Policy Challenge – Universal Health Care?



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I am about to finish my MSW and in one of our Social Policy Classes we prepared different arguments for the following options:

(1). Keep and adjust as needed the Affordable Care Act;

I think that, at best, keeping and adjusting as needed the Affordable Care Act would be a temporary solution for what I believe needs a deeper shift in paradigm. After reviewing the materials for this module, it was eye-opening to realize that perhaps, the reasons the Affordable Care Act could not efficiently deliver affordable health care to every American citizen are related to deeply rooted problems such as high health care costs/high profit and the power of government regulations. Historically, liberty, self-government, individualism, and the free market are some of the strongest values and beliefs that might have also played a role in the outcomes of the Affordable Care Act.

For instance, many Americans would not accept the government choosing or limiting their health insurance choices; many insurers fled because they did not want to be part of a “strict” government-run market in which they “could not make a profit”; many large employers found it outrageous to be mandated to provide health coverage to employees or have to face an IRS penalty; last but not least, the costs of health care remained exorbitant due to the high profits (laissez-faire) health care industry. In other words, instead of a health care system, the United State has a health care market, which makes offering affordable health care extremely challenging.

Keeping and adjusting the ACA goes beyond amending and enforcing rules.  In order to successfully establish universal health care, the government would have to intervene not only in how insurance companies operate and how consumers choose health coverage but also and perhaps most importantly in taking the profit out of the health care industry. That, in turn, would mean a shift in paradigm for Americans, in which it would be OK to have the government regulate welfare domains such as the health care system without losing its laissez-faire economic approach.

(2). Based on the alternatives to ACA in the materials you consulted for this assignment – propose a viable NEW health care policy.

Proposing a viable new health care policy also means taking the profit out of the health care through government price regulations, offering public/government-run hospitals and specialty care, and expanding federally qualified community health care centers so that they can attend to the needs of larger populations when it comes to primary and preventive care. In other words, the welfare state (societal health care needs, and other domains)  should be regulated by the government- not with the objective of profit making. Considering that choice is an important factor for consumers, when planning for health care coverage, they would still be able to choose between using the government-run health care system and having zero copayments and premiums (even though there is some waiting time, no system will be perfect); being employed by a company that offers private health care;  or paying the exorbitant premium prices charged by private insurance companies. Finally, due to culture, values, and beliefs, I believe that key factors for offering universal health care in the United States are related to the extent to which the government can or will regulate prices and to the extent that the population and businesses will accept government intervention. Any health care policy that proposes universal health care to American citizens will have to first address the way individuals and businesses see the world.

(a). Identify two core questions that will frame your ethical decision-making within the argument you prepared;

1) Will universal health care policies hurt American’s values and beliefs ( e.g. liberty, self-government, individualism, and opportunity)?

2) Will the universal health care policy be under the auspices of the social justice approach?

(b) Justify your course of action based on these questions.

When reflecting about keeping and adjusting the ACA or proposing a new health care policy, two main factors crossed my mind. First,  American’s values and beliefs and second, the need for equitable and accessible health care coverage for every American. I believe that establishing universal health care in the U.S. would be a long process not only because of structural modifications but also adaptation of a belief system. There has to be a grey area, in which American’s values are not hurt and health care equality can be achieved. There must be a grey area in which public health can be regulated and economic affairs can remain in laissez-faire mode.


19th and 21st Centuries Underfunded and Underregulated American Mental Health System


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19th and 21st Centuries Underfunded and Underregulated American Mental Health System

This paper has the objective to explain how the 19th century underfunded and underregulated American mental health system still needs reform in the 21st century. In the 1840s, the abuse and inhumane treatment of mentally ill individuals placed in county jails, almshouses and private homes gave origin to actions directed towards the betterment of the system. Dorothea Dix (1843) in the “Memorial to the Massachusetts Legislature”, describes in details how inhumane treatment of the mentally ill occurred. She depicts females and males caged in almshouses, some in more comfortable situations than others; an individual who had been chained for 17 years; individuals incarcerated with criminals in county jails who were left unclothed and chained in the dark, without any heat or sanitation; individuals in private homes confined in closets, stalls and cellars due to the lack of support of their family members; individuals who were beaten with rods and lashed to obedience; and, county jails and almshouse improperly staffed. Overall, the author’s findings were clear, there was no therapeutic method being applied to treat those individuals and they were being abandoned, abused and neglect.  Dix (1843) emphasized that while the usage of cages was very common and negligence a frequent occurrence, chaining people and willful abuses were less frequent than sufferings that originated from ignorance. In addition, she argued that it was also unjust to place convicts with insane persons since they were obligated to live with individuals screaming and shouting night and day. The social reformer presented the problems of abuse and inhumane treatment to the members of the Legislature of Massachusetts in a way that was coarse and severe, “The condition of human beings, reduced to the extreme states of degradation and misery cannot be exhibited in a softened language, or adorn a polished page.”

