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.

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.

Universal, comprehensive health care, equally available to all and disconnected from income and the ability to pay, was the goal of the founders of the National Health Service. This book, by one of the NHS's most eloquent and passionate defenders, tells the story of how that ideal has been progressively eroded, and how the clock is being turned back to pre-NHS days, when health care was a commodity, fully available only to those with money. How this has come about-to the point where even the shrinking core of free NHS hospital services is being handed over to private providers at the taxpayers' expense-is still not widely understood, hidden behind slogans like "care in the community," "diversity" and "local ownership." Allyson Pollock demystifies these terms, and in doing so presents a clear and powerful analysis of the transition from a comprehensive and universal service to New Labour's "mixed economy of health care," in which hospitals with foundation status, loosely supervised by an independent regulator, will be run on largely market principles. The NHS remains popular, Pollock argues, precisely because it created the "freedom from fear" that its founders promised, and because its integrated, non-commercial character meant low costs and good medical practice. Restoring these values in today's health service has become an urgent necessity, and this book will be a key resource for everyone wishing to to bring this about.

Introduction -- Key trade treaty rules and health safeguards -- Examing recent reports on health care reform -- Hazardous mixture : trade treaties and helath care reform proposals -- Towards healthy health care reform.

This book begins with the international context for health care reform and then moves from coast to coast, setting out what is known about the reforms in health care privatization that are underway and about their impact on women.

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.”

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.