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Photo by Ted Eytan; flickr creative commons.

President Trump recently declared that Obamacare is “essentially dead” after the House of Representatives passed legislation to replace existing health care policy. While members of the Senate are uncertain about the future of the proposed American Health Care Act (AHCA) — which could ultimately result in as many as 24 million people losing their health insurance and those with pre-existing conditions facing increasing health coverage costs — a growing number of Americans, especially women, are sure that the legislation will be bad for their health, if enacted.

On the same day that the House passed the Republican-backed plan, for example, a friend of mine revealed on social media that she had gotten her yearly mammogram and physical examination. She posted that the preventative care did not cost anything under her current employer benefit plan, but would have been prohibitively expensive without insurance coverage, a problem faced by many women across the United States. For instance, the American Cancer Society reports that in 2013 38% of uninsured women had a mammogram in the last two years, while 70% of those with insurance did the same. These disparities are certainly alarming, but the problem is likely to worsen under the proposed AHCA.

Breast care screenings are currently protected under the Affordable Care Act’s Essential Health Benefits, which also covers birth control, as well as pregnancy, maternity, and newborn care. The proposed legislation supported by House Republicans and Donald Trump would allow individual states to eliminate or significantly reduce essential benefits for individuals seeking to purchase health insurance on the open market.

Furthermore, the current version of the AHCA would enable individual states to seek waivers, permitting insurance companies to charge higher premiums to people with pre-existing conditions, when they purchase policies on the open market. Making health insurance exorbitantly expensive could have devastating results for women, like those with a past breast cancer diagnosis, who are at risk of facing recurrence. Over 40,000 women already die each year from breast cancer in our country, with African-American women being disproportionately represented among these deaths.

Such disparities draw attention to the connection between inequality and health, patterns long documented by sociologists. Recent work by David R. Williams and his colleagues, for instance, examines how racism and class inequality help to explain why the breast cancer mortality rate in 2012 was 42% higher for Black women than for white women. Limiting affordable access to health care — which the AHCA would most surely do — would exacerbate these inequalities, and further jeopardize the health and lives of the most socially and economically vulnerable among us.

Certainly, everyone who must purchase insurance in the private market, particularly those with pre-existing conditions stand to lose under the AHCA. But women are especially at risk. Their voices have been largely excluded from discussion regarding health care reform, as demonstrated by the photograph of Donald Trump, surrounded by eight male staff members in January, signing the “global gag order,” which restricted women’s reproductive rights worldwide. Or as illustrated by the photo tweeted  by Vice-President Pence in March, showing him and the President, with over twenty male politicians, discussing possible changes to Essential Health Benefits, changes which could restrict birth control coverage, in addition to pregnancy, maternity, and newborn care. And now, as all 13 Senators slated to work on revisions to the AHCA are men.

Women cannot afford to be silent about this legislation. None of us can. The AHCA is bad for our health and lives.

Jacqueline Clark, PhD is an Associate Professor of Sociology and Chair of the Sociology and Anthropology Department at Ripon College. Her research interests include inequalities, the sociology of health and illness, and the sociology of jobs, work, and organizations.

2 (1)Sociologists Martin Weinberg and Colin Williams wanted to know. They and their team interviewed 172 college students about their habits and concerns about farting and pooping. They published their results in an article called Fecal Matters. They discovered that everybody farts and everybody cares, but not everyone cares all the time or equally.

They separated their results by gender and sexual orientation. When they asked people if they were worried that the hearer would “feel disgust,” heterosexual women were most likely to agree and heterosexual men the least, with non-heterosexual men and women in the middle, but flipped such that men were more worried than women.

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Heterosexual men were the most likely to think it was funny and the most likely to engage in “intentional flatulence.” Almost a quarter said that they “often” did so, whereas only 7 percent of heterosexual women said the same. “Guys would say it’s raunchy and then say ‘Nice one,’” explained one heterosexual guy, “because if it’s strong it’s more manly. You know, because women would not try to clear a room with a fart.” Heterosexual women felt like they were violating gender norms if their farts were stinky: “The worse it stinks,” said one, “the nastier they think I am.”

Heterosexual women were the most concerned that it would affect their relationship with the hearer. They were also the most likely to do things to reduce the likelihood that others would detect their bathroom activities, like go into another room to pass gas or let their stool out slowly to avoid a kerplunk. Two thirds said they would wait until they were alone to poop and only women reported flushing repeatedly to ensure that the sights and smells of their defecation had disappeared.

