The Italian Renaissance and the Northern European Renaissance Essay

The Italian Renaissance and the Northern European Renaissance - Essay Example Commerce introduced the artistic ideas in the Northern Europe region.Both regions used the guild system, which was based on lessons on the craft. This involved painting and sculptures. According to Earls, the guild system was a regulatory system for any artistic work (34). In this regard, every artistic presentation had to be in agreement with the Guild. This is to make sure that the artwork produced was of high quality. Essentially, this meant that the rehearsals on various forms of art had to be tireless and time-consuming. After accepting the artworks, the Guild still continued to measure the artistic practices and standards. Another similarity is that both the north and Italy had unique artistic centers in their regions.   In this regard, the Italian’s center was the Republic of Florence while the center for the North was Flanders. This was a section of the Duchy of the Burgundy. The Florence City, which was the center of art for the Italian Renaissance was controlled by the Medici family. The members of Medici family were responsible for bringing wealth to Florence. According to Nici, Cosimo de’ Medici, established a library, which was full of the Greek and Roman manuscripts (Nici 47). This legend noticeably involved Italian artists and philosophers. This group helped in the changing of Florence to a cultural center. The Italian Renaissance was focused on individualism. An example of this was ‘Masaccio’s Trinity with the virgin’, which was highly recognized with the Italian Renaissance.   The other likeness of Italy and the North was their use of religion in their artistic works. Incidentally, religious scenes were always displayed to show the love of religion. The artworks of the religious scenes from the Italian Renaissance were â€Å"the last supper† and â€Å"the creation†. The northern Europe Renaissance examples are â€Å"Adam and Eve†, and the â€Å"Mystic Lamb†. Both renaissances were sharp in their artistic works.  

Compare Romeo and Juliet Essay Example for Free

Compare Romeo and Juliet Essay Romeo and Juliet and Pride and Prejudice are two of the most admirable and exquisite works ever written about the struggling love of two opposing forces. The novels have had a great literary importance and give us a sense of love and marriage on its most bewildered journey during the Elizabethan Era and the Napoleonic wars. Even though these two novels are from two different eras and are quite divergent as a result of it, this essay will argue that both Romeo and Juliet and Pride and Prejudice are indubitable similar in the concern of love and marriage. Firstly, this essay will present a short amount of background regarding love and marriage during the Elizabethan era and in the turn of the nineteenth century. Secondly, the essay will talk about the comparison and distinction in love and marriage present in the novels. Thirdly, this essay will discuss and hopefully conclude with the chosen thesis. During the Elizabethan era women were subservient to men and they were raised not to consider otherwise. They were expected to marry whomever the father would hold appropriate. The Scottish protestant leader John Knox wrote â€Å"Women in her greatest perfection was made to serve and obey man.( Alchin, L.K. Elizabethan Women.) The marriages were arranged to create alliances with other powerful families which becomes the obvious environment in the play about Romeo and Juliet. Love was not significant between a man and a woman. Instead the importance of financial security and a life in everlastingly safety was prioritized through the marriage of a wealthy suitor. In the play by Shakespeare Romeo and Juliet, Juliet is being arranged to marry Paris, a kinsman of the prince, a well suited husband for her despite of her disapproval. As Paris speaks â€Å"God shield I should disturb devotion!—Juliet, on Thursday early will I rouse ye.(kisses her) Till then, adieu, and keep this hol y kiss.