President Biden: Promise of better Health Insurance on the Horizon?

Emma Schanzenbach, MS4

One of the most hotly debated subjects in popular American politics is Health Insurance. In 2010, President Obama heavily supported the Affordable Care Act (ACA), to the point it was dubbed “Obamacare” by critics and allies alike. Now, in 2021, eleven years after the ACA was passed, many are looking to President Joe Biden to expand upon, and save, the ACA from some of its most vocal detractors.  

According to the Biden campaign’s website, the Biden Healthcare Plan promises to: one, give every American access to affordable healthcare, two, decrease the complexity of the healthcare system while still maintaining quality, three, stand up to prescription drug corporations, and, four, ensure healthcare as a right (1). While they are, indeed, lofty campaign promises, Biden has implied that he would veto a “Medicare for All” bill if it came across his desk (2). In contrast to this, his campaign website supports the passage of a public option, like Medicare, under the second tenet of his campaign healthcare promise (1). This would allow anyone, no matter their financial situation, to choose a public option over a private insurance or employer-based insurance plan (1). As it stands now, it is unclear what President Biden’s exact messaging on health insurance will be. If the American people are to take his campaign promises at face value, there would still be many hurdles a “similar-to-Medicare for All” insurance would have to clear before passage.  

If a public option were to pass, it seems unlikely that the option would remain completely public. For this to occur, the government would have to have a highly functioning department to handle this operation. When the ACA website first launched, the website crashed from the overwhelming traffic it received. The Obama administration had to pull tech executives to revamp the website, a task they luckily felt excited to get behind. A public option office would likely go through much of the same issues that the ACA website experienced. Additionally, President Biden has decided to move forward with a COVID-19 relief plan that was largely produced by two major insurance lobbying groups: America’s Health Insurance Plans and the Blue Cross Blue Shield Association (3). Their plan relies on subsidizing ACA plans, some of the most expensive plans on the market, which will likely allow them to increase the massive profits they made during the pandemic (4). Instead of a much-needed chance for change, with health insurance lobbyists involved, the future for a public option seems grim.  

In conclusion, despite the hope many Americans feel now that President Trump and his administration have left the office, the hope must be that of a reserved type. The Biden campaign promises were most likely empty, without real substance behind them. If Americans want a public health care option, they will have to band together and fight for it. This is the only way we will be able to create a more just and fair healthcare system. For if 2020 has taught Americans anything, it is to not rely solely on the government to mount a response to any sort of public health crisis. 2020 has taught us, in fact, that we can only rely on each other to hold elected officials accountable and create any sort of real, meaningful change.  

 

1. https://joebiden.com/healthcare/ 
2. https://www.cnbc.com/2020/03/10/biden-says-he-wouldd-veto-medicare-for-all-as-coronavirus-focuses-attention-on-health.html 
3. https://www.jacobinmag.com/2021/01/joe-biden-public-option-health-insurance-plan 
4. https://www.nytimes.com/2020/08/05/health/covid-insurance-profits.html 

 

Fact or Fiction: Is Gender a modifiable factor of Heart Disease?

 Temilolaoluwa Daramola, MS4

 One in every three deaths within the United States is associated with cardiovascular diseases with women increasingly closing the difference in rates between their male counterparts. More focus has been on the physiologic impact of estrogen on cardiac function over the lifecycle of women. While more studies are now increasingly recruiting female participation in studying cardiovascular diseases, it remains the leading cause of death in this group. Additionally, there is a 9-year delayed onset of a heart attack in women compared to men that is narrowing. Therefore, a complementary point of view and a deeper dive must be done to highlight the relationship between gender inequities and heart disease.

Unlike sex ascription which focuses primarily on the biological characteristics, gender is a social construct thwarted by some biological contexts. Therefore, gender should be viewed as a social determinant of health. Understanding the mechanism of early socialization into the gender roles during child development could help highlight some of the high-risk behaviors that result in a deleterious effect on cardiovascular disease among women during adulthood.

