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Conceiving Normalcy
Rhetoric, Law, and the Double Binds of Infertility
Elizabeth C. Britt
University of Alabama Press, 2001

This ground-breaking rhetorical analysis examines a 1987 Massachusetts law affecting infertility treatment and the cultural context that makes such a law possible

Elizabeth C. Britt uses a Massachusetts statute requiring insurance coverage for infertility as a lens through which the work of rhetoric in complex cultural processes can be better understood. Countering the commonsensical notion that mandatory insurance coverage functions primarily to relieve the problem of infertility, Britt argues instead that the coverage serves to expose its contours.

Britt finds that the mandate, operating as a technology of normalization, helps to identify the abnormal (the infertile) and to create procedures by which the abnormal can be subjected to reform. In its role in normalizing processes, the mandate is more successful when it sustains, rather than resolves, the distinction between the normal and the abnormal. This distinction is achieved in part by the rhetorical mechanism of the double bind. For the middle-class white women who are primarily served by the mandate, these double binds are created both by the desire for success, control, and order and by adherence to medical models that often frustrate these same desires. The resulting double binds help to create and sustain the tension between fertility and infertility, order and discontinuity, control and chaos, success and failure, tensions that are essential for the process of normalization to continue.

Britt uses extensive interviews with women undergoing fertility treatments to provide the foundation for her detailed analysis. While her study focuses on the example of infertility, it is also more broadly a commentary on the power of definition to frame experience, on the burdens and responsibilities of belonging to social collectives, and on the ability of rhetorical criticism to interrogate cultural formations.

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Exposed
Why Our Health Insurance Is Incomplete and What Can Be Done about It
Christopher T. Robertson
Harvard University Press, 2019

A sharp exposé of the roots of the cost-exposure consensus in American health care that shows how the next wave of reform can secure real access and efficiency.

The toxic battle over how to reshape American health care has overshadowed the underlying bipartisan agreement that health insurance coverage should be incomplete. Both Democrats and Republicans expect patients to bear a substantial portion of health care costs through deductibles, copayments, and coinsurance. In theory this strategy empowers patients to make cost-benefit tradeoffs, encourages thrift and efficiency in a system rife with waste, and defends against the moral hazard that can arise from insurance. But in fact, as Christopher T. Robertson reveals, this cost-exposure consensus keeps people from valuable care, causes widespread anxiety, and drives many patients and their families into bankruptcy and foreclosure.

Marshalling a decade of research, Exposed offers an alternative framework that takes us back to the core purpose of insurance: pooling resources to provide individuals access to care that would otherwise be unaffordable. Robertson shows how the cost-exposure consensus has changed the meaning and experience of health care and exchanged one form of moral hazard for another. He also provides avenues of reform. If cost exposure remains a primary strategy, physicians, hospitals, and other providers must be held legally responsible for communicating those costs to patients, and insurance companies should scale cost exposure to individuals’ ability to pay.

New and more promising models are on the horizon, if only we would let go our misguided embrace of incomplete insurance.

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Financing Medicaid
Federalism and the Growth of America's Health Care Safety Net
Shanna Rose
University of Michigan Press, 2013

Conventional wisdom holds that programs for the poor are vulnerable to instability and retrenchment. Medicaid, however, has grown into the nation’s largest intergovernmental grant program, accounting for nearly half of all federal funding to state and local governments. Medicaid’s generous open-ended federal matching grants have given governors a powerful incentive to mobilize on behalf of its maintenance and expansion, using methods ranging from lobbying and negotiation to creative financing mechanisms and waivers to maximize federal financial assistance. Perceiving federal retrenchment efforts as a threat to states’ finances, governors, through the powerful National Governors’ Association, have repeatedly worked together in bipartisan fashion to defend the program against cutbacks.

Financing Medicaid engagingly intertwines theory, historical narrative, and case studies, drawing on sources including archival materials from the National Governors’ Association and gubernatorial and presidential libraries, Centers for Medicare and Medicaid Services data, the Congressional Record, and interviews.