† ( Romeo and Juliet, 4.1 William Shakespeare) This is not a marriage for love and this typical prejudice of marriage is also highly present in Jane Austen’s book Pride and Prejudice. One of the characters Charlotte amongst other, is utterly convinced of a socially ideal marriage which was the most common way to unite in the turn of the nineteenth century. â€Å"I am not romantic, you know; I never was. I ask only a comfortable home; and considering Mr. Collinss character,  connection, and situation in life, I am convinced that my chance of happiness with him is as fair as most people can boast on entering the marriage state. (Chapter 22. Page 193. Pride and Prejudice. N.p.: Planet Pdf). Most women decided to marry rather than depend on other family members for financial support. Due to this choice or lack thereof, love and passion were presumed to be less essential in people’s lives. Charlotte’s quote expresses more or less the plight woman had throughout the turn of the nineteenth century. It’s very likely that the Author of Pride and Prejudice, Jane Austen intentionally tried to reveal woman’s position in love and marriage as they were. Shakespeare on the other hand probably had a slightly different agenda which was mainly to please the audiences. All though it is important to note that Shakespeare pre sumably wrote about this social decay because he did not approve of what was going on at the time. We might say that this includes the social condition of women and their meager rights in love and marriage. â€Å"Get thee a good husband, and use him as he uses thee.†(Alls Well That Ends Well 1.1.212-13) In Romeo and Juliet the matter of love dominates the play.† My bounty is as boundless as the sea, My love as deep; the more I give to thee, The more I have, for both are infinite. (Romeo and Juliet 2.2, William Shakespeare). Love in this play is simply not one-sided. There is puppy love or shallow love which is the love Romeo has for Rosalie, merely drawn to her appearances’. This view of love is also present in the novel Pride and Prejudice. One of the main characters Mr. Darcy speaks of the woman who later becomes his wife She is tolerable; but not handsome enough to tempt me;† (Jane Austen, Pride and Prejudice,Planet Pdf p.14 Ch. 3) Romeo and Juliet and Pride and Prejudice are both acclaimed love stories which center around a man and a woman and their love for each other. The other characters seem to play their important role converging upon these lovers or lovers to be. In both stories we see a strong opposing love due to a distinctness of social class as occurring in Pride and Prejudice between the middle class, the Bennett’s and the Aristocrats Darcy’s and new money the Bingley’s. In Romeo and Juliet the antagonistic love is more defined as a feud between two power ful families who will not by any circumstances find peace with each other. â€Å"Two households, both alike in dignity, In fair Verona, where we lay our scene, From ancient grudge break to new mutiny, Where civil blood makes civil hands unclean.† (Romeo and  Juliet, Prologue p.7 William Shakespeare). The House of Montegue and the House of Capulet are the two families who are sworn enemies, never to reconcile until Romeo and Juliet’s deaths. Nevertheless both the novel and the play have in common the opposing forces set in the story. These two main characters should not be together in love as a result of society’s rules. They both defy society’s instructions and give in to love rather than reason. This way of writing was probably intentional by Shakespeare considering the Renaissance period was also about universal order as in Humanism which was a significant factor in general in Shakespeare’s plays.( Renaissance Humanism and Shakespeare†.) Both Romeo and Juliet and Pride and Prejudice paint marriage as one of life’s most important choices. Even though this is the case, it is considerably important to envision that Pride and Prejudice has a slightly closer focus on family over husband whereas Romeo and Juliet leans more toward love for husband over family in my opinion. The reason for this is the personalities of the women in the Novel and the Play. Both Juliet and Elizabeth are strong female characters who are being presented as very respectable human beings despite their flaws. In a way we can say that both authors, Jane Austen and William Shakespeare speak for the women at that time and their difficult situations in love and marriage. Passion, love and hate is also a common denominator in these stories. These three words as a whole provide us with an overall understanding of these books. Passion as source of consistency, love as a diversity present in different elements, and hate as an opposition to love to create balance. All though there are quite a few similarities between the novel and the play, there are also a few contrasts present in the books which are important to consider in an analysis of love and marriage. The play Romeo and Juliet has an overwhelming amount of overpowering force of love in it which supersedes everything. The love Romeo and Juliet has for each other is almost obsessive, and self-destructive as a result of it. (â€Å"Love is a smoke raised with the fume of sighs; Being purged, a fire sparkling in lovers eyes; Being vexd a sea nourishd with lovers tears: What is it else? a madness most discreet, A choking gall and a preserving sweet.