ideas on what national health insurance should be like for Americans, so there were very many arguments when the different ideas began to come into conflict with each other. Nixon eventually failed to get his bill passed, and the Watergate scandal forced him to resign before he could attempt to try again. Almost all of his major competitors also were forced out of positions of influence, and a major reform of any kind for national health insurance was considered a dead issue until over 20 years later, when Bill Clinton took office. Clinton attempted to introduce his own version of comprehensive national health care reform in what was termed managed competition. This would set budget ceilings on all the states for health care to their own populations and even regionalize the costs. However, after a lengthy debate that included many protests and an ad campaign that is called the "most destructive in history," Clinton's plan failed and was tossed out of consideration.
I found it interesting that everyone had their own ideas about what health care should be, and that was one of the main reasons why any kind of reform took so long to come about. No one could agree to any compromise without seeming "weak," and so the movement almost always ended in defeat for whoever was proposing the new ideas.

Hoffman Chapters 6-Epilogue

Medicare was a drastic improvement to the country's health care system. After many years of hard fought battles with doctors and the associations that represented their interests, Medicare was finally introduced. It helped the elderly pay for the increasing costs of the medical care that they needed in order to stay healthy, and most of them greatly benefited from this new program. Medicaid was also added, to help support those that did not qualify for the age requirements and were unable to pay their medical costs. Even though doctors frequently denied Medicaid patients due to lack of reimbursement, it was immensely popular throughout the United States. Despite its benefits, Medicare and Medicaid had their problems, but these problems were fixable and were rather small compared to the benefits. Most of these problems resulted in the fact that hospitals were continuing the tradition of discriminating against people that could not pay their bills. A good portion of these people included females, Latinos, and African-Americans, and activists for civil rights groups protested these deficiencies in the system to no prevail. Hospitals also continued to use the "dumping" method, which helped bypass the costs they would have to incur with patients who were unable to pay. This also exacerbated the new AIDS problem, with many people around the country scared to even go near an infected person for fear of contracting the virus themselves. These were all issues that the medical profession and the general population were having to deal with during these times of great changes in the health care system.

Hoffman Chapters 1-5

Before the Great Depression hit the United States in the 1930s, many people had never experienced being in a public hospital in their entire lives. However, as unemployment rates across the country rose dramatically, more and more people were forced to go to public hospitals, free clinics, or even charities to get medical attention since they could not afford to pay a private physician anymore. This huge influx of new people to these hospitals caused many of them to quickly spend all their resources, with no way of being able to treat the massive amounts of people that came looking for treatment. Doctors were also resentful about the many new "unable to pay" patients that frequently began to come, to the point that some clinics and hospitals began to see patients based on their ability to pay. Government subsidies created some relief, but these did not last long as the President Roosevelt frequently began to focus more on unemployment rates rather than medical care. The issue of medical care for the majority of people lasted throughout the Great Depression, and was a constant problem that arose across the country. Many people at this time believed that medical care was a basic human right that everyone should have, and demanded that the government help the unemployed pay for their hospital bills. This was, of course, debated by the medical profession as not an option, since the doctors would not make as much money as they would if the patients were paying for their own treatments. This led to a national debate, one that helped create prepaid hospital insurance called Blue Cross, which only paid for hospital fees, and later, Blue Shield, which payed for the doctor's services. These services spread quickly across the nation, until most major employers used one or both of these plans for the benefit of their employees. This was just the beginning of national health insurance on a national scale.
When World War II broke out, there was an overwhelming rush by anyone that could, including doctors and nurses, to the army to help the cause. This rush devastated the civilian doctors who did not go, causing a massive shortage in doctors in areas that needed them from population shifts that occurred throughout the war. There was also the issue of men leaving their pregnant wives behind to pay for their medical bills on the meager pay that they earned. This was solved through the EMIC, which helped pay for millions of child-births across the country during the war. After the war, the Hill-Burton Act was the main bill passed for hospital reform. It sent millions of dollars to hospitals, and also sent millions of dollars to help build countless more. This bill was an important first step towards a national health care system.

Howell Chapters 6-8

When the blood count first started to become an important part of diagnosing and treating different types of diseases, it was met with skepticism and also greeted warmly. Many people felt that it was quicker and could lead to a more accurate diagnosis, thus potentially increasing the likelihood that the patient could survive. The rise of blood counts helped many patients with life-threatening illnesses survive and recover due to the quick and efficient diagnosis that they received. Though it took many years for a blood count to become a routine part of the original medical screening, it eventually caught on and became as important and possibly more than anything else that was done to the patient. Blood counts at first were done by the naked eye, and then later put onto hemocytometers and done with the microscope. The microscope provided a more efficient way to count the blood, and could help in efficiency and time when those were the most important factors that could save the patient's life. The rise of the Widal reaction also increased those two factors, and helped the blood count rise to be one of the most important ways to diagnose and determine treatment for a sick patient. These two tests saved countless lives, especially from the diseases that were common in the United States at that time, including typhoid, appendicitis, and pneumonia. All of these diseases were widespread, and caused many deaths throughout the nation before the blood count test was created. The blood count test saved many people, and should be considered one of the most important medical discoveries of the 20th century.

