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American Health Care Policy and Politics: Is Fragmentation a Helpful Category for Understanding Health Reform Experience and Prospects?

Theodore R. Marmor

in The Fragmentation of U.S. Health Care: Causes and Solutions

This chapter addresses the past four decades of American health care politics, asking whether the idea of fragmentation provides a central and helpful analytical perspective. Part I reviews the ... More

This chapter addresses the past four decades of American health care politics, asking whether the idea of fragmentation provides a central and helpful analytical perspective. Part I reviews the highlights of health policy disputes from the 1970s to the 2000s. Part II places the United States in comparative perspective. Part III discusses the regulation versus competition debate that has been such a dominant part of American medical care discussion since the 1970s. Part IV discusses the issues raised by efforts to reform Medicare, and questions whether the theme of fragmentation illuminates those policy disputes. Part V concludes that fragmentation refers to many disparate features of American medical care and politics, and is illuminating only when tied to specific institutions, internests, and ideas.Less

The Congressional Graveyard for Health Care Reform

Mark A. Peterson

in Healthy, Wealthy, and Fair: Health Care and the Good Society

This chapter argues that Congress may be called the graveyard of major health reforms. It begins by examining the institutional setting of U.S. governance in which Congress is embedded and highlights ... More

This chapter argues that Congress may be called the graveyard of major health reforms. It begins by examining the institutional setting of U.S. governance in which Congress is embedded and highlights the challenges this generally poses for large-scale policy making compared with of other countries. The chapter then examines the problem of coalition building in legislatures to illustrate the challenges and opportunities engendered by Congress in the twentieth century. It highlights the manner in which the system's institutional features and health-care politics have changed over time, creating different opportunities for coalition building, and then explains why those opportunities have been missed or ineffectively pursued. The chapter concludes with some ideas for enhancing future opportunities to enact universal coverage.Less

Repressed interests: explaining why patients and the public have little influence on healthcare policy: Alford's concepts of dominant, challenging and repressed interests

Stephen Peckham and Micky Willmott

in Shaping Health Policy: Case Study Methods and Analysis

Robert Alford used a case-study approach to determine why attempts at health care reform in New York in the 1970s often failed to resolve problems in the health system such as rising costs, staff ... More

Robert Alford used a case-study approach to determine why attempts at health care reform in New York in the 1970s often failed to resolve problems in the health system such as rising costs, staff shortages, poor outcomes and poor quality of care (1975, xi). His argument — set out in the book Health Care Politics: Ideological and Interest Group Barriers to Reform — was that embedded structural interests thwarted major reform. Alford identified three types of structural interests: dominant, challenging and repressed. His central argument has three broad elements, the first of which is that bureaucratic and market reforms of health care are likely ultimately to fail. This is due to their general failure to understand how embedded structural interests operate within health care systems. The second is that health policy is affected by an ongoing conflict between dominant and challenging interests. While in his example he shows ‘professional monopolisers’ as the dominant interest and ‘corporate rationalisers’ as the challenging interest, Alford was not prescriptive about this and foresaw that different interest groups may occupy these interests. However, his final point was that the community is normally the repressed interest, and that while both monopolisers and rationalisers may court and collaborate with groups representing these interests, this would be for the benefit of their own interests, too. This appears to be borne out in more recent UK-based studies.Less

A sick city in a sick country

David Baruffati, Mhairi Mackenzie, David Walsh, and Bruce Whyte

in Transforming Glasgow: Beyond the Post-Industrial City

The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow have become widely known. Drawing on a body of research compiled by the Glasgow Centre for Population ... More

The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow have become widely known. Drawing on a body of research compiled by the Glasgow Centre for Population Health, this chapter provides a detailed examination of the health profiles of these populations as they have been shaped over time. The chapter begins by tracing their historical development in their UK and European context, before turning to examine the political, social and economic causal factors and processes which have, over time, contributed to the particularly poor health outcomes experienced in Glasgow. Building on this knowledge, the chapter draws to a close by exploring the potential future health trajectory of the city’s population. Glasgow provides a potent case for other cities and countries as they consider the ways in which politics and policy come to shape health, and health inequalities, across their populations.Less

Markets and Metropolis

in Market Menagerie: Health and Development in Late Industrial States

This chapter examines the local and community institutions that influence technological development and markets for the pharmaceutical industry. It investigates the role of cities and localized ... More