† ( Romeo and Juliet, 1.1, William Shakespeare.) Romeo speaks of love as he has read in books, but unlikely experienced. Romeo’s passionate feelings develop into a deadly love at the end of the play when the couple’s  tragic destiny prevails and they both die by their own hands. Pride and Prejudice do not have this uncontrol lable intense love. The novel focuses more on the achievement of marriage and stability in life, financial and the image of respectability rather than the passionate lusty love. It is important to remember that love is also one of the themes of Pride and Prejudice and that the love in which the main characters Darcy and Elizabeth have for each other at the end of the novel is some of the reasons why this book is so successful. Even though the excessive love is more present in the play about Romeo and Juliet as a result of their lawless passion as archetypal lovers, it is relatively different than what we see in Pride and Prejudice. Both stories have a background of society’s expectation in love and marriage such as Juliet’s arranged marriage to Paris and Elizabeth’s friend Charlotte’s marriage to Mr. Collins an overbearing, and ridiculous heir to the entailed Bennett’s estate. In the play about Romeo and Juliet they are being referred to as star-crossed lovers â€Å"Where civil blood makes civil hands unclean. From forth the fatal loins of these two foes .A pair of star-crossd lovers take their life; Whose misadventurd piteous overthrows. Doth with their death bury their parents strife.( Romeo and Juliet, the Prologue. p.7, William Shakespeare,) The stars functions as an opposition to Romeo and Juliet’s destiny and is there-for an indication of a not intended univ ersal love as we can see clearly at the tragic end of the play followed by the death of the two young lovers. Pride and Prejudice have a slightly different ending. It has lot more satisfying completion where the two main characters finally can live a fulfilled life together despite the society’s heavy burden of commandment which the reader of the novel was most likely able to anticipate through-out the novel. We see that Romeo and Juliet and Pride and Prejudice have an evident distinction at the end of the two books towards the consideration of meaning. Clearly Romeo and Juliet is a forced equation whereas Darcy and Elisabeth are more likely to be predestined. By analyzing some of the similarities and contrasts in love and marriage in the two books I find the similarities no more substantial than the contrasts. This might be a result of the underlying elements that keep on grasping the connections as we see it. Some of the leading aspects of this influence are the love against all odds in Romeo and Juliet versus the more  predestined version in Pride and Prejudice. Another important element is shallow love which presents it-self in both books through the ignorance of the characters. We see similarities in the society’s established rules of marriage and the characters capability to oppose to these â€Å"decrees†. Then again there is an over-powering and obsessive force of love in Romeo and Juliet which is not accounted for in Pride and Prejudice. Due to these almost completely balanced analogies and divergences I cannot conclude with the chosen thesis and instead I accept the equity of exceptional authorship. Work cited Alchin, L.K. Elizabethan Women. Elizabethan Women. Www.elizabethan-era.org.uk, 16 May 2012. Web. 13 Feb. 2014. Shakespeare, William, Barbara A. Mowat, and Paul Werstine. The Tragedy of Romeo and Juliet. New York: Simon Schuster Paperbacks, 2011. Print. Austen, Jane. Pride and Prejudice. N.p.: Planet Pdf, n.d. Http://www.planetpdf.com/. Planet Pdf. Web. 13 Feb. 2014. Alls Well That Ends Well: Entire Play. Alls Well That Ends Well: Entire Play. Http://shakespeare.mit.edu/allswell/full.html, n.d. Web. 14 Feb. 2014. Renaissance Humanism and Shakespeare. Http://www.saylor.org/site/wp-content/uploads/2011/11/SAYLOR.ORG-ENGL401-RENAISSANCE-HUMANISM-SHAKESPEARE.pdf. The Sailor Foundation, n.d. Web.