Social Reformers as Change Agents

Dorothea Dix was a social reformer who vehemently advocated for the mentally ill. In the “Memorial to the Massachusetts Legislature” (1843), Dix appealed to the members of the legislature,

I come as the advocate of helpless, forgotten, insane, and idiotic men and women; of             beings sunk to a condition from which the most unconcerned would start with real                 horror; of beings, wretched in our prisons, and more wretched in our almshouses.

Interestingly, according to Barusch (2014), it was due to a Sunday school class at a jail outside Boston, that the social reformer became aware that the insane were housed with criminals and were victims of all sorts of abuse (p.227). Her indignation at such situation stimulated her career in social advocacy. From 1841 to 1842, she investigated the jails, almshouses and even the streets and private homes across the State of Massachusetts. Her methodology consisted of visiting jails and almshouses, observing the treatment and living conditions of the insane housed in them, and preparing a petition containing her findings to the members of the Legislature of Massachusetts. After Massachusetts, the mental health reformer continued her work in other states and encouraged state legislatures to expand and establish mental health institutions. Throughout Dix’s career, she was essential for the foundation and/or expansion of 31 asylums for people with mental illness. Barusch (2014) further explains how Dix responded to inhumane treatment. Like many other advocates, she used exaggeration or hyperbole during her presentations. The author compares Dix and her fellow reformer Samuel Gridley Howe, as both used dramatic presentations to convey the urgency of the matter they were advocating for. On the other hand, while Howe attributed the roots of insanity to failed social institutions, that is, insanity was caused by society, therefore, it should be responsible for the care of its victims; Dix postulated that the causes of insanity were irrelevant and argued for the moral necessity of protecting the insane from the “predatory forces of society” (p.228). In other words, Dix was not concerned about the roots of insanity, but on how to solve the problem of inhumane treatment of the mentally ill. Parry (2006), in the article “Dorothea Dix”, clarifies how the social reformer supported the model of care of “Moral Treatment” founded by William Tuke in England and Phillipe Pinel in France. Based on that finding, it is inferable that Dix´s conceptualization and critical analysis of inhumane and harsh conditions in the prisons and almshouses was strongly influenced by the “Moral Treatment” approach.

          Past and current social workers’ responses to the inhumane treatment of the mentally ill. Although social advocates throughout the history have fought for the betterment of the American mental health system, different versions of abuse and inhumane treatment continue to happen in the modern American prisons. If in the 1800s therapeutic treatments were basically nonexistent, nowadays, although they exist, many individuals don’t have access to them. For instance, according to Mental Health America, in its 2017 report, 56% of American adults with a mental illness did not receive treatment; and Arkansas, Mississippi and Alabama have over 57,000 people with mental health conditions in jail and prison (http://www.mentalhealthamerica.net/issues/state-mental-health-america ). Early in our history, social reformers responded to this issue through investigation, observation, and advocacy. They exposed the atrocities practiced in the jails and almshouses and petitioned their state legislatures for reforms. Nowadays, as much as social workers, counselors and other mental health professionals want to report abuse, they are often coerced to remain in silence by correction officers and other jail staff. A disheartening example is the Dade Correctional Institution, in Florida, in which the Staff Counselor Harriet Krzykowski witnessed mental ill inmates being abused and neglected. Inhumane treatment has happened in the form of starvation, sexual assault, seclusion, torture, badgering, and even murder. According to Krzykowski, her attempts to advocate were silenced by the fear of corrections officers and her superiors. Using human rights as a framework for this analysis, one can realize how the Florida Department of Corrections fails to provide a safe place for mental health treatment inside the jails, which results in not only the inmates’ human rights violation, but also in the violation of the counselors’ rights. One can observe how power relations are prevalent; as Krzykowski affirms, “I kept getting the message that whatever security says, goes”. Although in May, 2015, a senior adviser at Human Rights Watch released a report about physical maltreatment against inmates with mental disorders in American prisons; there is a “it’s none of our business culture,” which results in nobody advocating for them. Another important point according to Psychiatrist Kenneth Appelbaum, is that the American Psychiatry Association does not properly address the ethical challenges that their members who work in prisons face daily (Press, 2016). In other words, there is a lack of engagement in questioning how the mentally ill incarcerated population should be cared for. This lack of engagement is certainly a reflection of the elitism in the profession, that is, many professionals belittle the work developed in prisons.

