{"id":347,"date":"2016-05-01T01:53:16","date_gmt":"2016-05-01T01:53:16","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/introductiontosociology-waymaker\/?post_type=chapter&#038;p=347"},"modified":"2024-04-25T16:35:13","modified_gmt":"2024-04-25T16:35:13","slug":"healthcare-in-the-united-states","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/chapter\/healthcare-in-the-united-states\/","title":{"raw":"Healthcare Systems","rendered":"Healthcare Systems"},"content":{"raw":"<div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Learning Outcomes<\/h3>\r\n<ul>\r\n \t<li>Explain healthcare in the United States,\u00a0including healthcare reform (Affordable Care Act)<\/li>\r\n \t<li>Compare the healthcare system of the United States with that of other countries<\/li>\r\n<\/ul>\r\n<\/div>\r\nThere are broad, structural differences among the healthcare systems of different countries. In core nations, those differences might arise in the administration of healthcare, while the care itself is similar. In peripheral and semi-peripheral countries, a lack of basic healthcare administration can be the defining feature of the system. Most countries rely on some combination of modern and traditional medicine. In core countries with large investments in technology, research, and equipment, the focus is usually on modern medicine, with traditional (also called alternative or complementary) medicine playing a secondary role. In the United States, for instance, the American Medical Association (AMA) resolved to support the incorporation of complementary and alternative medicine in medical education. In developing countries, even quickly modernizing ones like China, traditional medicine (often understood as \u201ccomplementary\u201d by the western world) may still play a larger role.\r\n\r\n<\/div>\r\n<h2>U.S. Healthcare<\/h2>\r\nHealthcare\u00a0coverage can broadly be divided into two main categories: <strong>public healthcare<\/strong> (government-funded) and <strong>&gt;private healthcare&gt;<\/strong> (privately-funded).\r\n\r\nIn the United States, the healthcare system is more complex than what is found in other countries\u2014there is no uniform health system nor universal healthcare coverage provided (Citation P), and it is more of a hybrid system that what is found in other developed nations. In 2014, 48% of healthcare spending came from private funds, both from businesses and individuals, 28% came from the federal government, and 17% came from state and local governments (Citation P). Political changes have also resulted in drastic policy changes regarding healthcare.[footnote]Department for Professional Employees. (2016) <em>The U.S. Health Care System: An International Perspective.\u00a0<\/em>Retrieved from\u00a0<a href=\"https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/\" target=\"_blank\" rel=\"noopener\">https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/<\/a>.[\/footnote]\r\n<p id=\"import-auto-id1169033140349\">The two main public, government\u00a0funded healthcare programs are Medicare, which provides health services to people over sixty-five years old as well as people who meet certain standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements. Other government-funded programs include service agencies focused on Native Americans (the Indian Health Service), Veterans (the Veterans Health Administration), and children (the Children\u2019s Health Insurance Program).<\/p>\r\nThe most recent U.S. census\u00a0(2011) divides private insurance into employment-based insurance and direct-purchase insurance. Employment-based insurance is health plan coverage that is provided in whole or in part by an employer or union; it can cover just the employee, or the employee and their\u00a0family. Direct purchase insurance is coverage that an individual buys directly from a private company.\r\n\r\nWith all these insurance options, ranging from government-provided to employee-provided and individual-provided,\u00a0insurance coverage must be almost universal, right? Unfortunately, the U.S. Census Current Population Survey of 2013 showed that 18 percent of people in the United States had\u00a0no health insurance at all. Equally alarming, a study by the Commonwealth Fund showed that in 2010, 81 million adults were either uninsured or <strong><span id=\"import-auto-id1169033166084\">underinsured<\/span><\/strong>; that is, people who pay at least 10 percent of their income on healthcare costs not covered by insurance or, for low-income adults, those whose medical expenses or deductibles are at least 5 percent of their income (Schoen, Doty, Robertson, and Collins 2011). The Commonwealth study further reported that while underinsurance had historically been an issue that low-income families faced, today it is affecting middle-income families more and more.\r\n\r\n[caption id=\"\" align=\"alignleft\" width=\"250\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204707\/Figure_19_04_01.jpg\" alt=\"A group of protesters holding signs protesting federal health care changes are shown here. Some signs reads, &quot;Obama! Get your hands off my healthcare it's unconstitutional!&quot;, and &quot;Stop spending stop tyranny&quot;.\" width=\"250\" height=\"375\" \/> <strong>Figure 1.