Discuss Some Of The Main Ideas Essay -- essays research papers fc

Sigmund Freud considered himself a scientist whose intention was to find a physiological and materialist basis for his theories of the psyche. Freud revolutionised the way in which we think about ourselves. From its beginnings as a theory of neurosis, Freud founded and developed psychoanalysis into a general psychology, which became widely accepted as the predominant mode of discussing personality, behaviour and interpersonal relationships. Freud, who had been studying neuropathology, left Vienna in 1885 to continue his studies in Paris under the guidance of Jean Martin Charcot. This proved to be the turning point in his career, for Charcot’s work with patients classified as â€Å"hysterics† introduced Freud to the possibility that psychological disorders might have their source in the mind rather than the brain. Charcot’s hypnotic experiments demonstrated the link between hysterical symptoms such as paralysis of a limb and hypnotic suggestions to cure the paralysis. Although Freud later abandoned his faith in hypnosis, hypnotic experiments taught Freud that mental processes that took place unconsciously could have a powerful effect on behaviour. It was Freud who drew our attention to the unconscious mind. If we liken the mind to an iceberg, the nine tenths below the surface is the unconscious in which there are many mental processes going on that we have little control of. Our conscious mind is above the surface; it is what we are fully aware of and contains our perception, thought and memory. Freud also spoke of the preconscious which might include material put out of our conscious mind but which may be retrievable. Freudian psychoanalytical theory states that there are three agencies of the human personality. Below the surface is our â€Å"id†, these are our social and biological instincts such as hunger, thirst and self-preservation. The id seeks outlet in the pleasure principal with no regard to reality. It is our awareness of the outside world, our memory, perception and learning. The â€Å"Ego† develops to harmonise the impulses of the id with the demands of reality. It is our awareness of the outside world, our memory, perception and learning. The â€Å"super ego† develops later in varying degrees. It is like a conscience and brings in values and morals from parents and society and enables us to feel guilt. Freud grouped together ego and sexual instincts calling ... ...iar to most of us today. Psychoanalysis is a term that Freud coined in 1896. As a therapist he used mental rather than physical means to achieve behavioural or attitudinal change. One of Freud’s greatest achievements was his capacity to stimulate the creativity of others and his ideas have been developed by his many followers. Where Freud was perhaps wrong was in making psychosexual development so central that all other forms of social and emotional development were conceived as being derived from it. However, despite repeated criticism and attempted refutations of Freud’s work, his ideas remained powerful well after his death and the general way in which psychoanalysis and other forms of psychotherapy are conducted is still based on Freud’s procedure, and remains one of his most enduring legacies. BIBLIOGRAPHY: Storr A  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  1996  Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Freud†Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Oxford University Press Stevens R  Ã‚  Ã‚  Ã‚  Ã‚  1994  Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Freud and Psychoanalysis†Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Open University Press

Grieving in Amber by Eavan Boland :: essays research papers

Eavan Boland’s poem â€Å"Amber† was published in the Atlantic Monthly in December of 2005. This poem starts off sad, talking about a death of a friend and how grieving seemed to last forever. Boland shows us this through lines one through five. It then goes on saying that if you think of all the good memories that the grieving process will pass and you can be happy when thinking about the lost friend. Boland’s poem â€Å"Amber† is showing us that grieving shouldn’t last forever and that memories can take away the horrible feelings and bring happiness when thinking about a lost loved one. In the first five lines Boland presents the death of a friend and the writer is grieving â€Å"through seasons and centuries† (line 4), or in other words they are having a hard time getting over the grieving process. She then changes the mood by saying â€Å"On this fine September afternoon† (6). By putting the word â€Å"fine† in she is showing us that grieving is over. She starts talking about an ornament of amber that she is holding and that her friend gave this to her. By saying this she means that her friend gave her all of these memories and she is â€Å"holding† them, or keeping them in her memory. This ornament is the symbol of the memories the writer has of her lost friend. Then the writer is explaining that she has only memories because â€Å"The dead cannot see the living† (11) and vise versa. Boland then brings three images of seeds, leaves and feathers to our minds to present them as memories of a lost friend. In the middle of the poem Boland describes these â€Å"memories† by saying â€Å"as it fell and fell,† (15 and 16). By using â€Å"it† this shows that all of these memories are clumped together as one which makes them stronger. After this she goes on by saying â€Å"which now in a sunny atmosphere seem as alive as they ever were† (17 and 18). This is saying that the memories now bring bright and happy feelings and they seem alive because the memories are so strong that they seem as if they are real. When the writer refers to a Baltic honey this is referring back to the ornament of amber and how she was holding it in her hand, as if memories could be held. She then goes on to tell us a little about the friendship.

