英語(yǔ)論文：從社會(huì)文化角度解析奧巴馬總統(tǒng)醫(yī)療改革的障礙

從社會(huì)文化角度解析奧巴馬總統(tǒng)醫(yī)療改革的障礙

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The Obstacles to President Obama’s Health Care Reform──A Social and Cultural Perspective

AcknowledgementsI am especially thankful for all the help and assistance that I have receivedduring my thesis writing.
I am deeply indebted to my supervisor, Professor Song Aiqun, who has patientlyguided me through the whole thesis writing process and provided many constructivesuggestions, which proves greatly valuable in helping me complete the thesis writing.
I would also like thank Professor Zhang Lei whose courses on American historyand values inspired me to write this thesis on the relationship between Americanhealth care system and American values. Her sound knowledge base and meticulousattitude as a scholar also sets an e*ample for me.
I would also like to e*press my sincere gratitude to Professor Wei Ling. I learneda lot from her courses on social science research methodologies during the secondyear of my postgraduate study, which holds great significance in the writing of thisthesis.
My thanks also go to all the professors and teachers who have taught me in thepast years. I cannot complete the thesis without their selfless contribution and loftydeeds of teaching.
I would also like to e*press my heartfelt thanks to my parents who have alwaysgiven me support and courage in various forms in the past years.

ABSTRACTThe United States is the only industrialized country without a national coverageof health care insurance. The efforts of the Obama Administration to revamp the UShealth care system and e*pand the coverage of the medical insurance, aimed atimproving the living conditions and social benefits of the general public of the UnitedStates, have met with strong resistance from the society, which is almostincomprehensible to most of the countries desperately in need of the government’sdetermination in reforming the health care system. In e*amining the reasons for thestrong objection and resistance by the American public, the author delves further intoAmerican core values regarding work, mobility, status, moralism, etc. and the natureand structure of the American society, and arrives at the conclusion that cultural andsocial factors have also contributed in large measure to the obstacles to reforming thehealth care system of the United States by the Obama Administration.
Key Words: theObama Administration the US health care reform Cultural andSocial obstacles
摘要在所有發(fā)達(dá)國(guó)家中，美國(guó)是唯一一個(gè)沒有國(guó)家及全民醫(yī)療保險(xiǎn)的國(guó)家。由奧巴馬政府推行的醫(yī)療改革旨在推行全民醫(yī)療保險(xiǎn)，增加醫(yī)療投入，提高美國(guó)民眾的社會(huì)福利和生活水平，但此次醫(yī)療改革遭到了大部分社會(huì)民眾的反對(duì)。無論對(duì)于發(fā)達(dá)國(guó)家還是發(fā)展中國(guó)家，這都很難理解。但如果仔細(xì)沿著一些基本的文化價(jià)值層面探究美國(guó)的核心價(jià)值觀及美國(guó)社會(huì)構(gòu)成，我們就會(huì)找到美國(guó)民眾如此反對(duì)奧巴馬政府醫(yī)療改革的原因。因此，本文作者認(rèn)為社會(huì)和文化因素對(duì)奧巴馬政府推行的醫(yī)療改革構(gòu)成了很大的障礙。
關(guān)鍵詞：奧巴馬政府美國(guó)醫(yī)療改革社會(huì)文化障礙
ContentsIntroduction ...................................................................................................................1Chapter I Literature Review ........................................................................................3Chapter II The Historical Development of the US Health Care System ..................5
2.1 The Health Care System in Preindustrial America............................................5

2.2 The Health Care System in Postindustrial America ..........................................7

2.2.1 Reform of the Medical Education...........................................................7

2.2.2 Improvement of the Medical Profession and the Hospitals ....................8

2.2.3 Creation and the Rise of Private Health Insurance .................................9

2.2.4 Failure of National Health Care in the United States ...........................10

2.2.5 The Creation of Medicare and Medicaid ......................
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liefs, soas to provide a theoretical framework for the analysis of the reasons for the Americancitizen’s obstruction to the passage of the health care reform plan. The author e*pectsto find why cultural and social factors posed a lot of obstacles to the final adoption ofthe health care reform plan.
It is hoped that the thesis will facilitate a better understanding of the enormousdifficulties facing the Obama administration in its effort to put through the health carereform and of the profound influence of the American core values on every aspect ofAmerican life.The thesis can also provide some valuable lessons for countries whosehealth care system is desperately in need of reform and improvement.
Chapter I is a literature review, covering previous studies on the topic fromsocial and cultural as well as economic and financial perspectives. Chapter II providesan overview of the historical development of the American health care system andhow it evolved into its current form, which largely falls into two parts, the health caresystem in preindustrial America and that in the postindustrial era of the country,including the development of the medical profession, medical institutions, and thedelivery of the medical system, etc. Chapter III offers an introduction to the healthcare reform initiated by the Obama Administration, its motivations for launching thereform, and the favorable conditions that e*isted for effecting the reform. Chapter IVconducts an in-depth analysis of the American value system, the core values, andsome salient features of the US society in order to support the argument that culturaland social factors of the US society pose many obstacles to the health care reforminitiated by the Obama Administration.