\u00a0<\/strong>Some\u00a0in the United States worry that governmental oversight of healthcare represents a federal overstepping of constitutional guarantees of individual freedom. Others welcome a program that they believe will make healthcare accessible and affordable to everyone. (Photo courtesy of Fibonacci Blue\/flickr)[\/caption]\r\n\r\nWhy were\u00a0so many people uninsured or underinsured? Skyrocketing healthcare costs were\u00a0part of the issue. Many people cannot afford private health insurance, but their income level is not low enough to meet eligibility standards for government supported insurance. Further, even for those who are eligible for Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low payments and extensive paperwork (Washington University Center for Health Policy, n.d.).\r\n\r\nHealthcare in the United States looks different today than it did just a few years ago\u2014a result of changes in policy, such as the Affordable Care Act (PPACA or ACA or \"ObamaCare\").\u00a0You've probably heard of ObamaCare at some point\u2014but what did it seek to do? ObamaCare\u00a0expanded\u00a0eligibility to programs like Medicaid and CHIP, helped guarantee insurance coverage for people with pre-existing conditions, and established regulations to make sure that the premium funds collected by insurers and care providers go directly to medical care. It also included an <strong>individual mandate<\/strong>, which required everyone to have insurance coverage by 2014 or pay a penalty in their taxes. A series of provisions, including significant subsidies, were\u00a0intended to address the discrepancies in income that are currently contributing to high rates of uninsurance and underinsurance.\r\n\r\nWhile the program has been controversial and something of a flashpoint for strongly partisan politics, in 2012 the U.S. Supreme Court upheld the constitutionality of the PPACA's individual mandate. According to Blumenthal (2014), by 2014,\u00a020 million people in the United States had gained health insurance under PPACA. This lowered the number of uninsured people to 13 percent.\u00a0Three years later, by 2017, healthcare reform had lowered the number of uninsured people to the lowest it has ever been in the United States.\u00a0In 2017, less than 9% of the population was uninsured at some point during the year[footnote]Berchick, Edward R. and Emily Hood and Jessica C. Barnett. (2018)\u00a0<em>Health Insurance Coverage in the United States: 2017.<\/em>\u00a0Retrieved from <a href=\"https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html<\/a>.[\/footnote]\u2014a drastic drop relative to the alarming 18% in the early 2010's. Over half of the population was insured by an employer, over one third was covered by government-funded programs, and the rest were either covered by direct-purchase or by military funding.\r\n\r\nThe PPACA remains contentious and at the forefront of political debates. The Supreme Court ruled in the case of <em>National Federation of Independent Businesses v. Sebelius<\/em> in 2012, that states cannot be forced to participate in the PPACA's Medicaid expansion. This ruling has opened the door to challenges to the PPACA in Congress and the Federal courts, in\u00a0some state governments,\u00a0and among conservative groups and independent businesses.\r\n<div class=\"textbox examples\">\r\n<h3>WATCH IT<\/h3>\r\nStill confused about the healthcare system in the United States? Watch this video for clarification.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5113706&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=DublqkOSBBA&amp;video_target=tpm-plugin-3kbwrrc4-DublqkOSBBA\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/ca652f65-b251-46af-b0ba-572674ffc710\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/fb8cb22d-c3cf-4c95-a9a9-f96e7a718e54\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/0031b4ac-9ea9-4d2c-85d0-57daa9a63e8e\r\n\r\n<\/div>\r\n<h2>Healthcare Elsewhere<\/h2>\r\n<h3><strong>Other Developed Areas<\/strong><\/h3>\r\nClearly, healthcare in the United States has some areas for improvement. But how does it compare to healthcare in other countries? Many people in the United States are fond of saying that this country has the best healthcare in the world, and while it is true that the United States has a higher quality of care available than many peripheral or semi-peripheral nations, it is not necessarily the \u201cbest in the world.\u201d In a report on how U.S. healthcare compares to that of other countries, researchers found that the United States does \u201crelatively well in some areas\u2014such as cancer care\u2014and less well in others\u2014such as mortality from conditions amenable to prevention and treatment\u201d (Docteur and Berenson 2009). A 2016 study on global healthcare ranked the United States at 29th,[footnote]\u00a0<a class=\"loa__item__name article-header__info__ctrl loa__item__email\" href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#\" target=\"_blank\" rel=\"noopener\">GBD 2016 Healthcare Access and Quality Collaborators<\/a>\u00a0(May 2018).\u00a0<em>Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016<\/em>. The Lancet. Volume 391, issue 10136, p2236-2271. Retrieved from\u00a0<a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#seccestitle190\" target=\"_blank\" rel=\"noopener\">https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#seccestitle190<\/a>.[\/footnote] an improvement from its ranking of 37th by The World Health Organization in 2000.[footnote]The World Health Report (2000). Retrieved from <a href=\"https:\/\/www.who.int\/whr\/2000\/en\/whr00_en.pdf?ua=1\" target=\"_blank\" rel=\"noopener\">https:\/\/www.who.int\/whr\/2000\/en\/whr00_en.pdf?ua=1<\/a>.