Compare aspects of the life of your mother at the age of 15 with the life you have, aged 15

What did your mum do for fun at the age of fun when she was 15? What sort of career prospects did she have? What sort of food would she have eaten and what would she have viewed as cool? This essay is going to attempt to explore the differences between my mum's life at 15 and mine. My mum at 15 went to a boarding school in Devon, and so her leisure time was structured. My mothers TV viewing was decided by two prefects and the headmistress. At 15 I mostly choose what I watch on television and this varies from Eastenders to Big Brother, whereas the highlight of my mothers viewing every week was TOTP. The girls were never allowed into town except for dental treatment and could only go to the shops if the matron's helper was in a good mood and would let them. By the lower fifth (year 10) the year would have its own common room where they would listen to records by the Rolling Stones and Tamla Motown and talk. My mother told me that after half terms and exeats she and her friends having pooled their money together would have midnight feasts. Midnight feasts are now a feature of most sleepovers and shopping in town is a regular occurrence. As for music it has progressed from records to CDs and from the Rolling Stones to the Darkness. Although we do not have a common room we are now from year 10 upwards aloud to be in our form room at lunch. When my mother was 15 job prospects for women were still pretty limited and the expectation was that women should have a job but should give it up once married to look after the house and any children. There were few respectable professions for women. There example are nursing, teaching and secretarial work. This is very different from the prospects for women today. Today so long as you have the qualifications you can get almost anywhere. In 1970 there were no convenience foods such as pizza from the freezer. My mother remembers most mornings being able to have either a cooked breakfast or toast and cereal. At least once a week there would be a roast dinner as well as Sundays, and also a salad once a week. Desserts were traditionally stodgy such as spotted dick and jam roly poly. There were sometimes non-traditional foods such as paella as the school employed a Spanish cook. Today you can acquire most traditional foods at supermarkets as convenience foods though puddings at school still are mostly the same such as chocolate sponge. Roasts are not as frequent and at most schools you can have salad any day of the week, also food from other cultures are quite common. Fashion styles may have changed since my mother was 15 but the fact that if you were not in the most up to date fashions then you are considered ‘Square' has not. When my mother was 15 mini skirts had just gone out of fashion and skirts had gone to the opposite extreme of maxi skirts. Fashions were more fixed, it was either one thing or another and they did not change as often as today. There are 34 yrs between me and my mum being 15 and though some fashions and the names of the bands that teenagers listen to have changed. Teenagers still follow fashion avidly and try to break as many rules as possible even if boundaries have become wider. Prospects and boundaries may have widened but in essence things have stayed the same.

7 Tips for Writing for Online Readers

7 Tips for Writing for Online Readers 7 Tips for Writing for Online Readers 7 Tips for Writing for Online Readers By Mark Nichol For some people, if a topic interests them, they are quite content to immerse themselves in extensive online articles that are otherwise indistinguishable from print content. Most Web site visitors, however, have a different set of expectations when they read on a computer screen. Nearly every medium has its own rules; here are seven tips to help you write for an online audience, whether you have your own site or blog or whether you submit content to other people’s sites. 1. Write for scanners, not for readers. Before you buy a book, you probably read the jacket copy synopsis, testimonials, the author’s biography. When you pick up a magazine or a newspaper, you quickly peruse the headlines. The same principle applies online: Provide points of entry for scanners headlines, subheadings, bullet lists, captions. Write clear, concise sentences. Keep paragraphs and other blocks of copy short and tight. Most important, keep in mind that visitors may never click over from scanning to reading, so pack as much information as you can into the points of entry. 2. Know your audience. Do you want your readers to geek out about some high tech topic? Do you hope they’ll come back to your site because you rate products effectively and they know they can count on you? Should they leave your site knowing what’s happening in the world today? Is your goal to get them to bookmark your site because you busted their guts with your witty prose? Shape your content accordingly not just how it reads but also how it appears. 