The Authoritarian Reign in American Health Care

Abstract

The aim of this article is to increase understanding of the mechanisms of the continuation of elite hegemonic control of a highly valued social system--American health care. White, male physicians and administrators achieved control of the health care industry and its workers, including nurses, at the start of the 20th century. Using critical theorists' work on authoritarianism and incorporating gender analysis, the authors describe the health care system from a critical social- psychological perspective. The authors discuss the meaning and presence of authoritarian hierarchy and gender effects in today's health system through a critical analysis of the profession of medicine, the profession of nursing, corporate and bureaucratic health care, and patients or consumers. It is concluded that the social-psychological behavior of the American health care system has profound implications that must be taken into account in any recommendations for change.

Structural Racism in the COVID-19 Pandemic: Moving Forward

“…Although the U.S is neither a fragile democracy nor in the process of moving from a totalitarian to a democratic regime in its state and Federal governance structures, its healthcare system displays characteristics of an authoritarian regime. As scholars have observed, it was established by the powerful few-i.e., White, male physicians and administrators; it is controlled by private, corporatized bureaucrats who are segregated by class, gender and race from the general public and from workers from lower socioeconomic strata; and it has largely been a closed system, resistant to change and to the democratization of healthcare management (Ballou and Landreneau 2010). Although the Patient Protection and Affordable Care Act expanded access to health insurance to some underserved populations, it maintained the privatized healthcare system and considerable racial and ethnic gaps in insurability (Buchmueller and Levy 2020).…”

Epistemic Authority in Nursing Practice vs. Doctors’ Orders

“…Visions are easy to express, but difficult to realize given the hierarchy and authoritarianism within healthcare systems, historically and today (Ballou & Landreneau, 2010). Can nurses conceptualize a practice free of the paradigm and policies of doctors’ orders?…”

Walking the Talk: Insights Into Dynamics of Race and Gender for Nurses

“…Yet the complex, gendered dynamics shaping working conditions within the female-dominated caring professions are too often attributed simply to biology rather than to the historical ways that lives, including work, have been socially organized (Armstrong, Armstrong & Scott-Dixon, 2006;Ballou & Landreneau, 2010). Too often, gender and race are simply ignored as factors, leading to what Messing (1998) labels a "one-eyed science," and serving to underestimate the risks, including injury and illness, faced by the primarily female nurses.…”