[\/footnote]\r\n\r\nOne critique of the Patient Protection and Affordable Care Act is that it will create a system of socialized medicine, a term that for many people in the United States has negative connotations lingering from the Cold War era and earlier. Under a <strong><span id=\"import-auto-id1169033166092\">socialized medicine<\/span> <\/strong>system, the government owns and runs the system. It employs the doctors, nurses, and other staff, and it owns and runs the hospitals (Klein 2009). The best example of socialized medicine is in Great Britain, where the National Health System (NHS) gives free healthcare to all its residents. And despite some U.S. citizens\u2019 knee-jerk reaction to any healthcare changes that hint of socialism, the United States has one socialized system in the form of the Veterans Health Administration.\r\n\r\nIt is important to distinguish between socialized medicine, in which the government owns the healthcare system, and <strong><span id=\"import-auto-id1169033102645\">universal healthcare<\/span><\/strong>, which is simply a system that guarantees healthcare coverage for everyone. Germany, Singapore, and Canada all have universal healthcare. People often look to Canada\u2019s universal healthcare system, Medicare, as a model for the system. In Canada, healthcare is publicly funded and is administered by the separate provincial and territorial governments. However, the care itself comes from private providers\u00a0as opposed to government providers, and is therefore not a socialized medicine system. This is the main difference between universal healthcare and socialized medicine. The Canada Health Act of 1970 required that all health insurance plans must be \u201cavailable to all eligible Canadian residents, comprehensive in coverage, accessible, portable among provinces, and publicly administered\u201d (International Health Systems Canada 2010).\r\n<h3><strong>Underdeveloped and Undeveloped Regions<\/strong><\/h3>\r\nHeated discussions about socialization of medicine and managed-care options seem frivolous when compared with the issues of healthcare systems in developing or underdeveloped countries. In many countries, per capita income is so low, and governments are so fractured, that healthcare as we know it is virtually non-existent. Care that people in developed countries take for granted\u2014like hospitals, healthcare workers, immunizations, antibiotics and other medications, and even sanitary water for drinking and washing\u2014are unavailable to much of the population. Organizations like Doctors Without Borders, UNICEF, and the World Health Organization have played an important role in helping these countries get their most basic health needs met.\r\n<figure id=\"import-auto-id1169033159046\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"750\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204708\/Figure_19_04_02.jpg\" alt=\"A map highlighting countries where malaria is known to occur is shown. Those at risk of malaria include Mexico, countries in northern South America, most of Africa, and the lower half of Asia.\" width=\"750\" height=\"440\" \/> <strong>Figure 1.\u00a0<\/strong>This map shows the countries where malaria is known to occur. In low-income countries, malaria is still a common cause of death. (Photo courtesy of the CDC\/Wikimedia Commons)[\/caption]<\/figure>\r\n<p id=\"import-auto-id1169033140383\">WHO, which is the health arm of the United Nations, set eight Millennium Development Goals (MDGs) in 2000 with the aim of reaching these goals by 2015. Some of the goals dealt more broadly with the socioeconomic factors that influence health, but MDGs 4, 5, and 6 all related specifically to large-scale health concerns, the likes of which most people in the United States will never contemplate. MDG 4\u00a0was to reduce child mortality, MDG 5 aimed to improve maternal health, and MDG 6 strived to combat HIV\/AIDS, malaria, and other diseases. The goals may not seem particularly dramatic, but the numbers behind them show how serious they are.\u00a0In 2015, these goals were revised and were turned into the UN's Sustainable Development Goals\u2014one of which is focused specifically on Good Health and Well-Being, another which is focused on Clean Water and Sanitation, and a myriad of other goals that would support the implementation and improvement of healthcare systems (Citation S). These goals seek to show tangible results by 2030.<\/p>\r\nThe fact that these goals, some of which are closely related to healthcare, remain at the forefront of the United Nations' agenda suggests that preventable deaths and medical conditions continue to be an international issue. Maternal mortality has fallen by 37% since 2000, yet the maternal mortality ratio in developing countries is 14 times higher in developing regions relative to mothers in developed regions (Citation R). 37 million people globally were living with HIV in 2017, with tuberculosis being the leading cause of death among people living with HIV, accounting for roughly one third of deaths. Malaria incidence rates have dropped, as have mortality rates, but millions are still affected.[footnote]UN Sustainable Development Goals (n.d.).\u00a0<em>Goal 3: Ensure healthy lives and promote well-being for all at all ages<\/em>.\u00a0Retrieved from <a href=\"https:\/\/www.un.org\/sustainabledevelopment\/health\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.un.org\/sustainabledevelopment\/health\/<\/a>.[\/footnote] Access to healthcare would lower these numbers and improve the lives of individuals around the world.