3. Design your content. Provide visual clues about organization, intent, and content: Make subheadings smaller than headlines. In a heading for a pros-and-cons list, color â€Å"Pros† green and â€Å"Cons† red. On a site about target shooting, replace the dots in a bullet list with images of real bullets, or, on a gardening site, swap little flowers in place of the dots. But don’t push it your subliminal messaging should be â€Å"See how useful/entertaining this site is?† not â€Å"See how clever I am?† 4. Think like a journalist. One of the principles of journalistic writing is presenting information in an inverted pyramid of vital to trivial, with who, what, when, where, and why (otherwise known as the 5 Ws) right up top. Tell readers what you want them to know, now, and save the background information and the additional details for later. 5. Translate print content. When you upload copy already published on paper, repurpose it for the Internet: Offer points of entry, tighten and divide complex sentences, break up long paragraphs, and cut extraneous content. 6. Be witty sparingly. As much as it hurts a fan of punning and alliteration to write this, leave your sense of humor at the door (then sneak it in later). Straightforward headlines make it onto search engines’ search returns and draw readers in; chucklesome wordplay doesn’t. Save the wacky stuff for after they’ve committed to remaining on your site. 7. Link. Link. Link. When building an argument or providing an example, instead of extensively repeating what has already been published online, insert a link to the source. Don’t fear losing visitors; you’ve followed the rest of my advice, so they’ll come back. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Freelance Writing category, check our popular posts, or choose a related post below:7 Types of Narrative Conflict"Certified" and "Certificated"5 Examples of Insufficient Hyphenation

Price Discrimination in Health Care Essays

Price Discrimination in Health Care Essays Price Discrimination in Health Care Paper Price Discrimination in Health Care Paper Abstract The price of health care can vary dramatically depending on insurance coverage, and whether the care received was in network, out of network, government funded, or self-pay (Miller, 2012). Price discrimination is used by many industries such as airlines, hotels, and grocery stores with rewards for frequent users, or higher price for convenience or last minute reservations (Tiemstra, 2006). However, efficiency and fairness demand that new ways should be found to avoid price discrimination in health care in order to ensure patients equal access to care and economic justice. Uninsured or self-pay patients should not be charged rates significantly higher than those with Medicare, Medicaid, or insurance. Prices for health care should also be more transparent to allow patients to accurately shop for best prices and values in health care. Imagine a system in which you go to the grocery store and are told that the price you must pay for your groceries is dependent on whether you have a job, and if you have a job the price is dependent on where you work. If you are work for a certain employer the price you will pay is near wholesale, for another retail, another twenty to thirty percent more, and if self-employed or unemployed you must pay a price three to four times higher for these groceries. Unfortunately this is the way our current health system works. Most hospitals charge those without insurance three to four times the price of that paid by those with insurance or government coverage such as Medicare or Medicaid. New ways should be found to avoid price discrimination in health care in order to ensure patients equal access to care and economic justice. Uninsured or self-pay patients should not be charged rates significantly higher than those with Medicare, Medicaid, or insurance. Prices for health care should also be more transparent to allow patients to accurately shop for best prices and values in health care. Price discrimination Price discrimination is the practice of charging different customers different prices for the same product or service. While price discrimination is not necessarily unethical, the price should have commensurate value for the price charged. If this condition is met price discrimination is not necessarily wrong. It can be considered ethical for one to be given a better deal than another. However, if it is used to take advantage of those with a special need or the ignorance of customers it may be unethical. Under the Robinson-Patman Act 1936 it is unlawful when it substantially lessons competition or tends to create a monopoly. This has been cited in numerous lawsuits against hospitals and HMO’s. Because an uninsured person has limited resources to contest hospital rates class action attorneys have tried to obtain class action status for clients with limited success (Anderson, 2007). Many industries and firms utilize price discrimination because it can have a huge impact on company profits. It is much easier today because of improvements in technology to separate patients by demographic information to maximize the amount they are willing or able to pay (Elegido, 2009). Price discrimination is an attempt to get each consumer to pay for the