published_or_final_version / Public Health / Master / Master of Public Health

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Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 538-584). / Also available by subscription via World Wide Web / xvii, 584 leaves, bound 29 cm

This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.

This study investigates the representation of women's reproductive rights in the feminist blogopshere during 2009/10 United States health care reform. Focusing on two purposively selected feminist blogsites - Feministing and Jezebel- it critically examines the discursive and rhetorical strategies employed by feminist bloggers to contest the erosion of women's reproductive rights as proposed in health care reform legislation. While the reformation of the U.S. health care system was a lengthy process, my analysis is confined to feminist blog posts published in November 2009, December 2009 and March 2010. These three months have been designated as they are roughly representative of three pivotal stages in health care reform: the drafting of the House of Representatives health care reform bill and Stupak Amendment in November 2009, the creation of the Senate health care bill inclusive of the Nelson compromise in December 2009, and the passage of the finalised health care reform bill, the Patient Protection and Affordable Care Act and supplementary executive order, in March 2010. This study is informed by feminist poststructuralist theory and Foucault's conceptions of discourse and power - an appropriate framework for identifying and analysing the unequal power relations that exist between men and women in patriarchal societies. Foucault conceives of discourse as both socially constituted and constitutive and contends that through the constitution of knowledge, discourses designate acceptable ways of talking, writing, and behaving, while simultaneously restricting and prohibiting alternatives, thereby granting power and authority to specific discourses. However, Foucault also stresses the multi-directionality of power and asserts that though hegemonic discourses are privileged over others, power lays in discursive practice at all social sites; hence the socially and politically transformative power of contesting discourses. Critical discourse analysis is informed by this critical theory of language and regards the use of language as a form of social practice located within its specific historical context. Therefore, it is through engaging in the struggle over meaning and producing different 'truths' through the reappropriation of language that the possibility of social change exists. Employing narrative, linguistic and rhetorical analysis, this study identifies the discursive strategies and tactics utilised by feminist bloggers to combat and contest anti-choice health care legislation. The study further seeks to determine how arguments supportive of women's reproductive rights are framed and how feminist discourses are privileged while patriarchal discourse is contested. Drawing on public sphere theory, I argue that the feminist blogosphere constitutes a counter-public which facili tates the articulation and circulation of marginalised and counter-discourses. I conclude this study by examining the feminist blogopshere's role in promoting political change and transformation through alternative representations of women and their reproductive rights.

A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.

Human beings have two apparently conflicting fundamental rights. On the one hand, individuals have a right to health care as the United Nations declared in 1948. On the other hand, individuals have a right to liberty; that is, the freedom to make one's own health related choices, even poor ones. One goal of this essay is to show how to reconcile these two apparently conflicting core American values. This reconciliation is important, because a universal health care system that is fair and just must account for individual rights in tandem with attempts to address matters of social justice. In order for this reconciliation to occur, matters of individual responsibility, social responsibility, and social justice must be central to health care reform. / by Jennifer Lynn Mantoni. / Vita. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.