\r\n\r\nAn important component of disease prevention and control is <strong>epidemiology<\/strong>, or the study of the incidence, distribution, and possible control of diseases. Fear of Ebola contamination, primarily in Western Africa but also to a smaller degree in the United States, became national news in the summer and fall of 2014 and again in 2018, and Zika virus outbreaks\u00a0in the Pacific Islands as well as in South America, now spreading to Central and North America, have been alarming. Countries might have their own healthcare systems, but we live in an increasingly globalized and interconnected world, and the consequences of one system of healthcare do not stop at the country's borders.\r\n<div class=\"textbox examples\">\r\n<h3>WATCH IT<\/h3>\r\nIn 2018, the World Health Organization launched a pilot program for universal healthcare in a county in Kenya. Watch the video to learn more about it.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=3648582&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=5plA6EiTw4k&amp;video_target=tpm-plugin-2tt05ouf-5plA6EiTw4k\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Further Research<\/h3>\r\n<p id=\"import-auto-id1169033126210\"><a href=\"https:\/\/www.projectmosquitonet.org\/\" target=\"_blank\" rel=\"noopener\">Project Mosquito Net<\/a> says that mosquito nets sprayed with insecticide can reduce childhood malaria deaths by half.<\/p>\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Think It Over<\/h3>\r\n<ul>\r\n \t<li>What do you think are the best and worst parts of the PPACA? Why?<\/li>\r\n \t<li>Compare and contrast the healthcare system of the United States with the WHO\u2019s Sustainable Development Goals<\/li>\r\n<\/ul>\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/623adca6-f2c8-4301-b6a6-9499baa40c65\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/003ff586-4719-4e1d-a7e2-2f44ca634e88\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Glossary<\/h3>\r\n<dl>\r\n \t<dt>individual mandate:<\/dt>\r\n \t<dd>a government rule that requires everyone to have insurance coverage or they will have to pay a penalty<\/dd>\r\n<\/dl>\r\n<dl>\r\n \t<dt>private healthcare:<\/dt>\r\n \t<dd>health insurance that a person buys from a private company; private healthcare can either be employer-sponsored or direct-purchase<\/dd>\r\n<\/dl>\r\n<dl>\r\n \t<dt>public healthcare:<\/dt>\r\n \t<dd>health insurance that is funded or provided by the government<\/dd>\r\n<\/dl>\r\n<dl>\r\n \t<dt>socialized medicine:<\/dt>\r\n \t<dd>when the government owns and runs the entire healthcare system<\/dd>\r\n<\/dl>\r\n<dl>\r\n \t<dt>underinsured:<\/dt>\r\n \t<dd>people who spend at least 10 percent of their income on healthcare costs that are not covered by insurance<\/dd>\r\n<\/dl>\r\n<dl>\r\n \t<dt>universal healthcare:<\/dt>\r\n \t<dd>a system that guarantees healthcare coverage for everyone<\/dd>\r\n<\/dl>\r\n<\/div>","rendered":"<div>\n<div class=\"textbox learning-objectives\">\n<h3>Learning Outcomes<\/h3>\n<ul>\n<li>Explain healthcare in the United States,\u00a0including healthcare reform (Affordable Care Act)<\/li>\n<li>Compare the healthcare system of the United States with that of other countries<\/li>\n<\/ul>\n<\/div>\n<p>There are broad, structural differences among the healthcare systems of different countries. In core nations, those differences might arise in the administration of healthcare, while the care itself is similar. In peripheral and semi-peripheral countries, a lack of basic healthcare administration can be the defining feature of the system. Most countries rely on some combination of modern and traditional medicine. In core countries with large investments in technology, research, and equipment, the focus is usually on modern medicine, with traditional (also called alternative or complementary) medicine playing a secondary role. In the United States, for instance, the American Medical Association (AMA) resolved to support the incorporation of complementary and alternative medicine in medical education. In developing countries, even quickly modernizing ones like China, traditional medicine (often understood as \u201ccomplementary\u201d by the western world) may still play a larger role.<\/p>\n<\/div>\n<h2>U.S. Healthcare<\/h2>\n<p>Healthcare\u00a0coverage can broadly be divided into two main categories: <strong>public healthcare<\/strong> (government-funded) and <strong>&gt;private healthcare&gt;<\/strong> (privately-funded).<\/p>\n<p>In the United States, the healthcare system is more complex than what is found in other countries\u2014there is no uniform health system nor universal healthcare coverage provided (Citation P), and it is more of a hybrid system that what is found in other developed nations. In 2014, 48% of healthcare spending came from private funds, both from businesses and individuals, 28% came from the federal government, and 17% came from state and local governments (Citation P). Political changes have also resulted in drastic policy changes regarding healthcare.<a class=\"footnote\" title=\"Department for Professional Employees. (2016) The U.S. Health Care System: An International Perspective.\u00a0Retrieved from\u00a0https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/.\" id=\"return-footnote-347-1\" href=\"#footnote-347-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<p id=\"import-auto-id1169033140349\">The two main public, government\u00a0funded healthcare programs are Medicare, which provides health services to people over sixty-five years old as well as people who meet certain standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements. Other government-funded programs include service agencies focused on Native Americans (the Indian Health Service), Veterans (the Veterans Health Administration), and children (the Children\u2019s Health Insurance Program).