Howell Chapters 3-5

The urine test was an important part of 20th century hospital stays. But it increasingly became more important as doctors began to realize the potential diagnosis that could be determined by the test. When doctors realized this in the early years of the 20th century, they immediately began taking more notice of the urine tests than ever before. Urine tests had been known for a long time as a way to determine what the person was being affected by so the best possible treatment could be used. In 1900, the average patient admitted to the hospital had a urine test done right when they were admitted and not again. However, in 1925, it was not unusual for multiple urine tests to be conducted on a patient every other day for as long as they stayed at the hospital. This was mainly because doctors figured out that it was an important part of the diagnosis and treatment that they could use on the patient. Instead of the results being noted and barely looked at, doctors increasingly studied the results to find out something about the treatment the patient would need or to figure out what was wrong with them. Even when the patient was stricken with something that did not require the doctors to take a urine test, like a broken leg, urine tests were still taken from these patients in 1925.
The x-ray was another important technological advance that saw an increase in use between the years 1900 and 1925. It was especially important in looking at fractures, which was a major problem in those times, and determining patient history when they would or could not tell doctors themselves. Doctors also increasingly found that it was much simpler and easier to look at the fractures than just by feeling the patient or asking them directly. As doctors began to realize its importance, they began using it more and more, and by 1925 taking an x-ray was a regular occurrence during a hospital visit. World War I also helped the increase in use, as doctors had to maintain hospitals that saw an increased amount of men coming in, especially after a large battle. That, along with the many different injuries these soldiers suffered from, added to the idea that the x-ray was the quickest and easiest way to diagnose all the different assortments of injuries the doctors were seeing.

Howell Chapters 1-2

Technology in the hospital changed very quickly over a relatively short period of time between 1900 and 1925. In 1900, hospital care was not as efficient as it could have been. Tests were taken, but whenever possible, doctors relied on sight or their own knowledge to diagnose the symptoms and give out treatment. The tests that were taken were hardly even looked at, and long hospital stays might only take up one page of the record books of the hospitals. By 1925, however, things had changed. X-rays were used to take images of the body, and then used to confirm diagnoses. Doctors took much better records, and prided themselves in keeping a clean, tidy, well-furnished hospital setting. Blood tests were also an important part of the diagnoses, and doctors frequently referred back to them during treatment. Some people might say the hospital, by 1925, had become more scientific. Machines were relied on more heavily, and doctors and patients alike wanted to know and understand more about what kinds of illnesses they were suffering from and what caused them. The new technology both doctors and patients were experiencing in the hospital is a very important part of the upward use of technology at that time, which helped lead to more discoveries and made hospitals more about science than ever before. In other words, hospitals started to become a central part in medical education. This new technology often bewildered a patient who had never experienced these things before, and they must have been uncomfortable at first when their blood was taken for tests for the first time. As the technology became increasingly more advanced and people began to realize that it was alright to go to a hospital, the hospitals were faced with a management crisis. They fixed this by changing every part of their organization from the bottom up, thereby making it a lot more efficient in providing health care. Technology was the main cause of the rise of the hospital in the average American's life, and it continues to be an important aspect of the modern-day hospital as well.

Chapter 7-Afterword

While the Northern hospitals faced their fair share of problems regarding the conditions and the task of treating so many patients, Southern hospitals faced a more dire situation. Due to the blockade and lacking the industrialization that the North enjoyed before the start of the war, the South just did not have enough medical supplies to adequately attend to the flood of injured soldiers they began to face. Throughout the war, Southern doctors faced shortages in everything they needed to be able to help the wounded soldiers recover and send them back to the fight. They lacked in medicine, clean clothes, bandages, mattresses, and anything else that would make the soldiers' life more comfortable. They frequently turned to the government, but even they were unable to supply the hospitals due to the blockade, lack of reliable transportation, and the ever-obvious swath of destruction the Union Army caused while invading the South. The goal of hospitals back then was to help a soldier recover in order to return him back to his unit and back to the fight. The lack of materials caused this goal to be unreachable, and few soldiers were able to return to the fight healthy if at all. In fact, upon arriving to the hospital, many soldiers deserted the army altogether and returned home instead of returning to face the horrors of war again. They knew that the hospital would not be able to feed them, clothe them, or adequately care for them, making it all the more likely that they would either starve to death or die from their wounds. Southern prisoner-of-war camps were not much better. They too suffered from shortages in adequate materials to support the large numbers of Union prisoners. This caused a very high mortality rate among prisoners in the South compared to the North. Overall, however, neither the North or the South took very well care of their prisoners, causing many deaths that could have been prevented.
Due to the Civil War, doctors around the country learned many valuable things about their trade. They learned how to better care for the wounded depending on what kind of injury they had suffered, that quarantine and disinfectants could help stop the spread of disease, and also a lot knowledge about the anatomical aspect of the human body. The knowledge learned during the war helped stop the spread of diseases in later years, as in the smallpox, cholera, and yellow fever outbreaks that happened after the war. It also helped lead to research that helped discover even more technological advances in the future that led to an overall safer standard of living.