        Personal Reflection. In the beginning of the paper, I intended to discuss the evolution of the treatment of the mentally ill in the United States. However, as my research advanced and as I narrowed my subject of analysis to the prison system, I concluded that, despite historical advocacy, there was no evolution and that inhumane treatment continues to happen in different ways. Even though our society knows of the existence of human rights, the culture of human rights is far from implemented and internalized by individuals. Instead, I learned that there is the culture of fear and the culture of “it’s none of my business” inside prisons.



Barusch, A. (2014). Chapter 7: Mental Health. In Foundations of Social Policy: Social Justice in             Human Perspective (5th ed., Vol. 1, pp. 219-250). Stamford, CT: Cengage Learning.

Memorial to the Massachusetts Legislature (1843). (n.d.). Retrieved February 20, 2017,                 from http://chnm.gmu.edu/courses/jackson/revival/dix.html

Parry, M. (2006). Dorothea Dix (1802-1887). Am J Public Health,96(4), 624-625. doi:                        10.2105/AJPH.2005.079152

Press, E. (2016, May 2). Madness: In Florida prisons, mentally ill inmates have been                      tortured, driven to suicide, and killed by guards. The New Yorker. Retrieved February 20,         2017, from http://www.newyorker.com/magazine/2016/05/02/the-torturing-of-                     mentally-ill-prisoners.

The State of Mental Health in America. (2016, October 31). Retrieved February 20, 2017,                from http://www.mentalhealthamerica.net/issues/state-mental-health-america



The Sociology of Indifference


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I used to live in Belo Horizonte, the capital of the State of Minas Gerais, Brazil. As in most big cities, there is a lot of social inequalities such as homelessness and people suffering from hunger. Once I was coming back from work, and there was an African Brazilian man eating rotten food from a restaurant’s garbage bags. It was heartbreaking to see that human being looking for food in the garbage with so much food being wasted in Brazil daily. In a country where one of its main economic activities is the exportation of agricultural goods there should not be people going hungry. It was also uncomfortable to realize that people were coming in and out of the restaurant and even did not realize that there was a man eating from the garbage bags. When I saw that scene, it reminded me of a poem that we had studied in 5th grade and that I would like to share with you:

The Animal (Translated from Brazilian Portuguese Language)

Author: Manuel Bandeira

Yesterday I saw an animal
On a filthy hallway
Searching for food between the garbage
When finding anything
It did not inspect or smelled
Just swallowed with voracity
The animal was not a dog
Or a cat

Or a rat
The animal, oh my Lord, was a man!

I believe that in order to reflect on justice, fairness and equality one has also to consider the problem of indifference. I always questioned how can an individual be truly happy due to his prosperity if he walks on the streets and see children begging or homeless people searching for food in the garbage? How can someone who is fortunate and prosperous close his eyes to reality and keep living happily as if everybody else had the same life conditions? A way to explain and answer to those questions is through the concept of indifference and the sociology of the stranger. Rudolph Stichweh (1997), in his article, ‘The Stranger on the Sociology of Indifference’, explains how modern society is no longer a membership organization. Indifference can be defined as the status of not being a friend nor an enemy of one another. The state of being indifferent is part of people’s everyday activities and its macro-structural consequences in modern society translates into people’s unwillingness to care for and about others (p.3-4).  It seems like a lot of people are not affected by social inequities; there is a generalized state of numbness in which individuals carry on with their lives when witnessing others in painful situations. In other words, there is a trivialization of social problems in which the other is simply ignored. An example of that is the picture shared below, in which a blind man drowned while swimming in a famous Brazilian beach in Rio de Janeiro. His body was not removed by the police for a while and irrespective of that, tourists kept smiling, enjoying the beach, taking pictures as if there was nobody there. Such indifference caught the photographer’s attention. He then decided to publish the picture and raise awareness on the subject.