Physical fitness is typically emphasized to boys compared to emotional and verbal skills that are inculcated into girls. While parental styles may help modulate the degree of conformity to these values, studies have noted that girls at the age of 6-8 are more sedentary than boys. These early childhood behaviors increase the risk of transferring such traits into the adolescent age. Additionally, women are reported to be less likely to exercise in public spaces at night or through the cities due to safety issues.

            While cigarette smoking used to be previously linked to boys, this has changed to be an equally high-risk factor of girls as well. A behavior that begins most critically during adolescence has a lasting impact during adulthood. Furthermore, girls are more likely to learn this behavior from parental influence compared to boys whereby their scope of influence is with their peers. Specifically, females that start smoking at greater than 16 years of age are more likely to develop heart disease and high blood pressure. Cigarette smoking is also more likely to be adopted by women for weight loss and body disturbances, especially in a society that places a high degree of emphasis on the esthetic values of body image in women.

Adverse childhood events specifically related to trauma can result in chronic stressors; this negatively affects heart health due to increased autonomic and endocrine response. More specifically, female victims of intimate partners violence, who are younger than 25 years of age have been associated with traditional risk factors that negatively impacts heart disease such as obesity, low high-density lipoproteins, high low-density lipoproteins and substance use disorder. Additionally, workplace harassment can be associated with eroding heart health, with 33% of women more likely to report sexual harassment compared to 9% of men in the workplace. The added responsibilities of working women having competing obligations between their professional and domestic role, specifically as caregivers has been identified as an independent factor that can increase the incidence of non-fatal chronic heart disease in this group.

Modifying these risk factors through the process of deconstructing socialized behaviors that negatively impact women can help lower the rates of heart diseases. Also paying special attention to these factors before adulthood in early child development allows for targeted behavioral changes during those critical periods of life before it becomes more difficult to curb. School based policy interventions that emphasize increased participation and normalizes equal gender representation in different sports and gym activities can continue to promote a physically active lifestyle that is not transient. Secondly, more local government safety measures should be enacted to create more public spaces in the city and at night for individuals to feel more comfortable exercising. Thirdly, engaging family members in smoking cessation conversations can utilize role-modeling to positively augment teenage-acquired habits. On a more upstream level additional focus should emphasize policies that promote gender equality within the workspace and financial independence through extensive day care services, combined couple paid leaves and scrutinize workplace harassment, which further positively augments those effects on women’s health.

These behaviors have physiological implications that is vital to focus on. Therefore, viewing gender through a social and biological lens provides a more comprehensive approach to decreasing cardiovascular disease burden and disparities related to this.

Sources:

·         McLean CP, Anderson ERBrave men and timid women? A review of the gender differences in fear and anxiety.Clin Psychol Rev. 2009; 29:496–505. doi: 10.1016/j.cpr.2009.05.003

·         Lampinen EK, Eloranta AM, Haapala EA, Lindi V, Väistö J, Lintu N, Karjalainen P, Kukkonen-Harjula K, Laaksonen D, Lakka TAPhysical activity, sedentary behaviour, and socioeconomic status among Finnish girls and boys aged 6-8 years.Eur J Sport Sci. 2017; 17:462–472. doi: 10.1080/17461391.2017.1294619

·         Kimm SY, Glynn NW, Kriska AM, Barton BA, Kronsberg SS, Daniels SR, Crawford PB, Sabry ZI, Liu KDecline in physical activity in black girls and white girls during adolescence.N Engl J Med. 2002; 347:709–715. doi: 10.1056/NEJMoa003277

·         Wesely JK, Gaarder EThe gendered “nature” of the urban outdoors: women negotiating fear of violence.Gender Soc. 2004; 18:645–663.

·         Aldred R, Dales JDiversifying and normalising cycling in London, UK: an exploratory study on the influence of infrastructure.J Trans Health. 2017; 4:348–362

·         Thompson AB, Tebes JK, McKee SAGender differences in age of smoking initiation and its association with health. Addict Res Theory. 2015; 23:413–420. doi: 10.3109/16066359.2015.1022159

·         Cawley J, Markowitz S, Tauras JObesity, cigarette prices, youth access laws and adolescent smoking initiation. Eastern Econ J. 2006; 32:149–170.