product the highest price he is willing to pay. Price discrimination is common in industries that have high fixed costs and low marginal costs. Setting prices at the level of marginal costs would make it difficult to recover original investment costs. In order for price discrimination to occur there are several conditions that must exist. The producer must have information about what the maximum price of each group of consumers are or have reliable indicators of such. This information is obtained through prices for services set by government diagnosis related groupings for payment that set a near minimum price. The hospital then establishes a charge-master file that is several times more for each item. This may be updated several times a year and is not published for the public. There must not be significant competition from rival firms. For many consumers there are not multiple options for hospital care resulting in limited competition that might lesson cost. Arbitrage must not be possible. The buyer cannot resell the product for a higher price to others (Elegido, 2009). The uninsured or self-pay patient In a study published as a Web Exclusive by the journal Health Affairs, it was determined that approximately half of U. S. bankruptcies, were reportedly attributable to illness or medical bills (Anderson, 2007). It is estimated that three-fourths of these individuals were covered by insurance when they got sick. However, skimpier policies, rising health care costs, and the cancellation of coverage when illness results in job loss have increased the financial risk for those with insurance as well as the uninsured. When patients lose their insurance due to inability to work they become vulnerable to higher self-pay prices. While there are many uninsured that are unable or won’t pay their bills, hospitals pursue those that don’t pay with aggressive collections activities. Price discrimination in health care Hospitals do not charge every patient the same price. Uninsured and self-pay patients are often charged two and one half to four times as much for the same care as those covered by insurance or government plans such as Medicare or Medicaid. This gap has grown substantially since the mid 1980’s (Anderson, 2007). Patients that are uninsured or self-pay are often presented with bills that reflect full charges derived from the hospital’s charge-master file. There are five categories of patients that routinely receive undiscounted bills based on charge-master files created by each hospital. These include those that are international visitors, those that are uninsured, people covered by automobile insurers, people covered by workman’s compensation plans, and those covered by health plans that are lacking contracts with the hospital such as individuals that utilize health care savings accounts or are out of network. Equals should be treated equally in order to satisfy justice and should appropriately balance the gains of trade between buyer and seller with neither side having disproportionate power over the other (Tiemstra, 2006). If prices are directly related to costs and equal for all, the allocation of resources will be more efficient. The ratio of charges to costs measures the relationship between actual charges for services and Medicare allowable charges. In 2004 this ratio for U. S. hospitals was 3. 7 meaning that for every $100 in Medicare charges the average charge was $307. There is considerable variation in hospital charges depending on the type of hospital and the setting, rural or urban. The gross to net revenues overall averaged 2. 57 meaning that collected from all payers, for each $100 collected the initial charge was $257. Since 1984 the charge to cost ratio has increased from 1. 35 to 3. 07 and the gross to net revenues from 1. 25 to 2. 57 in 2004 (Anderson, 2007). Hospital charges have increased faster than costs. Increased charges have not been shown to significantly increase revenues however because as charges rise insurers negotiate for larger discounts and only self-pay patients are expected to pay these higher charges (Anderson, 2007). In Pennsylvania, hospitals collect only about one fourth of what they charge. These discounts are reflected on explanation of benefits forms from insurers. The only ones expected to pay the full charges are often those least able to pay them (Miller, 2012). There is evidence that discounts and price discrimination are making health care less affordable because fixed prices, discounts, and variable reimbursement systems distort normal marketplace competition. Patients and business are the losers as hospitals and health plans try to get bigger to â€Å"win† price negotiation. Insurance is discounted from the standard billed charge, Medicare and Medicaid pay flat rates and those without medical insurance pay the highest charges. When money spent is from somewhere else such as insurance or government coverage there is no incentive for hospitals or patients to control costs and may result in unnecessary medical costs for unneeded tests and procedures when insurance deductibles are met (Lilly, 2011). Cost shifting Cost shift policies in hospitals have