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Harry S. Truman versus the Medical Lobby
The Genesis of Medicare
Monte M. Poen
University of Missouri Press, 1996
“I have some bitter disappointments as President,” reflected Harry Truman after leaving office, “but the one that has troubled me the most in a personal way, has been the failure to defeat organized opposition to a national compulsory health-insurance program.”
 
Harry S. Truman versus the Medical Lobby by Monte M. Poen examines proposals for national health insurance from 1914 to 1965 focusing on Truman’s efforts during his presidency.
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Healthy Markets?
The New Competition in Medical Care
Mark A. Peterson, ed.
Duke University Press, 1999
When federal and state policy makers’ efforts to enact sweeping health care reform in the mid-1990s ended in stalemate, the private sector unleashed initiatives that have affected virtually every aspect of health care. With updated essays first published in issues of the Journal of Health Politics, Policy and Law, Healthy Markets? offers the most comprehensive and critical examination yet found in a single volume of the economic, political, and social implications of this recent market transformation of health care in the United States.
With original contributions from leading social science health policy analysts, this volume addresses the full context of health system change. Believing that the analysis of health care change is too important to be left to economists alone, Mark A. Peterson has collected a mulitdisciplinary group of experts who revisit the contentious debate over the market approaches to health care and consider the disparate effects of these approaches on cost, quality, and coverage of both managed care and Medicaid and Medicare. While market enthusiasts applaud the enhanced efficiency, reduced excess capacity, and abatement of the decades-long health care cost explosion, a backlash has emerged among many providers and the public against the perceived excesses of the market: diminished access to care, commercialization of the physician-patient relationship, and exacerbated inequality. Contributors assess these varied responses while examining the impact that market-based applications are likely to have for future health policy making, the significance of the U.S. experience for policy makers abroad, and the lessons that these changes might provide for thinking sensibly about the future of our health care system.
This volume will be useful for public policy analysts, economists, social scientists, health care providers and administrators, and others interested in the future—and in understanding the past—of American health care.

Contributors. Gary S. Belkin, Lawrence D. Brown, Robert G. Evans, Martin Gaynor, Paul B. Ginsburg, Marsha Gold, Theodore R. Marmor, Cathie Jo Martin, Jonathan B. Oberlander, Mark V. Pauly, Mark A. Peterson, Thomas Rice, Deborah A. Stone, William B. Vogt, Kenneth E. Thorpe

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Hospital Costs and Health Insurance
Martin Feldstein
Harvard University Press, 1981

The cost of hospital care has grown so rapidly in the past thirty years that it is threatening to bend our economy completely out of shape. A hospital bed that cost $16 per day in 1950 cost $214 per day by 1978—an increase of more than 1200 per cent! What is the cause of this fantastic inflation, which has been far higher than for any other major good or service? In this pathbreaking book, Martin Feldstein sets forth a novel explanation, provides empirical support for it, and suggests some remedies for the problem.

Feldstein demonstrates a complex relationship between the growing sophistication of hospital care, physician and patient demand, third-party insurance payments, and the tax treatment of insurance premiums. This last, he argues, is the key to the problem in that government policies stimulate the purchase of excessive insurance by a tax deduction and exclusion that cost the Treasury about $10 billion a year. To mitigate the increasingly severe burden of hospital costs, Feldstein recommends that this preferential tax treatment be ended. In its place, he proposes a new national health insurance plan that would give incentives to physicians and their patients to economize on costs and at the same time provide adequate coverage for major illnesses.

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Inquiries in the Economics of Aging
Edited by David A. Wise
University of Chicago Press, 1998
For over a decade, the National Bureau of Economic Research has sponsored the Economics of Aging Program, under the direction of David A. Wise. The program addresses issues that affect the well-being of individuals as they age and a society that is composed increasingly of older people.

Within the next twenty years, an unprecedented proportion of Americans will be over sixty-five. New research in the economics of aging is an essential element of understanding what the future holds for this aging population. Inquiries in the Economics of Aging presents both empirical papers that consider questions that are fundamental to public policy and more theoretical contributions that lay new groundwork for future research in the economics of aging.

