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A growing body of evidence suggests that even with the adoption of reforms such as NHI, inequities in the delivery of health care will persist. Some argue that a major problem overlooked by most reform efforts is the chronic undersupply of minority and female physicians.

Regardless of good intentions, a health care delivery system reliant upon physicians who are, by and large, white, upper-class, able-bodied, and heterosexual males will inevitably yield poorer health care outcomes for patients who fall outside these categories. Others argue that even if a ready supply of physicians outside these privileged groups existed, inequities sustained by the existing system of medical beliefs remain unaddressed. These barriers stem from the nature of medical training and the ways in which medical knowledge is applied within health care delivery. Medical professionals are trained to complete the process of diagnosis and treatment by taking symptoms presented by a patient and using them as clues to construct a diagnosis for which they can then prescribe treatment. Thus, patients who receive the best care are those who can most skillfully cooperate in the construction of these standardized medical narratives. Patients who are unfamiliar with the appropriate medical terms and phrases, whose cases are complicated, or who attempt to present alternative narratives to the standard medical ones are less likely to receive good care.

Ideological barriers to improvements in the U.S. health care system do not exist solely in the opposition to large-scale policy reform but also in health care delivery. Traditionally, research limited its focus to structural barriers such as health care financing and discrimination in patient-provider interactions. At the level of patient-provider interactions, the focus has been on difficulties arising from factors such as differences in communication styles due to class, race, or gender, or from conscious or subconscious discrimination, which can lead to insufficient information or misinformation, improper or inadequate provision of care and referrals for treatment, and erroneous assumptions about either the patient or the provider. Thus, most reforms have addressed financial barriers or training and reporting policies aimed at the prevention of discriminatory practices. Ideological barriers impeding health care reform and enabling gaps in care are the most pervasive yet the most challenging for reformers to address.

Bibliography:

1) Geyman, John P. 2003. "Myths as Barriers to Health Care Reform in the United States." International Journal of Health Services 33(2):315-29.

2) Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, edited by Brian D. Smedley. Washington, DC: National Academies Press.

3) Mechanic, David. 2006. The Truth about Health Care: Why Reform Is Not Working in America. New Brunswick, NJ: Rutgers University Press.

4) Schuster, Mark A., Elizabeth A. McGlynn, and Robert H. Brook. 1998. "How Good Is the Quality of Health Care in the United States?" The Milbank Quarterly 76(4):517-63.

5) Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic Books.

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