This chapter examines the local and community institutions that influence technological development and markets for the pharmaceutical industry. It investigates the role of cities and localized production in the wider context of the distribution of medicines, changing global regulation, and knowledge production and national pressures for redistributive health politics. It also explores the political philosophies and local context that undergird market exchange and suggests that the regulation of production, delivery, and consumption influence the markets in distinct spatial, temporal, and historical ways.Less

African American Responses to Medical Discrimination Before 1966

Alondra Nelson

in Body and Soul: The Black Panther Party and the Fight against Medical Discrimination

This chapter gives an account of the history of African American health-focused activisms that led to the Black Panther Party’s health politics. It surveys significant moments of the long civil ... More

This chapter gives an account of the history of African American health-focused activisms that led to the Black Panther Party’s health politics. It surveys significant moments of the long civil rights movement that were mobilized in response to the forms of health inequality experienced by black communities, such as lack of access to healthcare resources; exclusion from whites-only hospitals; refusal of admission to professional schools, associations, and organizations; deficient or non-existent medical care; and deliberate neglect and medical abuse. The Black Panther was considered an heir to health activism, which directly reflected tactics drawn from the tradition of African American health politics.Less

“Carthage Must Be Destroyed”: Health, Housing, and the New Deal

Betty Livingston Adams

in Black Women's Christian Activism: Seeking Social Justice in a Northern Suburb

This chapter discusses black church women’s activism under the stress of the Great Depression and New Deal, social and economic dislocations that turned black housing and black bodies into contested ... More

This chapter discusses black church women’s activism under the stress of the Great Depression and New Deal, social and economic dislocations that turned black housing and black bodies into contested sites. In the politics of health and housing, white and black suburbanites appropriated New Deal language and formulated competing narratives of citizenship and rights: black residents conflated personal responsibility and government-directed structural intervention to make their claim for civil rights; white middle-class homeowners’ associations cast black residents as inimical to the suburb’s civic and economic security. Despite the popularity of taxpayer-funded National Housing Acts, anti-syphilis campaigns, and racial covenants and local zoning and health ordinances that reinforced the trope of the suburb as a white middle-class preserve, black women staved off imminent threats of racial cleansing and educated a new generation of women in the struggle for social justice.Less

The NHS in 1990

Ian Greener, Barbara E. Harrington, David J. Hunter, Russell Mannion, and Martin Powell

in Reforming healthcare: What's the evidence?

This chapter aims to provide the context for the rest of the book, exploring the NHS in 1990 in terms of its organisational structure and dynamics at that time. The chapter proceeds by presenting the ... More

This chapter aims to provide the context for the rest of the book, exploring the NHS in 1990 in terms of its organisational structure and dynamics at that time. The chapter proceeds by presenting the background to health organisation and policy in 1990 to provide a starting point for the account of subsequent reorganisations. It explores in more depth attempts at reorganisation during the 1980s in order to construct the ‘shared vision’ of health politics in the 1990s which provides the starting point, and context, for the book’s analysis.Less

Origins of Black Panther Party Health Activism

Alondra Nelson

in Body and Soul: The Black Panther Party and the Fight against Medical Discrimination

This chapter explores how and why the survival or “serve the people” programs came to play a central role in the Black Panther Party organization, focusing on factors that caused the evolution of the ... More

This chapter explores how and why the survival or “serve the people” programs came to play a central role in the Black Panther Party organization, focusing on factors that caused the evolution of the Black Panther’s health politics. The ideas of Ernesto “Che” Guevara, Mao Zedong, and Frantz Fanon provided a conceptual bridge between the Panther’s political philosophy, its community service ethos, and its health politics. The theorists’ influence is reflected in how the Party afforded an integral role to medicine in its imagination of a “robust” social body. Between January 1968 and December 1969, the Black Panther became subject to repressive police power, resulting to at least 28 murdered members.Less

The World Health Organization

Nitsan Chorev

in The World Health Organization between North and South

This book examines the nature of international health politics by focusing on how the World Health Organization (WHO) bureaucracy has responded to external demands in a way that satisfies the member ... More

This book examines the nature of international health politics by focusing on how the World Health Organization (WHO) bureaucracy has responded to external demands in a way that satisfies the member states making those demands while protecting the organization's material interests and core principles. More specifically, it discusses the WHO's strategic response to the New International Economic Order in the 1970s and early 1980s and, following a period of relative inaction, to neoliberalism in the late 1990s and early 2000s. For each period, the book identifies the exogenous demands and then analyzes the adaptive strategies used by the WHO secretariat in protecting the organization's goals. It shows that the WHO secretariat was able to reframe the content of the demands of member states to fit its own institutional culture.Less