Inquiries in the Economics of Aging provides a timely overview of some of the most important questions facing researchers on aging and outlines new techniques and models that may help to answer these questions. This important volume will be of great interest to specialists and policy makers as it paves the way for future analysis.

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Just Don't Get Sick
Access to Health Care in the Aftermath of Welfare Reform
Seccombe, Karen
Rutgers University Press, 2007
The ability to obtain health care is fundamental to the security, stability, and well-being of poor families. Government-sponsored programs provide temporary support, but as families leave welfare for work, they find themselves without access to coverage or care. The low-wage jobs that individuals in transition are typically able to secure provide few benefits yet often disqualify employees from receiving federal aid.

Drawing upon statistical data and in-depth interviews with over five hundred families in Oregon, Karen Seccombe and Kim Hoffman assess the ways in which welfare reform affects the well-being of adults and children who leave the program for work. We hear of asthmatic children whose uninsured but working mothers cannot obtain the preventive medicines to keep them well, and stories of pregnant women receiving little or no prenatal care who end up in emergency rooms with life-threatening conditions.

Representative of poor communities nationwide, the vivid stories recounted here illuminate the critical relationship between health insurance coverage and the ability to transition from welfare to work.
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The Lost Reform
The Campaign for Compulsory Health Insurance in the United States from 1932 to 1943
Daniel S. Hirshfield
Harvard University Press, 1970
One of the more important American reform movements during the thirties and one that was supported by members of the New Deal coalition was the futile struggle to enact federal legislation for compulsory health insurance. In this comprehensive historical account of the movement, the author outlines its strategy and tactics and traces the crucial episodes in its struggle. Daniel Hirshfield concludes that the nature of the movement, including its timing, tactics, leadership, and opponents, caused its failure—a failure which contrasts markedly with the success of other equally sweeping reforms.
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The Managed Care Blues and How to Cure Them
Walter A. Zelman and Robert A. Berenson
Georgetown University Press, 1998

Shattering the myths about what’s wrong with managed health care, this penetrating introduction to managed care explains its origins and identifies its real achievements and shortcomings.

Walter A. Zelman and Robert A. Berenson argue that many criticisms of managed care tend to idealize the costly and fragmented insurance system it supplanted, without pinpointing the true inadequacies of today’s managed care. In addition to providing reasoned answers to the most alarmist critiques of managed care, the authors maintain that it has not fulfilled its potential to improve the overall quality of care.

The authors propose thirteen concrete recommendations for raising quality in managed care programs, ranging from enacting additional legal protections and increased disclosure to putting the purchasing power in the hands of those who care most about quality — individuals, rather than employers.

With practical solutions for making managed care better, The Managed Care Blues and How to Cure Them is a bold call for greater consumer protection, knowledge, and power in the health care arena.

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Medical Care, Medical Costs
The Search for a Health Insurance Policy
Rashi Fein
Harvard University Press, 1986

