Welcome to the Disciplinary Corporation
posted by Frank Pasquale
The market has done a characteristically fantastic job of “trimming the fat” at nursing homes–i.e., squeezing out more profit by providing less care. One may wonder, how do the residents of such homes get taken care of when staff are fired and other corners are cut? The WSJ reports on one solution: drug them.
Nearly 30% of the total nursing-home population is receiving antipsychotic drugs. . . . In a practice known as “off label” use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not.
Federal and some state regulators are pushing back, questioning the use of antipsychotic drugs and citing nursing homes for using them in ways that violate federal rules. New York has increased its focus on antipsychotics in nursing homes, training inspectors to spot signs of medication abuse.
Meanwhile, some employees are finding their health increasingly managed by their employers. “Employers Tell Workers To Get Healthy or Pay Up” is the headline, and here are some of the pressures:
Employees at some companies who are overweight, smoke, or have high cholesterol, for instance, and who don’t participate in supplementary wellness programs, will pay more for health insurance. In extreme cases, employees’ insurance deductibles could rise by $2,000.
What I wonder is: will the same people who are so distressed by the possibility of government-mandated purchase of health insurance also rise up against the corporate imposition of health standards? Or is paternalism perfectly fine when it’s a product of the market?
Finally, I highly recommend Frederick Crews’s piece on the increasing pressures to conform one’s personality to a sanguine norm. Observing some trends I noted in a review of a book on the pathologization of shyness, Crews notes that we are entering a world “in which convictions, perceived needs, and choices regarding health care are manufactured along with the products that will match them.” Here’s one part of a fascinating review:
[E]pisodic sadness has always been a socially approved means of adjusting to misfortune and that much is lost, both medically and culturally, when it is misread as a depressive disorder. Yet [DSM-III] has propagated that very blunder by failing to clarify the difference between environmentally prompted moods—those responding to stress or hardship—and dysfunctional states persisting long after the causes of stress have abated. In no sense, however, can that indictment be confined to just one disorder. The Loss of Sadness [a book reviewed by Crews] implies that nearly every nonpsychotic complaint is subject to overdiagnosis unless contextual factors—familial, cultural, relational, financial—are weighed in the balance.
As I have suggested in Technology, Competition, and Values, we cannot ignore how “financial factors” play into our pathologization of certain ways of thinking, feeling, and acting. If Medicaid were funded adequately, perhaps we could properly pay the number of staff necessary to treat elderly nursing home residents as people in need of care, not sedation. Perhaps a universal health care system would excuse employers from the terrible choice the market forces on them: avoid sick workers or face a competitive disadvantage vis a vis the companies that do. And finally, perhaps a society with less pressure to “sell oneself” would give the shy, the sad, and the anxious a little breathing room to explore many alternative routes to well-being.
Image Credit: Wikipedia, Bentham’s Panopticon.
December 4, 2007 at 6:34 pm
Posted in: Health Law, Insurance Law, Law and Inequality, Privacy
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Responses (2)
Daniel Goldberg - December 4, 2007 at 7:38 pm
Good post. You do not even want to know the literature on pain management in nursing homes. It’s truly horrifying, with estimates of as high as 80% of LTC residents suffering persistent unremediated pain. I have an article coming out on pain in the elderly that addresses this, though not from the vantage of regulation of nursing homes.
hkjkjh - December 4, 2007 at 11:11 pm
The nursing home part of your post is troubling, but I don’t understand what’s wrong with the programs incentivizing employees to become healthier. Some estimate that 80% of our health care costs are due to chronic diseases that could be preventable if people eat better and exercise more. Shouldn’t we, then, being providing at least some incentives to people to do just that? I agree that there may be limits, based on privacy and other concerns, on how much that we should do this, but as a general matter it seems like a good deal.
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