·         Stene LE, Jacobsen GW, Dyb G, Tverdal A, Schei BIntimate partner violence and cardiovascular risk in women: a population-based cohort study.J Womens Health (Larchmt). 2013; 22:250–258. doi: 10.1089/jwh.2012.3920.

·         Australian Human Rights Commission. Working Without Fear: Results of the National Sexual Harassment Survey 2012. https://www.humanrights.gov.au/sites/default/files/content/sexualharassment/survey/SHSR_2012%20Web%20Version%20Final.pdf. ISBN 978-1-921449-37-6. Accessed March 2, 2017

·         Revenson TA, Griva K, Luszczynska A, Morrison V, Panagopoulou E, Vilchinsky N, Hagedoorn MGender and caregiving: the costs of caregiving for women.In: Caregiving in the Illness Context. London, United Kingdom:Springer; 2016:48–63.

·         Lyons JG, Cauley JA, Fredman LThe effect of transitions in caregiving status and intensity on perceived stress among 992 female caregivers and noncaregivers. J Gerontol A Biol Sci Med Sci. 2015; 70:1018–1023. doi: 10.1093/gerona/glv001.

·         O'Neil, A., Scoville, A., Milner, A., & Kavanagh, A. (2018). Gender/Sex as a Social Determinant of Cardiovascular Risk. Circulation, 137(8), 854-864. doi:10.1161/CIRCULATIONAHA.117.028595

·         Westerman S, Wenger NK. Women and heart disease, the underrecognized burden: sex differences, biases, and unmet clinical and research challenges. Clin Sci. (2016) 130:551–63. 10.1042/CS20150586

Remember to Screen All Your Patients for Eating Disorders

My cousin died during the Coronavirus pandemic for reasons unrelated to COVID-19. When I first heard my cousin had been hospitalized, I immediately attributed it to the virus. She would get through it, I was sure – she was young, healthy, and strong. But slowly, as her brother entrusted me with more information, I realized that wasn’t the case. “You’re a doctor,” he said, knowing full well I was just a medical student. In hindsight, it was more than that. I was a source of support. Someone to share the burden with. But even with this relay of information, I struggled to make the pieces fit. My uncle was forced to unhinge her bedroom door when she failed to answer his calls. Inside, he found her listless and unresponsive. I was told she weighed a meager 89 pounds on admission and her glucose level was 10. Rumors drifted through the family, born of disbelief. She was suffering from depression and anorexia. I could not understand how we could have collectively let it get to the point of required intubation. To the point of total parenteral nutrition. To the point where she coded twice and required dialysis. 

Eventually, her body failed her. And in many ways, it felt like we did too. 

As someone training to be in the medical field, I found myself fraught with grief and regret. I should have seen the signs. I should have asked. Eating disorders have the potential to be life threatening. Often, they’re a source of jokes in mainstream media and I didn’t understand the full impact it could have until it truly hit close to home. As someone who wants to go into primary care this motivates me to do proper screening and aim for early intervention if possible. The American Academy of Family Physician (AAFP) suggests reviewing not only clinical factors but also psychosocial factors because there are additional things to work on such as self-worth and coping with emotions and stressors (Klein, 2021). Though eating disorders are often diagnosed in teenagers and young adults, it’s important to keep in mind that it can occur in people of all ages. My cousin was in her thirties when she passed.

Treatment options include cognitive behavior therapy, family-based therapy, and pharmacotherapy such as antidepressants like fluoxetine. What’s important is that health related goals be emphasized and not strictly weight. The AAFP defines some markers of recovery as eliminating harmful behaviors, reducing body dissatisfaction and valuing actual health more than weight and numbers (Klein, 2020). I wish there was less of a stigma on talking about mental health and eating disorders and a wider air of acceptance that fostered an environment where people felt comfortable talking about their troubles and maybe my cousin would still be here today. This experience further fueled my desire for better follow up, screenings, and preventative measures for patients. 

Hinal Patel, MS4

Drexel University College of Medicine

Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021 Jan 1;103(1):22-32. PMID: 33382560.