<\/p>\n<p>The most recent U.S. census\u00a0(2011) divides private insurance into employment-based insurance and direct-purchase insurance. Employment-based insurance is health plan coverage that is provided in whole or in part by an employer or union; it can cover just the employee, or the employee and their\u00a0family. Direct purchase insurance is coverage that an individual buys directly from a private company.<\/p>\n<p>With all these insurance options, ranging from government-provided to employee-provided and individual-provided,\u00a0insurance coverage must be almost universal, right? Unfortunately, the U.S. Census Current Population Survey of 2013 showed that 18 percent of people in the United States had\u00a0no health insurance at all. Equally alarming, a study by the Commonwealth Fund showed that in 2010, 81 million adults were either uninsured or <strong><span id=\"import-auto-id1169033166084\">underinsured<\/span><\/strong>; that is, people who pay at least 10 percent of their income on healthcare costs not covered by insurance or, for low-income adults, those whose medical expenses or deductibles are at least 5 percent of their income (Schoen, Doty, Robertson, and Collins 2011). The Commonwealth study further reported that while underinsurance had historically been an issue that low-income families faced, today it is affecting middle-income families more and more.<\/p>\n<div style=\"width: 260px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204707\/Figure_19_04_01.jpg\" alt=\"A group of protesters holding signs protesting federal health care changes are shown here. Some signs reads, &quot;Obama! Get your hands off my healthcare it's unconstitutional!&quot;, and &quot;Stop spending stop tyranny&quot;.\" width=\"250\" height=\"375\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1.\u00a0<\/strong>Some\u00a0in the United States worry that governmental oversight of healthcare represents a federal overstepping of constitutional guarantees of individual freedom. Others welcome a program that they believe will make healthcare accessible and affordable to everyone. (Photo courtesy of Fibonacci Blue\/flickr)<\/p>\n<\/div>\n<p>Why were\u00a0so many people uninsured or underinsured? Skyrocketing healthcare costs were\u00a0part of the issue. Many people cannot afford private health insurance, but their income level is not low enough to meet eligibility standards for government supported insurance. Further, even for those who are eligible for Medicaid, the program is less than perfect. Many physicians refuse to accept Medicaid patients, citing low payments and extensive paperwork (Washington University Center for Health Policy, n.d.).<\/p>\n<p>Healthcare in the United States looks different today than it did just a few years ago\u2014a result of changes in policy, such as the Affordable Care Act (PPACA or ACA or &#8220;ObamaCare&#8221;).\u00a0You&#8217;ve probably heard of ObamaCare at some point\u2014but what did it seek to do? ObamaCare\u00a0expanded\u00a0eligibility to programs like Medicaid and CHIP, helped guarantee insurance coverage for people with pre-existing conditions, and established regulations to make sure that the premium funds collected by insurers and care providers go directly to medical care. It also included an <strong>individual mandate<\/strong>, which required everyone to have insurance coverage by 2014 or pay a penalty in their taxes. A series of provisions, including significant subsidies, were\u00a0intended to address the discrepancies in income that are currently contributing to high rates of uninsurance and underinsurance.<\/p>\n<p>While the program has been controversial and something of a flashpoint for strongly partisan politics, in 2012 the U.S. Supreme Court upheld the constitutionality of the PPACA&#8217;s individual mandate. According to Blumenthal (2014), by 2014,\u00a020 million people in the United States had gained health insurance under PPACA. This lowered the number of uninsured people to 13 percent.\u00a0Three years later, by 2017, healthcare reform had lowered the number of uninsured people to the lowest it has ever been in the United States.\u00a0In 2017, less than 9% of the population was uninsured at some point during the year<a class=\"footnote\" title=\"Berchick, Edward R. and Emily Hood and Jessica C. Barnett. (2018)\u00a0Health Insurance Coverage in the United States: 2017.\u00a0Retrieved from https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html.\" id=\"return-footnote-347-2\" href=\"#footnote-347-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a>\u2014a drastic drop relative to the alarming 18% in the early 2010&#8217;s. Over half of the population was insured by an employer, over one third was covered by government-funded programs, and the rest were either covered by direct-purchase or by military funding.<\/p>\n<p>The PPACA remains contentious and at the forefront of political debates. The Supreme Court ruled in the case of <em>National Federation of Independent Businesses v. Sebelius<\/em> in 2012, that states cannot be forced to participate in the PPACA&#8217;s Medicaid expansion. This ruling has opened the door to challenges to the PPACA in Congress and the Federal courts, in\u00a0some state governments,\u00a0and among conservative groups and independent businesses.