Chapter I Literature ReviewA number of scholars have conducted e*tensive and intensive research on thehealth care system of the USA, President Clinton’s health care reform and PresidentObama’s health care reform.
General accounts of the US health care system can be found on the followingbooks. Professor Donald A. Barr provides an overview of the American health caresystem in his book Introduction to US Health Policy: the Organization, Financingand Delivery of Health Care in America.Professor M. Kronenfeld and professor D.
Singh provided characteristic and details of the US health care system in the bookHealth Care Reform in America: A Reference Handbookand Essentials of the USHealth Care System. the two books can facilitate for the readers a generalunderstanding of the emergence, evolution and development of the US health caresystem, especially the failure of the national health insurance, the creation of theMedicare and Medicaid, corporatization of the delivery of the US health care system,etc.
Professor Jacob S. Hacker and Nicholas Laham discusses President Clinton’sHealth Care Reform plans and the reasons for their failure in their books The Road tonowhere: the Genesis of President Clinton’s plan for Health Security and A LostCause: Bill Clinton’s Campaign for National Health Insurance. There are alsoscholars who have made in-depth studies on President Obama’s health care reform.
Professor Elizabeth A. Mcgylnn analyses President Obama’s health care reform froman international perspective in her book Analysis of President Obama’s proposal forHealth Reform.
Quite a few scholars also study the relationship between the US health caresystem and American values. Professor ElhangeEiner analyzes the relationshipbetween the evolution of the US health care system and American tradition in hisbook The Fragmentation of US Health Care: Causes and Solutions. He points out thatthe US health care system is a product of American history and values by analyzing5the role traditional values plays in the health management system of the US. ProfessorJohn Tropman points out in his book American Values and Social Welfare: CulturalContradictions in the Welfare State that the American welfare system is a silhouetteof the clash of American values. The author first provides a detailed introduction tothe US value system and its culture and then draws the reader’s attention to the clashbetween the welfare system and American values by pointing out the threats posed bythe welfare system to traditional American core values.
Several scholars study the health care system of the United States and its reformfrom political and economic perspectives. Professor William Weissert and CarolWeisserte*amine health care policy making in their book Governing Health: ThePolitics of Health Policyfrom a long-term, political perspective, describing how thepresident,Congress, special interest groups, bureaucracy, and state governmentsdefine health policy problems and find politically feasible solutions.In his book Power,Politics, and Universal Health Care: The Inside Story of a Century-Long Battle,Stuart Altman, an e*pert in health policy and advisor to five US presidents, e*plainsnot only the Obama plan but also many of the eventsin the hundred-year saga leadingup to the landmark 2010 legislation.The author describes the sometimes haphazard,piece-by-piece construction of the nations healthcare system, from the early efforts ofFranklin Roosevelt and Harry Truman to the later additions of Ronald Reagan andGeorge W. Bush. In each case, hee*amines the factors that led to success or failure,often by illuminating little-known political machinations that brought about immenseshifts in policy or thwarted herculean efforts at reform. Professor Regina E.
Herzlinger, one of the nation’s most respected health care analysts, points out why thecurrent US health care system is unsustainable in the long run in her book Who KilledHealth Care? Americas $2 Trillion Medical Problem and the Consumer-DrivenCure.Theauthor e*poses the motives and methods of those who have crippledAmericas health care system, for e*ample, figures in the insurance, hospital,employment, governmental, and academic sectors. She proves how the current system,which is organized around payers and providers rather than the needs of its users, isdangerously eroding patient welfare, and is pushing medical e*penses out of the reachof millions.
Many Chinese scholars also conduct e*tensive research on the welfare system ofthe US, of whom Professor Chen Mengmeng stands out with his book Studies on theAmerican Social Welfare System. He studies not only the health care system, but alsothe social security system for the disabled, the unemployed and senior citizens, withspecial emphasis on the system’s structure, characteristics, problems and reformmeasures. Articles on the study of the motivation, content and measures of Obama’shealth care reform by Chinese scholars also abound, of which the best-known includeAn Introduction to the Health Care Reform Initiated by the ObamaAdministrationwritten by professor Wang Mei, The Reasons for, Goals and Measuresof the Health Care Reform by the Obama Administrationwritten by ProfessorGuWenyan and A Social Analysis of the Opposition to the Health Care ReformInitiated by the Obama Administration written by professors *iao Yunnan and ChenYong.
Chapter IIThe Historical Development of theUS HealthCare System
2.1 The Health Care System in Preindustrial America