As a counter example, one of the heterosexual men interviewed said that the only thing he was willing to do to protect others from his bathroom activities was close the door.

Non-heterosexual men were an interesting conundrum. They were as likely as heterosexual men to think that the hearer would think it was funny, but the least likely to engage in intentional flatulence and the most likely to make sure that when they poop, they do so alone.

Non-heterosexual women were also a conundrum. They were the least likely to think the hearer would laugh at a fart, but second only to heterosexual men in the practice of farting on purpose to get a reaction.

This study is a great example of what social scientists call doing gender, modifying our behavior to conform to gendered expectations. Generally, women are expected to have better control of their body, to be more polite, and to avoid offending others. All of these things are consistent with being more discreet with farts and poops.

The interesting data from non-heterosexual men and women may be explained by the conflation of sexual object choice and the performance of gender. It’s not universally this way, but in the U.S. today gay men are feminized and lesbians masculinized. This is a stereotype, but also gives non-heterosexual men and women some permission to deviate from gender rules. As one non-heterosexual man explained:

Only around people that I’m regularly naked with would I be comfortable with them knowing what I was doing in the bathroom. I’m on the self-prescribed “pretty pill”—where you don’t fart, sweat, burp, or use the bathroom… I learned it from my diva friends.

Similarly, some non-heterosexual women may feel a little less pressure to be as girly or girly all the time.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

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Today is Labor Day in the U.S. Though many think of it mostly as a last long weekend for recreation and shopping before the symbolic end of summer, the federal holiday, officially established in 1894, celebrates the contributions of labor.
Here are some SocImages posts on a range of issues related to workers, from the history of the labor movement, to current workplace conditions, to the impacts of the changing economy on workers’ pay:

The Social Construction of Work

Work in Popular Culture

Unemployment, Underemployment, and the “Class War”

Unions and Unionization

Economic Change, Globalization, and the Great Recession

Work and race, ethnicity, religion, and immigration

Gender and Work

The U.S. in International Perspective

Academia

Just for Fun

Bonus!

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

A merry day of celebration to those of you who care, from The Society Pages and card-maker extraordinaire, Letta Page!

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Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Prisoners who can maintain ties to people on the outside tend to do better — both while they’re incarcerated and after they’re released. A new Crime and Delinquency article by Joshua Cochran, Daniel Mears, and William Bales, however, shows relatively low rates of visitation.

The study was based on a cohort of prisoners admitted into and released from Florida prisons from November 2000 to April 2002. On average, inmates only received 2.1 visits over the course of their entire incarceration period. Who got visitors? As the figure below shows, prisoners who are younger, white or Latino, and had been incarcerated less frequently tend to have more visits. Community factors also shaped visitation patterns: prisoners who come from high incarceration areas or communities with greater charitable activity also received more visits.  

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There are some pretty big barriers to improving visitation rates, including: (1) distance (most inmates are housed more than 100 miles from home); (2) lack of transportation; (3) costs associated with missed work; and, (4) child care. While these are difficult obstacles to overcome, the authors conclude that corrections systems can take steps to reduce these barriers, such as housing inmates closer to their homes, making facilities and visiting hours more child-friendly, and reaching out to prisoners’ families regarding the importance of visitation, both before and during incarceration.

Cross-posted at Public Criminology.

Chris Uggen is a professor of sociology at the University of Minnesota and the author of  Locked Out: Felon Disenfranchisement and American Democracy, with Jeff Manza. You can follow him at his blog and on twitter.

Screenshot_1Today is Labor Day in the U.S. Though many think of it mostly as a last long weekend for recreation and shopping before the symbolic end of summer, the federal holiday, officially established in 1894, celebrates the contributions of labor.

Here are some SocImages posts on a range of issues related to workers, from the history of the labor movement, to current workplace conditions, to the impacts of the changing economy on workers’ pay:

The Social Construction of Work

Work in Popular Culture

Unemployment, Underemployment, and the “Class War”

Unions and Unionization

Economic Change, Globalization, and the Great Recession

Work and race, ethnicity, religion, and immigration

Gender and Work

The U.S. in International Perspective

Academia

Just for Fun

Who is the highest paid employee of your state?

Bonus!

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Ross Douthat is puzzled. He seems to sense that a liberal policy might actually help, but his high conservative principles and morality keep him from taking that step. It’s a political version of Freudian repression – the conservative superego forcing tempting ideas to remain out of awareness.