<\/p>\n<div class=\"textbox examples\">\n<h3>WATCH IT<\/h3>\n<p>Still confused about the healthcare system in the United States? Watch this video for clarification.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5113706&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=DublqkOSBBA&amp;video_target=tpm-plugin-3kbwrrc4-DublqkOSBBA\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_ca652f65-b251-46af-b0ba-572674ffc710\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/ca652f65-b251-46af-b0ba-572674ffc710?iframe_resize_id=assessment_practice_id_ca652f65-b251-46af-b0ba-572674ffc710\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_fb8cb22d-c3cf-4c95-a9a9-f96e7a718e54\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/fb8cb22d-c3cf-4c95-a9a9-f96e7a718e54?iframe_resize_id=assessment_practice_id_fb8cb22d-c3cf-4c95-a9a9-f96e7a718e54\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_0031b4ac-9ea9-4d2c-85d0-57daa9a63e8e\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/0031b4ac-9ea9-4d2c-85d0-57daa9a63e8e?iframe_resize_id=assessment_practice_id_0031b4ac-9ea9-4d2c-85d0-57daa9a63e8e\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>Healthcare Elsewhere<\/h2>\n<h3><strong>Other Developed Areas<\/strong><\/h3>\n<p>Clearly, healthcare in the United States has some areas for improvement. But how does it compare to healthcare in other countries? Many people in the United States are fond of saying that this country has the best healthcare in the world, and while it is true that the United States has a higher quality of care available than many peripheral or semi-peripheral nations, it is not necessarily the \u201cbest in the world.\u201d In a report on how U.S. healthcare compares to that of other countries, researchers found that the United States does \u201crelatively well in some areas\u2014such as cancer care\u2014and less well in others\u2014such as mortality from conditions amenable to prevention and treatment\u201d (Docteur and Berenson 2009). A 2016 study on global healthcare ranked the United States at 29th,<a class=\"footnote\" title=\"\u00a0GBD 2016 Healthcare Access and Quality Collaborators\u00a0(May 2018).\u00a0Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. The Lancet. Volume 391, issue 10136, p2236-2271. Retrieved from\u00a0https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#seccestitle190.\" id=\"return-footnote-347-3\" href=\"#footnote-347-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> an improvement from its ranking of 37th by The World Health Organization in 2000.<a class=\"footnote\" title=\"The World Health Report (2000). Retrieved from https:\/\/www.who.int\/whr\/2000\/en\/whr00_en.pdf?ua=1.\" id=\"return-footnote-347-4\" href=\"#footnote-347-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<p>One critique of the Patient Protection and Affordable Care Act is that it will create a system of socialized medicine, a term that for many people in the United States has negative connotations lingering from the Cold War era and earlier. Under a <strong><span id=\"import-auto-id1169033166092\">socialized medicine<\/span> <\/strong>system, the government owns and runs the system. It employs the doctors, nurses, and other staff, and it owns and runs the hospitals (Klein 2009). The best example of socialized medicine is in Great Britain, where the National Health System (NHS) gives free healthcare to all its residents. And despite some U.S. citizens\u2019 knee-jerk reaction to any healthcare changes that hint of socialism, the United States has one socialized system in the form of the Veterans Health Administration.<\/p>\n<p>It is important to distinguish between socialized medicine, in which the government owns the healthcare system, and <strong><span id=\"import-auto-id1169033102645\">universal healthcare<\/span><\/strong>, which is simply a system that guarantees healthcare coverage for everyone. Germany, Singapore, and Canada all have universal healthcare. People often look to Canada\u2019s universal healthcare system, Medicare, as a model for the system. In Canada, healthcare is publicly funded and is administered by the separate provincial and territorial governments. However, the care itself comes from private providers\u00a0as opposed to government providers, and is therefore not a socialized medicine system. This is the main difference between universal healthcare and socialized medicine. The Canada Health Act of 1970 required that all health insurance plans must be \u201cavailable to all eligible Canadian residents, comprehensive in coverage, accessible, portable among provinces, and publicly administered\u201d (International Health Systems Canada 2010).<\/p>\n<h3><strong>Underdeveloped and Undeveloped Regions<\/strong><\/h3>\n<p>Heated discussions about socialization of medicine and managed-care options seem frivolous when compared with the issues of healthcare systems in developing or underdeveloped countries. In many countries, per capita income is so low, and governments are so fractured, that healthcare as we know it is virtually non-existent. Care that people in developed countries take for granted\u2014like hospitals, healthcare workers, immunizations, antibiotics and other medications, and even sanitary water for drinking and washing\u2014are unavailable to much of the population. Organizations like Doctors Without Borders, UNICEF, and the World Health Organization have played an important role in helping these countries get their most basic health needs met.