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Reinsuring Health
Why More Middle-Class People Are Uninsured and What Government Can Do
Katherine Swartz
Russell Sage Foundation, 2006
America's current system of health insurance, which relies almost exclusively on employer-sponsored coverage, is in danger of collapse, and this problem is not limited to the poor and working class. An increasing number of middle class Americans do not have employer-provided insurance and—due to skyrocketing premiums—cannot afford to purchase coverage for themselves. Reinsuring Health, by economist Katherine Swartz, examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans. Reinsuring Health documents why the number of uninsured Americans—now 45.5 million people—has grown in the last twenty-five years. Swartz focuses on how labor market changes—such as the decline of domestic manufacturing, decreased unionization, and the growth of non-standard work arrangements—have led U.S. employers to retreat from providing health insurance for their workers. These trends, combined with the increasing costs of medical care, have led to an explosion in health insurance premiums and a decline in coverage, particularly among the middle-class. Since those who seek insurance as individuals are generally most likely to need health care, private insurers charge higher premiums in the individual (non-group) markets than to people who obtain group insurance. This makes individual health insurance less attractive to the young and increasingly unaffordable for middle-class Americans. Similarly, insurers charge higher per person (or per family) premiums to small firms than to large companies, so many small firms do not sponsor coverage for their employees. Reinsuring Health shows how these problems can be overcome if the federal government provides a new reinsurance program which would protect insurance companies that provide small group and individual health insurance against the possibility that their policy-holders will incur very high medical expenses. By assuming some of the risk that people will face extremely costly medical bills, the government will make insurers less hesitant to offer coverage to high-risk individuals, and will help drive down premiums for others. Reinsuring Health demonstrates that this form of government reinsurance has worked in the past, helping to establish smooth running private markets for catastrophe insurance and secondary mortgages. Today, growing numbers of middle class Americans lack health insurance. Protection against the possibility of falling ill or getting hurt and having to pay extraordinary health care bills should not be a luxury available only to the very rich and the very poor. Reinsuring Health proposes a straightforward solution that would bring health insurance back within the reach of the increasing ranks of the uninsured, particularly those who are in the middle class.
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Self-Interest and Universal Health Care
Why Well-Insured Americans Should Support Coverage for Everyone
Larry R. Churchill
Harvard University Press, 1994

“I’m covered—why should I foot the bill for somebody who isn’t?”

This question, unspoken but simmering at the center of the debate over universal health care coverage, comes in for a thoughtful hearing—and, perhaps, gentle corrective—in Larry Churchill’s timely book. Churchill, whose Rationing Health Care in America put the nation’s health care crisis into perspective, here does the same for our crisis of conscience over health care coverage. As Clinton and Congress spar over the financing and organization of a national health system, the true debate, this book reveals, is about moral and political values, about the meaning and ethics of health care reform.

Churchill begins by cutting through the confused discussion about rationing health care. Concerns about rationing, with all the moral and political questions they raise, deflect our attention from a more important issue, which this book brings into focus. Arguing that care is already rationed by ability to pay, Churchill suggests that the proper question is not whether to ration but how to do so fairly, and that answering requires a clear sense of the aims of a health care system. In pursuit of this necessary understanding, Churchill explores values and concepts such as security and solidarity, self-interest and social affinity, rights and responsibilities. Drawing on philosophical ideas of justice and individual responsibility, rendered here with remarkable clarity, he shows that universal care is morally as well as economically comprehensible and that a truly inclusive health care system should be seen as a common civic purpose rather than as a supply of services to be consumed. Accessible, deeply felt, and cogently argued, this book should revise the terms of the national debate over health care reform.

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Total Cure
The Antidote to the Health Care Crisis
Harold S. Luft
Harvard University Press, 2008

Proposals to reform the health care system typically focus on either increasing private insurance or expanding government-sponsored plans. Guaranteeing that everyone is insured, however, does not create a system with the quality of care patients want, the flexibility clinicians need, and the internal dynamics to continually improve the value of health care.

In Total Cure, Hal Luft presents a comprehensive new proposal, SecureChoice, which does all that while providing affordable health insurance for every American. SecureChoice is a plan that restructures payment for medical care, harnessing the flexibility and responsiveness of the market by aligning the incentives of clinicians, hospitals, and insurers with those of the patient. It uses the accountability of government to ensure transparency, competition, and equity.

SecureChoice has two major components. A universal pool covers the major risks of hospitalization and chronic illness, which account for almost two-thirds of all costs. Everyone would be in the pool, irrespective of employment, income, or health status. The second component emphasizes choice, flexibility, and responsibility. People will be able to choose any physician to serve as their “medical home,” to keep track of their health records, provide much of their care, and suggest referrals. Clinicians will have the information and incentives to continually enhance quality. SecureChoice also facilitates improvements in areas ranging from malpractice to pharmaceuticals and establishes new roles for key stakeholders such as health insurers.

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