In his column, Douthat recounts several anecdotes of criminal charges brought against parents whose children were unsupervised for short periods of time.  The best-known of these criminals of late is Debra Harrell, the mother in South Carolina who let her 9-year-old daughter go to a nearby playground while she (Debra) worked at her job at McDonald’s. The details of the case make it clear that this was not a bad mom – not cruel, not negligent. The playground was the best child care she could afford.

One solution should be obvious – affordable child care.  But the U.S. is rather stingy when it comes to kids. Other countries are way ahead of us on public spending for children.

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Conservatives will argue that child care should be private not public and that local charities and churches do a better job than do state-run programs. Maybe so. The trouble is that those private programs are not accessible to everyone. If Debra Harrell had been in France or Denmark, the problem would never have arisen.

The other conservative U.S. policy that put Debra Harrell in the arms of the law is “welfare reform.”  As Douthat explains, in the U.S., thanks to changes in the welfare system much lauded by conservatives, the U.S. now has “a welfare system whose work requirements can put a single mother behind a fast-food counter while her kid is out of school.”

That’s the part that perplexes Douthat. He thinks that it’s a good thing for the government to force poor women to work, but it’s a bad thing for those women not to have the time to be good mothers. The two obvious solutions – affordable day care or support for women who stay home to take care of kids – conflict with the cherished conservative ideas: government bad, work good.

This last issue presents a distinctive challenge to conservatives like me, who believe such work requirements are essential. If we want women like Debra Harrell to take jobs instead of welfare, we have to also find a way to defend their liberty as parents, instead of expecting them to hover like helicopters and then literally arresting them if they don’t.

As he says, it’s a distinctive challenge, but only if you cling so tightly to conservative principles that you reject solutions – solutions that seem to be working quite well in other countries – just because they involve the government or allow poor parents not to work.

Conservatives love to decry “the nanny state.”  That means things like government efforts to improve kids’ health and nutrition. (Right wingers make fun of the first lady for trying to get kids to eat sensibly and get some exercise.)

A nanny is a person who is paid to look after someone else’s kids. Well-off people hire them privately (though they still prefer to call them au pairs). But for the childcare problems of low-income parents, what we need is more of a nanny state, or more accurately, state-paid nannies.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

When my primary care physician, a wonderful doctor, told me he was retiring, he said, “I just can’t practice medicine anymore the way I want to.” It wasn’t the government or malpractice lawyers. It was the insurance companies.

This was long before Obamacare.  It was back when President W was telling us that “America has the best health care system in the world”; back when “the best” meant spending twice as much as other developed countries and getting health outcomes that were no better and by some measures worse. (That’s still true).

Many critics then blamed the insurance companies, whose administrative costs were so much higher than those of public health care, including our own Medicare. Some of that money went to employees whose job it was to increase insurers’ profits by not paying claims.  Back then we learned the word “rescission”  — finding a pretext for cancelling the coverage of people whose medical bills were too high.   Insurance company executives, summoned to Congressional hearings, stood their ground and offered some misleading statistics

None of the Congressional representatives on the committee asked the execs how much they were getting paid. Maybe they should have.

Health care in the U.S. is a $2.7 trillion dollar business, and the New York Times has an article about who’s getting the big bucks.  Not the doctors, it turns out.  And certainly not the people who have the most contact with sick people — nurses, EMTs, and those further down the chain.  Here’s the chart from the article, with an inset showing those administrative costs.

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As fine print at the top of the chart says, these are just salaries — walking-around money an exec gets for showing up.  The real money is in the options and incentives.

In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year.

The anti-Obamacare rhetoric has railed against a “government takeover” of medicine. It is, of course, no such thing. Obama had to remove the “public option”; Republicans prevented the government from fielding a team and getting into the game. Instead, we have had an insurance company takeover of medicine. It’s not the government that’s coming between doctor and patient, it’s the insurance companies. Those dreaded “bureaucrats” aren’t working for the government of the people, by the people, and for the people. They’ve working for Aetna and Well-Point.

Even the doctors now sense that they too are merely working for The Man.

Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin [demanded] . . . health reforms . . . requiring that 95 percent of insurance premiums be used on medical care. The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

That $12,000 tab, for what it’s worth, is slightly under the U.S. average.

Cross-posted at Pacific Standard.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.