Exam 12: Social Work and Services in Health Care

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Students' answers will vary.The provision of health care today in the United States is expensive and complex.For more than a century, U..politicians have been debating the issue of national health insurance-a publicly funded program that would expand the current system of health-care provision to give some level of coverage to everyone, regardless of their ability to pay.Much of the debate about establishing a national system has historically focused on two issues-cost and freedom of choice.Questions involve what types of coverage should be included and how coverage should be funded.The freedom-of-choice debate also concerns the extent to which each citizen could choose his or her own health-care provider.The United States has a strongly ingrained commitment to freedom of choice.Prior to 2010, all industrialized countries except for the United States had established some kind of national system so that all citizens would have access to some type of health-care coverage.After a long and bitter debate, Congress passed the Patient Protection and Affordable Care Act of 2010 (ACA), also often referred to as Obamacare.The intention of the law is to reduce the inequalities in health care by requiring all U..citizens and legal residents to have medical insurance.Those who cannot afford health insurance will be provided it by raising taxes on those who have higher incomes.Only as the years pass will people see what impact this law has on inequalities in health care.In advance, however, people can be certain that the law will not eliminate the inequalities.These are built into our social structure.People with higher incomes will always be able to afford higher-quality medical care.And unless there is fundamental change-which there will not be-people living in poverty will continue to be exposed to more harmful conditions at work.In the absence of such fundamental change, they will also continue to eat less healthy food, exercise less, and have a higher rate of obesity.The end result is that they will continue to suffer from more health problems and to die at a younger age.Adversaries of the ACA vehemently say that it is not possible to provide better service to more people without incurring more costs.The law requires "virtually all Americans to purchase health insurance or pay a fine. Many small business owners maintain they can't afford health insurance for all employees and that the Act involves "an onslaught of new taxes and burdensome paperwork;" it may be much more economical for them to forego the tax credit rather than purchase expensive insurance.​

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Acquired immune deficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is a disease that destroys the body's immune system. Infected people thus gradually become increasingly vulnerable to opportunistic diseases. HIV is a type of virus called a retrovirus. HIV attacks normal white blood cells (called T-cells) that fight off diseases invading the body. The specific type of T-cell that's vulnerable has CD4 molecules on its surface that help coordinate the body's resistance "to certain microorganisms such as viruses." After invading the CD4 T-cell, HIV immediately begins destroying this host cell and injecting its own genetic material into the cell. The transformed CD4 T-cell then begins producing more HIV instead of reproducing its former self. As the invaded CD4 T-cells produce more of the virus and fewer disease attacking white blood cells, the body's immune system deteriorates. As a result, the body is left defenseless and becomes easy prey to other diseases that eventually may cause death. HIV is a frightening agent that has continued to mutate into various strains, making it difficult to find a cure. HIV gradually destroys the immune system, so it may take a while to develop the serious conditions characterizing AIDS. According to the Centers for Disease Control, full-blown AIDS diagnosis applies when a person has a positive HIV blood test and has a CD4 T-cell count of less than 200 (normal people have between 500 and 1600) or has any of a number of "life-threatening opportunistic infections."
No cure exists for HIV or AIDS. However, treatment can significantly delay the progress of the disease. A major breakthrough was the discovery of antiviral drugs (e.g., azidothymidine or AZT) that can stop the virus from multiplying; however, such drugs cannot repair the person's damaged immune system. Another step forward was the discovery of protease inhibitors that attack the viral enzyme protease, which is necessary for HIV to make copies of itself and multiply. Today most treatment involves highly active antiretroviral therapy (HAART). HAART is the combination of three or more HIV drugs, often referred to as "drug cocktails" or "cocktail drugs." This development, in conjunction with the development of HIV RNA testing (which allows health-care providers to monitor the amount of virus in the bloodstream), has allowed for better control of HIV and has slowed the disease progression. Various types of clinical research are currently being conducted to combat HIV, although clinical trials take years to complete; for example, some researchers are trying to develop a vaccine to prevent transmission of HIV.