The Privatization Of Care

Nursing homes are where some of the most vulnerable live and work. In too many homes, the conditions of work make it difficult to make care as good as it can be. For the last eight years an international team from Germany, Sweden, Norway, the UK, the US and Canada have been searching for promising practices that treat residents, families and staff with dignity and respect in ways that can also bring joy. While we did find ideas worth sharing, we also saw a disturbing trend toward privatization. Privatization is the process of moving away not only from public delivery and public payment for health services but also from a commitment to shared responsibility, democratic decision-making, and the idea that the public sector operates according to a logic of service to all. This book documents moves toward privatization in the six countries and their consequences for families, staff, residents, and, eventually, us all. None of the countries has escaped pressure from powerful forces in and outside government pushing for privatization in all its forms. However, the wide variations in the extent and nature of privatization indicate privatization is not inevitable and our research shows there are alternatives.

Markets, not politics, are driving health care reform in America today. Inventive entrepreneurs have transformed medicine over the past ten years, and no end to this period of rapid change is in sight. Consumer anxieties over managed care are mounting, and medical costs are again soaring. Meanwhile, the federal government remains mostly on the health policy sidelines, as it has since the collapse of the Clinton administration's campaign for health care reform. This book addresses the changes that the market has wrought- and the challenges this transformation poses for courts and regulators. The law that governs the medical marketplace is an incomplete, overlapping patchwork, conceived mainly without medical care specifically in mind. The ensuing confusion and incoherence are a central theme of this book. Fragmentation of health care lawmaking has foreclosed coordinated, system-wide policy responses, and lack of national consensus on many of the central questions in health care policy has translated into legal contradiction and bitter controversy. Written by leading commentators on American health law and policy, this book examines the widely-perceived failings of managed care and the law's relationship to them. Some of the contributors treat law as a cause of trouble; others emphasize the law's potential and limits as a corrective tool when the market disappoints. The first two chapters present contrasting overviews of how the doctrines and decision-makers that constitute health law work together, for better or worse, to constrain the medical marketplace. The next six chapters address particular market developments and regulatory dilemmas. These include the power of state versus federal government in the health sphere, conflict between insureres and patients and providers over medical need, financial rewards to physicians for frugal practice, the role of antitrust law in the organization of health care provision and financing, the future of public hospitals, and the place of investor-owned versus non-profit institutions. Acknowledging the health sphere's complexities, the authors seek remedies that fit this country's legal, political, and cultural constraints and can contribute to reasoned regulatory goverance. Within limits they believe a measure of rationality is possible.

An analysis of the transition from universal, publicly funded health care to New Labour s application of market principles: a national institution reaching crisis point and a key lesson for those concerned with health care everywhere.

The surge of privatization in Canada threatens the social security network that has been carefully built over the years. People are asking, "What will this mean for 'human' services in the future? Will the same service be forthcoming under privatized health care as that to which we have become accustomed under a publicly owned system?" These are some of the questions that Vera Ingrid Tarman examines in this timely new book. After carefully laying out the boundaries and the theoretical issues surrounding the private versus public debate, she then uses nursing homes in Ontario as a case study to illustrate the impact of privatization. A careful reading of this book will help us to understand what some of our most cherished institutions will look like under a profit oriented private system.

The book the American Prospect calls “an essential resource for future reformers on how not to govern,” by America’s leading defender of the public interest and a bestselling historian “An essential read for those who want to fight the assault on public goods and the commons.” —Naomi Klein A sweeping exposé of the ways in which private interests strip public goods of their power and diminish democracy, the hardcover edition of The Privatization of Everything elicited a wide spectrum of praise: Kirkus Reviews hailed it as “a strong, economics-based argument for restoring the boundaries between public goods and private gains,” Literary Hub featured the book on a Best Nonfiction list, calling it “a far-reaching, comprehensible, and necessary book,” and Publishers Weekly dubbed it a “persuasive takedown of the idea that the private sector knows best.” From Diane Ravitch (“an important new book about the dangers of privatization”) to Heather McGhee (“a well-researched call to action”), the rave reviews mirror the expansive nature of the book itself, covering the impact of privatization on every aspect of our lives, from water and trash collection to the justice system and the military. Cohen and Mikaelian also demonstrate how citizens can—and are—wresting back what is ours: A Montana city took back its water infrastructure after finding that they could do it better and cheaper. Colorado towns fought back well-funded campaigns to preserve telecom monopolies and hamstring public broadband. A motivated lawyer fought all the way to the Supreme Court after the state of Georgia erected privatized paywalls around its legal code. “Enlightening and sobering” (Rosanne Cash), The Privatization of Everything connects the dots across a wide range of issues and offers what Cash calls “a progressive voice with a firm eye on justice [that] can carefully parse out complex issues for those of us who take pride in citizenship.”