Introduction: Diseases in American Public Life

Rachel Kahn Best

in Common Enemies: Disease Campaigns in America

For more than a century, disease campaigns have been the causes Americans ask their neighbors to donate to and the issues that inspire them to march and volunteer. Studies of social movements, ... More

For more than a century, disease campaigns have been the causes Americans ask their neighbors to donate to and the issues that inspire them to march and volunteer. Studies of social movements, interest groups, agenda setting, and social problems tend to focus on contentious politics and study one movement or organization at a time. But these approaches cannot reveal why disease campaigns are the battles Americans can agree to fight, why some diseases attract more attention than others, and how fighting one disease at a time changes charity and public policy. Understanding the causes and effects of disease campaigns, requires studying consensus politics and collecting data on fields of organizations over long time periods.Less

[Untitled]: Race and Health in the Post–Civil Rights Era

Alondra Nelson

in Body and Soul: The Black Panther Party and the Fight against Medical Discrimination

This chapter summarizes the scope of the Black Panther Party’s activism, considering its influence on how health inequality is historicized and theorized. It talks about the Black Panther’s health ... More

This chapter summarizes the scope of the Black Panther Party’s activism, considering its influence on how health inequality is historicized and theorized. It talks about the Black Panther’s health politics that emphasized the demands for healthcare access and liberation from “medical apartheid”, and describes how the Black Panther and their allies struggled to remedy the lack of access to medical services for members of marginalized groups by supplying basic preventive care at the People’s Free Medical Clinics (PFMC). The chapter concludes with a discussion of Black Panther’s health politics that suggests why today some African Americans still hold a complex and critical perspective that recognizes the particular vulnerability of blacks as patients and research subjects.Less

Publicity Over Prevention, Cures Over Care

Rachel Kahn Best

in Common Enemies: Disease Campaigns in America

Focusing on diseases shapes the types of goals advocacy organizations pursue and the types of laws Congress passes. Over time, the pressure to adopt goals that fit neatly within disease categories, ... More

Focusing on diseases shapes the types of goals advocacy organizations pursue and the types of laws Congress passes. Over time, the pressure to adopt goals that fit neatly within disease categories, corporate influence, and the strategic avoidance of controversy encouraged disease advocates to prioritize awareness and research over prevention and access to treatment. This creates a health policy portfolio that subsidizes corporate interests, ignores collective risks, fails to challenge inequalities, and may actually make people less healthy by encouraging overtreatment. Yet while only a small proportion of organizations focus on prevention and treatment access, the phenomenal growth of disease advocacy means that large numbers of organizations continue to pursue the latter goals. Narrow goals outnumber broader goals but do not displace them.Less

Conclusion

Kirsten Leng

in Sexual Politics and Feminist Science: Women Sexologists in Germany, 1900-1933

The Conclusion accounts for the fate of the women whose ideas are examined in this book, and takes stock of the legacies of their sexological work. It further lays out the benefits of pursuing a ... More

The Conclusion accounts for the fate of the women whose ideas are examined in this book, and takes stock of the legacies of their sexological work. It further lays out the benefits of pursuing a larger twentieth century history of women’s sexological work, one that is international in its scope and grapples with the rupture in female sexual knowledge production affected by the Second World War and its geopolitical realignments, the reshuffling of the ideological landscapes after 1945, and the rise of new social movements in the 1960s. Finally, the Conclusion argues that the history of women’s sexological work is especially significant at this particular moment in time, as twenty-first century feminist theorists positively embrace science and nature as intellectual and rhetorical resources once again.Less

Conclusion: Picking Fights

Rachel Kahn Best

in Common Enemies: Disease Campaigns in America

Disease campaigns reveal why private charity cannot replace political solutions to social problems. Private charity and voluntary campaigns favor narrow, corporate-friendly, and uncontroversial ... More

Disease campaigns reveal why private charity cannot replace political solutions to social problems. Private charity and voluntary campaigns favor narrow, corporate-friendly, and uncontroversial causes. Funneling vast sums of money to awareness campaigns and research into a few favored conditions is an inefficient way to promote collective health and well-being. But it would be incorrect to assume that disease campaigns use up time, resources, and empathy that would otherwise be devoted to solving other problems. Disease campaigns, while not an optimal target for charitable and political efforts, inspire outpourings of beneficence and can help train people to come together to solve social problems.Less