Have you ever started to work on something with a clear idea of the direction the project would take, and then ended things very differently than you expected? That is exactly what happened to me while working on a dissertation in 2019.
Convinced that I could draw on my decade of working for policymakers themselves (NY Legislators) and my experience with physician professional societies after that, to my thesis, I started interviewing people working in healthcare about how things changed following the passage of the Affordable Care Act. Generally, I was interested in learning about whether health policy reform initiatives targeting increased access and cost-containment derived from the ACA change the way that physicians practice medicine and, if so, how? What kind of changes are they? What are the implications of these changes for patients? How are changes manifest in physician-patient decision-making about health care choices? What do we need to know to recognize them?
Instead of finding a host of policy directives in black and white for healthcare professionals and administrators, however, I instead learned about hidden policies operating right under our noses that perpetuate and exacerbate inequality. These policies are not the ones we think about when we consider what rules control public policymaking. Instead of being created by public elected officials, they are made in closed board rooms by private entities. Yet, the changes they make influence who gets medical care and, worse yet, normalize the new way of distributing benefits. To find these policies, I use a tool I call the Inequality & Privilege Matrix which helps me see the root of the private policy so that is can be identified for reform.
Ultimately, in the process, I learn that systemic racism is not a relic of the past, but also a current influence that amplifies inequality for the present and future. My book project under development seeks to help put language around this hidden influence so it can be identified and targeted for extinction.
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