A transformation in American health care delivery and financing is taking place, led by the private sector. This transformation presents legal and regulatory questions that have received little scholarly attention. These issues receive critical attention in this work.

Privatization and the New Medical Pluralism is the first collection of its kind to explore the contemporary terrain of healthcare in Guatemala through reflective ethnography. This volume offers a nuanced portrait of the effects of healthcare privatization for indigenous Maya people, who have historically endured numerous disparities in health and healthcare access. The collection provides an updated understanding of medical pluralism, which concerns not only the tensions and exchanges between ethnomedicine and biomedicine that have historically shaped Maya people’s experiences of health, but also the multiple competing biomedical institutions that have emerged in a highly privatized, market-driven environment of care. The contributors examine the macro-structural and micro-level implications of the proliferation of non-governmental organizations, private fee-for-service clinics, and new pharmaceuticals against the backdrop of a deteriorating public health system. In this environment, health seekers encounter new challenges and opportunities, relationships between the public, private, and civil sectors transform, and new forms of inequality in access to healthcare abound. This volume connects these themes to critical studies of global and public health, exposing the strictures and apertures of healthcare privatization for marginalized populations in Guatemala.

An international look at the theory and practice of health service privatization. The book examines the restructuring of health care systems and argues that conflicts implicit in privatization will limit the extent to which any government can dismantle its health care services.

In Unmanageable Care, anthropologist Jessica M. Mulligan goes to work at an HMO and records what it's really like to manage care. Set at a health insurance company dubbed Acme, this book chronicles how the privatization of the health care system in Puerto Rico transformed the experience of accessing and providing care on the island. Through interviews and participant observation, the book explores the everyday contexts in which market reforms were enacted. It follows privatization into the compliance department of a managed care organization, through the visits of federal auditors to a health plan, and into the homes of health plan members who recount their experiences navigating the new managed care system. In the 1990s and early 2000s, policymakers in Puerto Rico sold off most of the island's public health facilities and enrolled the poor, elderly and disabled into for-profit managed care plans. These reforms were supposed to promote efficiency, cost-effectiveness, and high quality care. Despite the optimistic promises of market-based reforms, the system became more expensive, not more efficient; patients rarely behaved as the expected health-maximizing information processing consumers; and care became more chaotic and difficult to access. Citizens continued to look to the state to provide health services for the poor, disabled, and elderly. This book argues that pro-market reforms failed to deliver on many of their promises. The health care system in Puerto Rico was dramatically transformed, just not according to plan.

Disobedience : doctor workers unite! / Howard Waitzkin -- Becoming employees : the deprofessionalization and emerging social class position of health professionals / Matt Anderson -- The degradation of medical labor and the meaning of quality in health care / Gordon Schiff and Sarah Winch -- The political economy of health reform / David Himmelstein and Steffie Woolhandler -- The transformation of the medical industrial complex : financialization, the corporate sector, and monopoly capital / Matt Anderson and Robb Burlage -- The pharmaceutical industry in the context of contemporary capitalism / Joel Lexchin -- Obamacare : the neoliberal model comes home to roost in the United States, if we let it / Howard Waitzkin and Ida Hellander -- Austerity and health / Adam Gaffney and Carles Muntaner -- Imperialism's health component / Howard Waitzkin and Rebeca Jasso-Aguilar -- U.S. philanthrocapitalism and the global health agenda : the Rockefeller and Gates foundations, past and present / Anne-Emanuelle Birn and Judith Richter -- Resisting the imperial order and building an alternative future in medicine and public health / Rebeca Jasso-Aguilar and Howard Waitzkin -- The failure of Obamacare and a revision of the single payer proposal after a quarter century of struggle / Adam Gaffney, David Himmelstein, and Steffie Woolhandler -- Overcoming pathological normalcy : mental health challenges in the coming transformation / Carl Ratner -- Confronting the social and environmental determinants of health / Carles Muntaner and Rob Wallace -- Conclusion : moving beyond capitalism for our health / Adam Gaffney and Howard Waitzkin