<\/p>\n<figure id=\"import-auto-id1169033159046\">\n<div style=\"width: 760px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/120\/2016\/04\/15204708\/Figure_19_04_02.jpg\" alt=\"A map highlighting countries where malaria is known to occur is shown. Those at risk of malaria include Mexico, countries in northern South America, most of Africa, and the lower half of Asia.\" width=\"750\" height=\"440\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1.\u00a0<\/strong>This map shows the countries where malaria is known to occur. In low-income countries, malaria is still a common cause of death. (Photo courtesy of the CDC\/Wikimedia Commons)<\/p>\n<\/div>\n<\/figure>\n<p id=\"import-auto-id1169033140383\">WHO, which is the health arm of the United Nations, set eight Millennium Development Goals (MDGs) in 2000 with the aim of reaching these goals by 2015. Some of the goals dealt more broadly with the socioeconomic factors that influence health, but MDGs 4, 5, and 6 all related specifically to large-scale health concerns, the likes of which most people in the United States will never contemplate. MDG 4\u00a0was to reduce child mortality, MDG 5 aimed to improve maternal health, and MDG 6 strived to combat HIV\/AIDS, malaria, and other diseases. The goals may not seem particularly dramatic, but the numbers behind them show how serious they are.\u00a0In 2015, these goals were revised and were turned into the UN&#8217;s Sustainable Development Goals\u2014one of which is focused specifically on Good Health and Well-Being, another which is focused on Clean Water and Sanitation, and a myriad of other goals that would support the implementation and improvement of healthcare systems (Citation S). These goals seek to show tangible results by 2030.<\/p>\n<p>The fact that these goals, some of which are closely related to healthcare, remain at the forefront of the United Nations&#8217; agenda suggests that preventable deaths and medical conditions continue to be an international issue. Maternal mortality has fallen by 37% since 2000, yet the maternal mortality ratio in developing countries is 14 times higher in developing regions relative to mothers in developed regions (Citation R). 37 million people globally were living with HIV in 2017, with tuberculosis being the leading cause of death among people living with HIV, accounting for roughly one third of deaths. Malaria incidence rates have dropped, as have mortality rates, but millions are still affected.<a class=\"footnote\" title=\"UN Sustainable Development Goals (n.d.).\u00a0Goal 3: Ensure healthy lives and promote well-being for all at all ages.\u00a0Retrieved from https:\/\/www.un.org\/sustainabledevelopment\/health\/.\" id=\"return-footnote-347-5\" href=\"#footnote-347-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a> Access to healthcare would lower these numbers and improve the lives of individuals around the world.<\/p>\n<p>An important component of disease prevention and control is <strong>epidemiology<\/strong>, or the study of the incidence, distribution, and possible control of diseases. Fear of Ebola contamination, primarily in Western Africa but also to a smaller degree in the United States, became national news in the summer and fall of 2014 and again in 2018, and Zika virus outbreaks\u00a0in the Pacific Islands as well as in South America, now spreading to Central and North America, have been alarming. Countries might have their own healthcare systems, but we live in an increasingly globalized and interconnected world, and the consequences of one system of healthcare do not stop at the country&#8217;s borders.<\/p>\n<div class=\"textbox examples\">\n<h3>WATCH IT<\/h3>\n<p>In 2018, the World Health Organization launched a pilot program for universal healthcare in a county in Kenya. Watch the video to learn more about it.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=3648582&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=5plA6EiTw4k&amp;video_target=tpm-plugin-2tt05ouf-5plA6EiTw4k\" width=\"800px\" height=\"520px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Further Research<\/h3>\n<p id=\"import-auto-id1169033126210\"><a href=\"https:\/\/www.projectmosquitonet.org\/\" target=\"_blank\" rel=\"noopener\">Project Mosquito Net<\/a> says that mosquito nets sprayed with insecticide can reduce childhood malaria deaths by half.<\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Think It Over<\/h3>\n<ul>\n<li>What do you think are the best and worst parts of the PPACA? Why?<\/li>\n<li>Compare and contrast the healthcare system of the United States with the WHO\u2019s Sustainable Development Goals<\/li>\n<\/ul>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_623adca6-f2c8-4301-b6a6-9499baa40c65\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/623adca6-f2c8-4301-b6a6-9499baa40c65?iframe_resize_id=assessment_practice_id_623adca6-f2c8-4301-b6a6-9499baa40c65\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_003ff586-4719-4e1d-a7e2-2f44ca634e88\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/003ff586-4719-4e1d-a7e2-2f44ca634e88?iframe_resize_id=assessment_practice_id_003ff586-4719-4e1d-a7e2-2f44ca634e88\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Glossary<\/h3>\n<dl>\n<dt>individual mandate:<\/dt>\n<dd>a government rule that requires everyone to have insurance coverage or they will have to pay a penalty<\/dd>\n<\/dl>\n<dl>\n<dt>private healthcare:<\/dt>\n<dd>health insurance that a person buys from a private company; private healthcare can either be employer-sponsored or direct-purchase<\/dd>\n<\/dl>\n<dl>\n<dt>public healthcare:<\/dt>\n<dd>health insurance that is funded or provided by the government<\/dd>\n<\/dl>\n<dl>\n<dt>socialized medicine:<\/dt>\n<dd>when the government owns and runs the entire healthcare system<\/dd>\n<\/dl>\n<dl>\n<dt>underinsured:<\/dt>\n<dd>people who spend at least 10 percent of their income on healthcare costs that are not covered by insurance<\/dd>\n<\/dl>\n<dl>\n<dt>universal healthcare:<\/dt>\n<dd>a system that guarantees healthcare coverage for everyone<\/dd>\n<\/dl>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-347\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Florencia Silveira for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Comparative Health and Medicine. <strong>Authored by<\/strong>: OpenStax CNX. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/cnx.org\/contents\/AgQDEnLI@10.1:htZZFvZp@3\/Comparative-Health-and-Medicine\">https:\/\/cnx.org\/contents\/AgQDEnLI@10.1:htZZFvZp@3\/Comparative-Health-and-Medicine<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/contents\/02040312-72c8-441e-a685-20e9333f3e1d@3.49<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>US Healthcare System Explained. <strong>Provided by<\/strong>: The Infographics Show. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=3&#038;v=DublqkOSBBA\">https:\/\/www.youtube.com\/watch?time_continue=3&#038;v=DublqkOSBBA<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-347-1\">Department for Professional Employees. (2016) <em>The U.S. Health Care System: An International Perspective.\u00a0<\/em>Retrieved from\u00a0<a href=\"https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/\" target=\"_blank\" rel=\"noopener\">https:\/\/dpeaflcio.org\/programs-publications\/issue-fact-sheets\/the-u-s-health-care-system-an-international-perspective\/<\/a>. <a href=\"#return-footnote-347-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-347-2\">Berchick, Edward R. and Emily Hood and Jessica C. Barnett. (2018)\u00a0<em>Health Insurance Coverage in the United States: 2017.<\/em>\u00a0Retrieved from <a href=\"https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html\" target=\"_blank\" rel=\"noopener\">https:\/\/www.census.gov\/library\/publications\/2018\/demo\/p60-264.html<\/a>. <a href=\"#return-footnote-347-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-347-3\">\u00a0<a class=\"loa__item__name article-header__info__ctrl loa__item__email\" href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#\" target=\"_blank\" rel=\"noopener\">GBD 2016 Healthcare Access and Quality Collaborators<\/a>\u00a0(May 2018).\u00a0<em>Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016<\/em>. The Lancet. Volume 391, issue 10136, p2236-2271. Retrieved from\u00a0<a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#seccestitle190\" target=\"_blank\" rel=\"noopener\">https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30994-2\/fulltext#seccestitle190<\/a>. <a href=\"#return-footnote-347-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-347-4\">The World Health Report (2000). Retrieved from <a href=\"https:\/\/www.who.int\/whr\/2000\/en\/whr00_en.pdf?ua=1\" target=\"_blank\" rel=\"noopener\">https:\/\/www.who.int\/whr\/2000\/en\/whr00_en.pdf?ua=1<\/a>. <a href=\"#return-footnote-347-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-347-5\">UN Sustainable Development Goals (n.d.).\u00a0<em>Goal 3: Ensure healthy lives and promote well-being for all at all ages<\/em>.\u00a0Retrieved from <a href=\"https:\/\/www.un.org\/sustainabledevelopment\/health\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.un.org\/sustainabledevelopment\/health\/<\/a>. <a href=\"#return-footnote-347-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":9,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Comparative Health and Medicine\",\"author\":\"OpenStax CNX\",\"organization\":\"\",\"url\":\"https:\/\/cnx.org\/contents\/AgQDEnLI@10.1:htZZFvZp@3\/Comparative-Health-and-Medicine\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/contents\/02040312-72c8-441e-a685-20e9333f3e1d@3.49\"},{\"type\":\"copyrighted_video\",\"description\":\"US Healthcare System Explained\",\"author\":\"\",\"organization\":\"The Infographics Show\",\"url\":\"https:\/\/www.youtube.com\/watch?time_continue=3&v=DublqkOSBBA\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Florencia Silveira for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"43b48e2b-ef91-4f88-ba1e-d3d54c548cb7, 455131fc-9bd2-4cb8-9319-d12c42d2bfcc, 1c022306-aec2-46c2-95ef-26558e09d1ef","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-347","chapter","type-chapter","status-publish","hentry"],"part":580,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/chapters\/347","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":41,"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/chapters\/347\/revisions"}],"predecessor-version":[{"id":9555,"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/chapters\/347\/revisions\/9555"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/parts\/580"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/chapters\/347\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/wp\/v2\/media?parent=347"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/pressbooks\/v2\/chapter-type?post=347"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/wp\/v2\/contributor?post=347"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-introductiontosociology\/wp-json\/wp\/v2\/license?post=347"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}