Stichweh, R. (1997). The Stranger – on the Sociology of the Indifference. Thesis Eleven,51(1), 1-16. doi:10.1177/0725513697051000002


The Pervasive US Idea of our Classless Society


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Jimenez (2010), sheds some light on the concept of ideology as “templates, or reassuring explanatory structures that can explain contingencies, both the unexpected and the taken-for- granted aspects of social order” (p.45). Community, government and the media exert considerable influence on the formation of the individuals’ ideologies. That said, the beliefs of upward income mobility and equal opportunity are, according to Jimenez (2010), ideological positions aimed at promoting social control and quieting feelings of social unrest (p.60). That was a reality in the 19th century and continues to be nowadays. An interesting example is immigration; the image sold in countries such as Brazil, is that the United States offers equal professional growth opportunities to everybody who works hard. Therefore, people want to come here and pursue the American dream, nonetheless, when they arrive in the country, they start facing social barriers. The thought of a completely open social and economic order and the association of economic success with individual merit does not correspond to the reality of many immigrants who are educated but when applying for a job, face unfair situations such as the other candidate’s personal connections, favoritism and ethnic discrimination.

The ideas of upward income mobility and equal opportunity prevalent in the U.S society tend to hinder the development of individuals’ critical thinking about inequality and lack of economic opportunities (Jimenez, p.61). In other words, if everybody believes that their social condition is only temporary and that their personal success is solely influenced by their own choices and not external factors such as the political environment, there is no reason for people to fight for better social conditions or even to fight for a complete change in the economic and social systems of government. Jimenez (2010), further clarifies that it is unlikely that most people will criticize ongoing poverty and oppression in the United States due to the lack of a major political party leading a critique of the market’s economy (p.77). In the 19th Century, Socialist political traditions were a reaction against industrial capitalism’s ways of exploiting workers in England and Germany (http://public.wsu.edu/~brians/hum_303/socialism.html).  Nonetheless, in the U.S, the myths of upward mobility and equal opportunity kept society optimistic and working hard on pursuing the American dream, if not for them, for their next generations.



Introduction to 19th-Century Socialism. (n.d.). Retrieved January 10, 2017, from http://public.wsu.edu/~brians/hum_303/socialism.html

Jimenez, J. (2010). Social policy and social change: Toward the creation of social and economic justice. Thousand Oaks, CA: Sage Publications, Inc. (Chapter 3: Historical values influencing social problems and policies).

Social Work as Means of Social Control


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The view of social work as a means of social control presented by McLaughlin in the article “Social Work’s Legacy: Irreconcilable Differences?”  is an eye-opener to those new to the field of social work. According to the author, critics affirm that the mission of social work is no longer to help the poor and oppressed, but to control them, utilizing psychotherapy as a method of intervention (p.188). Interestingly, if one compares social work in the United States and social work in Brazil, one will realize that in Brazil the scope of social work does not include the clinical aspect. In other words, psychologists and psychiatrists will work in the mental health field, while social workers will address social justice issues at collective and individual levels. Perhaps, the Brazilian approach to social work would be more in alignment with scholars such as Spechat and Courtney, however, McLaughlin (2002), urges social workers to think reflectively about the betterment of the individual and the betterment of society as complementing each other (p.196-197).

Day (1981) in the article “Social Welfare: Context for Social Control”, shed some light on how social workers and human services organizations might control vulnerable communities and individuals. The author explains that “social workers are generally unaware of the extent of their control and most of them enter the human service field from feelings of caring” (p.30). Day (1981) corroborate McLaughlin’s thoughts on the importance of developing critical thinking about social work as a means of social control, so that social workers don’t become agents of such control, supporting and legitimating it (p.31). Historically, some of the ways social welfare exerted control over society was through the Statute of Laborer in 1349, in which people were kept in certain areas of work to economically benefit others; The War on Poverty in 1965, aiming at controlling civil disorder started by the disadvantaged; and the expansion of Community Mental Health Acts, which had the objective of quieting political unrest in the 1960s (p.32). The author does not deny the usefulness of such programs nor the unselfish feelings of people working for them, however, he emphasizes what he calls “the programs’ latent functions; public intrusion into private lives, expanding definitions of deviance and new pressures for and legitimation of conformity” (p.33).

