Clearly health care falls into that category, and accordingly, a dignitarian society will see to it that everyone can readily obtain both routine and specialized evaluation and treatment in the mode of their choice. The organization Search for Common Ground has put together a project involving leading national stakeholders reflecting a broad spectrum of interests and perspectives. Its goal is to identify consensus-based recommendations to provide health care coverage to "as many people as possible as quickly as possible." The idea is to develop widely supportable proposals among these "strange bedfellows" in the hope of breaking a decades-old gridlock on how to extend coverage to the uninsured.
In conclusion, here is an example that illustrates both the bureaucratic obstacles to building a dignitarian health care system, and what a determined government official can do to offset the dependence of health on social status. In 1995, Thomas A. Purvis, an evaluator in the office of the Inspector General in the U.S. Department of Health and Human Services, became aware that only a small fraction of youth covered by Medicaid were actually making use of the dental services for which they were eligible. He conducted a study to find out why. His principal findings were:
- Bureaucratic red tape and inadequate reimbursement were factors in why dentists did not seek business from low-income families. But these were not the only reasons.
- Dentists were turning down young Medicaid patients and their families because they viewed them in a way that smacked of rankism. The dentists tended to stereotype all such patients as being uninformed about the importance of good dental care, disruptive in the waiting room, unreliable about keeping appointments, and disinclined to follow their recommendations regarding home care between visits.
As a result of Purvis's analysis, state and federal agencies began working together to disabuse the dental profession of its perception of Medicaid patients. In combination with raising the fees paid to dentists, this strategy resulted in a significant elevation in the percentage of children from low-income families served by the Medicaid-funded dental program.
This story suggests that positive intervention by a service-oriented bureaucracy can offset the impact of rankism on health. But an October 2005 article in the New York Times indicates that, while some progress has been made, the same social status factors that were identified by Purvis ten years ago continue to limit the numbers of those eligible for Medicaid who are actually served by the program.
Today, rankist barriers in health care are like the racist barriers in public accommodations that existed before the nation enacted the civil rights legislation of the 1960s. Until these barriers are removed, they will continue to do serious disservice to a large group of citizens.
For further background on the connection between rankism and indignity, listen to Rob Kall's interview with me here.
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