Chapters 4-6

Millions of soldiers were sent to hospitals around the country during the Civil War from diseases due to camp conditions or from battle wounds. Most of these soldiers had never been to a hospital before, since at that time hospitals were for travelers or poorer people. They had always been cared for by their families, mainly the women of their families, until they were well enough. So, when soldiers started to pour in from distant battlefields or from camping armies, they were in for a surprise when the hospital was nothing like what they were used to. The doctors, who were mostly male, had no clue that a good environment and morale among the sick and wounded helped them recover faster and improved mortality rates. Women, on the other hand, knew this, since they had spent their entire lives caring for men when they became sick. Women wanted to help these men recover, and they sought out ways in order to accomplish that. Through the United States Sanitary Commission, created to send supplies out to armies and hospitals that were desperately needed, women began to send needed materials to the men that helped many recover from their wounds. These included blankets, clothing, bedding, bandages, and other critical materials that made their lives easier. However, the organization that they worked through, the United States Sanitary Commission, was not without its critics. Many believed that they took the materials and donations they received for themselves through corrupt agents and doctors. This was mostly untrue, and without the efforts of this organization, many more lives would have been lost due to diseases, camp conditions, hospital conditions, and the lack of materials needed by almost every army and hospital that existed during the war.

Intro-Chapter 3

Intro-Chapter 3

When the Civil War broke out in 1861, thousands of men rushed to join the ranks of both the Union and the Confederate Armies. They had visions of glorious battles, where they would fight heroically and be welcome back home as heroes to their own countries. However, no one even thought once of the thousands of wounded and dead that a battle can produce, and that each of these men would need medical care once the battles were over and even as the battle raged on around them. By the beginning of the Civil War, there were relatively few doctors and even fewer hospitals, and the ones that were already there were incapable of handling all the wounded that each battle caused. At the start, th medical practices the doctors used were both technologically advanced for the time and out of date at the same time to help the thousands of wounded.The doctors used anesthesia, in the form of either ether or chloroform, instead of bloodletting, which had fallen out of favor. Doctors used quinine when available and alcohol to stop fevers, purgatives or opium for diarrhea, and mercury to improve liver function. For serious limb injuries, the doctor had no choice but to amputate the limb to avoid infection and losing the soldier.These techniques helped save millions of lives, as long as they were in the care of doctors that knew what they were doing with the treatments and were not corrupt. During the battle or after it, ambulance crews went to pick up the wounded to transport them to a field hospital. If the injury was serious enough, they would then be transported over large areas of the country to general hospitals, where the soldier could stay and recuperate. 

Though most doctors were men, a few women had already been able to achieve being a doctor by the time the war broke out. Most women, however, worked as nurses in the hospitals. Women reformers and relief organizions sought to improve these women's status to professional nurse, with much criticism from other doctors and around the nation. 

Healthcare Before the 1920's

Before the 1920's, there were some various techniques of healthcare that in today's time might have seen as mediocre to just plain cruel. People back then were forced to use the resources and materials that were at hand, and these were often ineffective or tended to make things worse for the patient. Hospitals were rarely used back in those days, and most medical treatment was performed by women on their own family members in their own house. The treatments they used mostly just succeeded in making the patient comfortable enough and let their own body fight whatever illness they had. This was considered the best treatment, since hospitals were few and far between and it usually made things worse to try to travel with the sick person all the way to one. Also, doctors back then did not know much about how to fight various diseases, so most people considered going to the hospital a death sentence. They thought that they would rather die in the comfort of their own home surrounded by their loved ones rather than in a nasty, dirty hospital with doctors that did not know at all what they were doing for the most part. There were few women doctors, if any at all, and men did not know how to make the patients more comfortable by providing certain things like baths and healthy food. Male doctors often overlooked these little things that women who were used to dealing with these things would have remembered. Most of the practices that doctors used only made things worse, and few patients ever recovered fully from their stay at the hospital. Luckily, as the years passed, technology and therefore medicine and medical practices began to improve slowly, and the hospital began to start becoming not so much of a death sentence as it was once viewed as.