resulted in shifting of costs to private patients due to inadequate payments from state and federal government plans such as Medicare and Medicaid. Cost shifting is also use to cover bad debts of unpaid hospital bills. Cost shifting acts like a tax on the costs of private pay patients. The burden of cost shifting falls on non-Medicare and non-Medicaid households in proportion to the sum of their out of pocket expenses and hospital premiums. The government does not assume costs of serving people that are ineligible for government programs but that are unable to pay their bills. They also do not cover common costs for research and teaching. Private pay patients subsidize public program beneficiaries through cost shifting. Because Medicare and Medicaid patients utilize socially valuable resources these costs must be borne by society. These costs may be covered implicitly through cost shifting by price discrimination or explicitly when government taxes are used to finance the full cost (Meyer Johnson, 1983). Hospitals obtain what revenues they can from insurers and those over whom they have little control such as Medicare and Medicaid. They then demand as much as possible from those over whom they have the most leverage. Over fifty percent of health care costs are paid by state and federal governments. This system results in lower incentives to be more efficient and contain costs. Charges for self-pay and uninsured patients are inflated to compensate for discounts given to insurers and low reimbursement rates of Medicare and Medicaid. Public program beneficiaries are subsidized by private pay patients (Lilly, 2011). Recommendations The commercial health industry has called for equitable payment rules for all patients including mandatory rate setting or doing away with rates by diagnosis and cost shifting in favor of transparency and the same rate no matter the payer source. One regulatory approach might be to have the government regulate prices so hospitals cannot charge more based on their type of insurance coverage. Maryland has done this and their hospital costs are lower than other states. However the regulation of prices removes incentives for hospitals to look for innovations to deliver care in a more cost effective way. Another option would be to establish maximum rates that can be charged to all payers for medical care. This may be set by the hospital voluntarily, be set by legislation, or have the rate determined by courts. A single rate would also decrease administrative and collection costs associated with multiple charge rates by payer type. Price transparency has been suggested as a tool to allow patients to comparison shop. Hospitals may increase transparency by limiting the price that can be charged above the Medicare rate. Hospitals could advertise their charge as being a certain percentage above the Medicare rate for comparison. Another approach would be systemic changes that let hospitals charge patients any price but all must be charged the same and prices must be made public. Instead of being restricted to in-network providers, patients could go anywhere but be able to make choices based on quality of care and pricing. Greater transparency in pricing and an ability to make informed decisions based on quality of care and price may allow patients to choose those hospitals that give quality care at lower costs. Transparency in pricing would encourage people to economize on the use of routine health services. These changes would make consumers more aware of and accountable for health decisions based on choice, limits, and patient responsibility (Miller, 2012). Health care reform is necessary and decreasing the use of price discrimination in health care pricing is just one component of those needed. Though the Affordable Care Act 2010 may increase the number of patients with insurance there still will be those that are uninsured. Price discrimination in health care should not be allowed. No patient should be charged more than another for the same service based solely on their payer source. References Anderson, G. F. (n. d. ). From soak the rich to soak the poor: Recent trends in hospital pricing. Health Affairs, 26(3), 780-789. Elegido, J. (2009). The ethics of price discrimination. In 2009 BEN-Africa Annual Conference (pp. 1-19). Accra, Ghana: GIMPA. Retrieved April 21, 2012, from benafrica. org/downloads/Elegido,%20Juan. pdf Geyman, M. D. , J. , Fegan M. D. , C. , Skala, N. (2005, February 2). Bankruptcy Study Highlights Need For National Health Insurance. Http://www. pnhp. org/facts/bankruptcy_study. php. Retrieved April 21, 2012, from pnhp. org/news/2005/february/bankruptcy_study_hig. php Lilly, J. (2011, June 16). Medicare reform; Its the price-fixing, stupid. Www. Americanthinker. com. Retrieved April 7, 2012, from www. americanthinker. com/articles Meyer, J. A. , Bruce, W. R. (1983). Cost shifting in health care: An economic analysis. Health Affairs, 2(2), 20-35. Miller, H. D. (2012, March 04). Price discrimination in health care. : Price Discrimination in Health Care. Retrieved May 04, 2012, from pittsburghfuture. blogspot. com/2012/03/price-discrimination-in-health-care. html