From Colonial times to the mid- and late 1800s, medical education and practicein the US lagged far behind those in Great Britain, France, and Germany. There wasno health insurance, private or public. The health care system in the US during thisperiod had some salient features worth mentioning. The medical education at thattime was not standardized.
Until around 1870, most of medical students received training through individualapprenticeship rather than through university education. It was also quite ironic thatmost of the medical teachers themselves lacked proper training. As time went by, thetraditional training method, the apprenticeship, could not meet the growing demandfor doctors. Thus, medical schools began to emerge. At first, there were only a fewmedical schools in the US, and the opening of such medical schools was partly drivenby economic factors. Student fees were directly paid to the physicians who openedmedical schools. Science had no place in medical education during this period.
Relatively low standards and easy curriculum were deemed necessary to attractmedical students. Even the best medical schools admitted students without a highschool diploma. Laboratories were non-e*istent. Library facilities were inadequate,and clinical observation and practice were not part of the curriculum.
Another feature was medical practice at that time was quite primitive, lacking inscientific foundation. Any tradesman could be a physician or surgeon, which led tointense competition. The early practice of medicine was a trade without muchsignificance or prestige. It did not require rigorous study, clinical practice, residencytraining and licensing, etc. medical procedures at that time were primitive due to thefact that medical science was still in its infancy. Some primitive forms of clinical8therapy were quite popular and common at that time, such as the use of emetics,purging with enemas and purgatives. Surgery was limited becauseanesthesia had notyet been developed, and antiseptic techniques were not known.Some basic andcommon medical tools widely in use today were just simply unavailable for medicaldiagnosis, such as the stethoscope, *-rays, clinical thermometer and the microscope,which had not been discovered or invented at that time. Physicians mainly relied ontheir five senses and e*perience to diagnose and treat medical problems. In a word,they were quite unprofessionalby today’s standard. One of the main consequences ofnonprofessional medicine was that anyone, trained, or untrained, could practice as aphysician. For e*ample, the clergy often combined medical services and religiousduties. Tradesmen such as, tailors, barbers, commodity merchants, and those fromnumerous other trades also entered into the medical practice by selling herbalprescriptions, nostrums, eli*irs and cathartics, etc. Free entry into the medicalprofession created intense competition. The social status, influence and income ofdoctors were quite low compared with today. Most of the physicians found itnecessary to engage in a second occupation to better support their families.
There were few hospitals in those days and they were mainly located in largecities. Most of them had poor conditions and unskilled staff. Two types of medicalinstitutions, the almshouse and the pesthouse, were more popular and they laterevolved into today’s hospitals. Before the 1880s, American hospitals played a minorpart in delivering medical care because most of them only provided basic nursing careto the destitute, the orphans or the disabled. They had poor sanitation and ventilation.
Unhygienic practices prevailed because nurses were generally unskilled and untrained.
It was far more risky to receive care in a hospital than at home. Besides, thosehospitals had an image as houses of death and institutions of welfare. The almshouse(also called a poorhouse) could be found in almost all cities of moderate size and wasrun by the local government. Technically speaking, the almshouse was not a hospital.
It was a place that took care of the disabled, the orphans, the sick, and the homeless,giving them food, shelter and basic nursing care. It was actually an old-age facility,mental asylum, homeless shelter and orphanage for the people who could not be taken care of by their own families. Another important type of institution at that time wasthe pesthouse, which was also operated by the local government. It mainly aimed atisolating people who had contracted contagious diseases, such as cholera, smallpo*,typhoid, or yellow fever. It mainly served to contain the spread of some deadlycommunicable diseases.
As a result of such poor medical training, primitive medical practices, and poorconditions of the hospitals, most of Americans at that time relied on family members,neighbors or publications for domestic remedies.
In the small communities of rural America, the spirit of self-reliance prevailed.
Families and communities treated the sick using folk remedies that werepassed on from one generation to the ne*t. It was common for people toconsult published books and pamphlets on home remedies.
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2.2 The Health Care System in Postindustrial America
The postindustrial era witnessed reforms in medical education, the growth anddevelopment of the medical profession and the formation of professionalorganizations by physicians. Hospitals also saw drastic changes, which became truemedical institutions for the general public. Private and public health insuranceemerged and took its current shape during this period.

2.2.1 Reform of the Medical Education
Rapid advances in medical sciences brought about by industrialization and rapidurbaniz ……（未完，全文共92922字，當(dāng)前僅顯示16713字，請(qǐng)閱讀下面提示信息。收藏《英語(yǔ)論文：從社會(huì)文化角度解析奧巴馬總統(tǒng)醫(yī)療改革的障礙》）