Other important ways in which social workers and human services agencies exert control over society are through values, attitudes and the power relations. Day (1981) exemplifies human services organizations as symbols of power, in which the social worker is the expert and the client is the one seeking for help. One can imply that the client is inadequate and needs to be taught how to meet society’s standards of functioning (p.34). If not carefully observed, the power relation might translate into social workers adopting the position of experts and disregarding the client’s abilities, knowledge and rights.


Day, P. (1981). Social Welfare: Context for Social Control. The Journal of Sociology & Social Welfare,8(1), 29-44. Retrieved January 6, 2016.

McLaughlin, A. (2002). Social work’s legacy: Irreconcilable differences? Clinical Social Work Journal, 30(2), 187-198.


Human Resources Peer Reviewed Article Poorly Written – What a Shame!

Brainstorming Ideas - The Social Worker


Dear cohorts,

I would like to respectfully write some words about the article that was assigned to us this week: 

 Owais Shafique (2012) ‘Recruitment in the 21st Century’. IJCRB.webs.com 4 ( 2) Institute of Interdisciplinary Business Research, Available online from: http://search.ebscohost.com.ezproxy.liv.ac.uk/login.aspx?direct=true&db=bth&AN=83518189&site=eds-live&scope=site 

I just finished reading it and it is surreal how it lacks basic English writing skills and has a truncated aspect. 

Here I have some examples of the article that show  what I meant by stating the above: 

Strategic recruitment is of vital importance in recruitment planning now a day(now a days). We also found the usefulness of Generation X approach in identifying the differences between the old generation and the young new ( young or new? chose one)Generation x and the different needs and attitudes of both the( there is no need for “the”)  generations.

…” Try to use “you” instead of “we need” & “must have”…

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Teaming Concept: a Remedy against the Factory Model in the School System


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   The teaming concept, when applied to the schools’ structural design could be seen as a “remedy” against the factory model or the traditional departmentalized school structure. In order to effectively answer to the unique needs of young adolescents, many middle schools have been shifting their organizational structure from departmentalized and deterministic into a more holistic and contingent structure (Brown and Knowles, 2007, 226).  Having a Business Management academic background makes me realize that while the corporate world has been successfully changing their organizational structures from the factory model into a holistic-team oriented approach, implementing successful teaming in schools might take great time and efforts. If the schools’ objective is to prepare citizens with a well-rounded education, there must be a shift from the industrial era paradigm into the knowledge era paradigm. In other words, teaming is not only necessary in order to answer to young adolescents’ needs, but also to prepare them to join a job market that is each day more focused on selling knowledge and innovation rather than manufactured products.

          Common planning time is much needed so that the teachers team can become more cohesive and synchronized. According to Manning and Bucher (2012), one of the benchmarks for effective teams tells that, “Teachers should have compatible personalities and good interpersonal skills” (134). I strongly believe that teachers will work better in groups and get to know each other’s thoughts if they have the time to work and plan together. In that way, they’ll be more competent when managing disagreements such as different point of views. They’ll also be more aware of their individual educational philosophies and better able to compromise in order to achieve long term goals. Teams would work together by sharing their thoughts, brainstorming ways to approach the chosen theme, defining ways to assess their students, and last but not least, including the students in the process of integrating the curriculum. In addition, teachers would work in looping in which a core group of teachers and students remain together for several years. Looping is an effective way to promote personalized instruction, facilitate the students’ transition from elementary to middle school and reduce anxiety since students will already know their teachers’ expectations when a new school year begins (Manning and Bucher, 2012, 135). Since there is interaction among individuals with different perspectives, common time planning instruction will certainly present challenges. I believe that one of the main challenges would be teachers who are not willing to give up all the autonomy they have when they are isolated in their classrooms and can freely plan their instruction (Manning and Bucher, 2012, 136). In order to overcome that challenge, teachers should be willing to compromise some of their views so that the entire group can benefit. If we want to teach cooperation to our students, we should be the first ones to model cooperation by willing to make common time planning succeed.


Brown, Dave F, and Trudy Knowles. What Every Middle School Teacher Should Know. 2nd ed. Portsmouth, NH: Heinemann, 2007. 290. Print.

Manning, M. Lee., and Katherine T. Bucher. Teaching in the Middle School. 4th ed. Boston: Pearson, 2012. Print.