Conflict Theory and Health Care Access

Inequality of Socioeconomics with Regards to Access to Health Care
This topic was selected because I am pursuing a degree in health care administration/nursing and I want to show how inequality of access to health care is determined by one’s socioeconomic status. In other words, the research shows that if one has a low socioeconomic status, access to quality care will be less likely than if one has a higher socioeconomic status (Nicks, 2012). As the Office of Disease Prevention and Health Promotion (ODPHP, 2017) has shown, access to quality health care services is critical for sustaining and promoting health in communities—especially in ones that suffer from a low socioeconomic status; by improving access to care in these communities, health care providers can work to prevent the spread of disease, eliminate unnecessary disabilities, and reduce the number of deaths of low socioeconomic status individuals. Though insurance coverage has been expanded in recent years under the Affordable Care Act (Somanader, 2016), access to health services is still an issue that prevents patients from obtaining the kind of quality care they need. This paper will use conflict theory to explain why access to care is still a problem for the people from low socioeconomic backgrounds and will provide two recommended solutions that can be implemented to help address this issue.
Conflict theory is based on Marxist principles that were developed in the 19th century, which focused on class issues and the inequalities viewed between the working class and the owners of the means of production. Then in the following century, these principles were elaborated upon and conflict theory emerged, mainly in response to another sociological theory that had come into being by that time, which was called structural functionalism (Ritzer, Stepnisky, 2017). The theory of structural functionalism was developed in order to describe the way that societies and institutions work to achieve a stable and functioning environment. It suggested that society will tend to work towards achieving a balance within communities so that communities function optimally. Conflict theory reversed this idea and after being promulgated by thinkers such as Ralf Dahrendorf, conflict theory began to emerge as a more explanatory take on why societies so often failed to achieve satisfactory objectives regarding functionality, equality and stability. In other words, Dahrendorf showed that societies often have “two faces” that represent two opposing aims within society—one that is meant to help the whole, and one that is meant to help those who are already in control and simply want to maintain their position of power (Ritzer, Stepnisky, 2017, p. 120).
The Frankfurt School of philosophers, including Max Horkheimer and Theodore Adorno reckoned that society had failed to initiate a class uprising that would allow the lower working class to assume more power in the means of production and obtain equality with the upper class because of a cultural war that was being waged against the lower class. The cultural way, they posited, was waged via popular media—the mainstream media—through songs, movies, and books, all of which had a pacifying effect on the lower classes and caused them to be content with their menial jobs, low income, and low socioeconomic status (Horkheimer & Adorno, 1944).
The main tenet of conflict theory, therefore, is that all the parts and classes of society are battling for control but that those who own the means of production inevitably win the battle because they have the most power. That is why government, schools, corporations, and lobbyists are all tools of the ruling class and those of a low socioeconomic background will never be able to obtain equality. In terms of health care access, this theory shows that the limited access to health care for people of a low socioeconomic background is deliberate on the parts of the ruling class. Some examples of this can be seen in the fact that in spite of legislation like the Affordable Care Act, people of a low socioeconomic status still have limited access to health care. The ruling parties hailed the ACA as a breakthrough yet the results have not helped these people. The CDC (2016) shows that from 2014-2015, 17.3% of people between the ages of 18 and 64 were without a usual source of care. This percentage increased as the age of the population decreased, showing that children of low socioeconomic backgrounds are the most likely to suffer: more than 10% of them had no health care visits to an office or clinic for an entire year from 2014-2015 (CDC, 2016). Another example is that in some parts of the nation, there are simply not enough doctors to see all the patients and those from low socioeconomic backgrounds simply try to treat themselves as a result and many become addicted to drugs that they purchase on the black market, which only worsens the problem (Szabo, 2014).
One solution as the IOM (2012) has stated is for advanced practice nurses (APRNs) to begin to assume more of a leadership position in health care and operated independently of physicians. So as to improve access to health care, APRNs need to be able to practice to the full extent of their abilities and knowledge so that more patients can be seen over a wider area. By opening up more doors to treatment, APRNs who operate independently provide communities with more alternatives and opportunities to obtain health care. If states do not allows APRNs to operate independently (even though they have been trained and equipped with the skills and knowledge to do precisely this) then access to health care for persons from low socioeconomic backgrounds will continue to persist. Part of the problem and reason APRNs still have to work with physician oversight is that outdated and antiquated laws are on the books of many states because the APRN field was relatively new when the laws were written. However, as many doctors have left the field of primary care to pursue specialized medicine, APRNs were developed to fill the gap (O’Brien, 2003). All through the 1950s and ‘60s, physicians worked with and trained nurses so that the latter could provide primary care to these patients (O’Brien, 2003). When, in1965, the U.S. began offering Medicare and Medicaid services to low socioeconomic status patients, the U.S. government essentially increased the demand for primary care among this population. However, doctors were already moving into specialized medicine because it paid more, and there were too few nurses and too many restrictive laws to help fill the gap completely (Medicare Payment Advisory Commission, 2002).
Therefore, APRNs should be allowed to expand their roles in providing primary care as was originally intended. The more that nurses become trained in providing quality care through advancing their education, the more that this problem can be addressed adequately.
However, as conflict theory shows, there is also the problem of the system being deliberately set up to prevent equality from being achieved; therefore, some action has to be taken to overthrow systemic obstacles to equality—and these begin in terms of the culture that is being promoted in the mainstream media, which effectively works against the interests of persons from low socioeconomic backgrounds. The popular media often presents through music especially the popularity of drug use as an acceptable pastime for people and individuals in low socioeconomic backgrounds follow the example given them in popular media and thus turn to illegal and illicit drugs as a way to treat their own symptoms. This is not acceptable and has to be confronted. More families and community leaders must get involved with nursing leaders who want to make a difference and confront the drug problem in America. The drug problem is linked to the war problem (the heroin trade, for example, boomed as a result of the U.S. entering into Afghanistan), and now heroin has flooded American streets. Moreover, the opioid epidemic is linked to the corporate press for profits within the pharmaceutical industry, where Big Pharma pushes its products onto physicians who then overprescribe (Goldhill, 2009). These opioids then end up on the streets as well. All these factors are interlinked—the military, lawmakers, the pharmaceutical industry, the health care industry and the culture industry—and together they create an environment that keeps low socioeconomic status people in a state of oppression. In order to fight back against this oppression, community leaders have to get engaged, join arms with nursing leaders, and march on Washington in order to address the abuses coming from Big Pharma, the military-industrial complex, the culture industry which is pouring vast amounts of corrupt content into the ears and eyes of America’s youth.
In conclusion, these two solutions are both practical and idealistic—but both must be pursued to address the problem of low socioeconomic status individuals failing to receive access to quality health care. The first solution is the practical one: APRNs must expand their influence and independent practice in communities so that there are more options available to receive care. The second solution is idealistic and will require a coordinated effort among various groups of people who are willing to come together, join in a mission to fight back against the oppressive ruling class, and help the lower socioeconomic class to obtain better equality through the dismantling of the system that keeps them in a state of mental and economic oppression.

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