Unmanageable Care

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.

Essays in Interactionist Sociology contains a selection of contributions, spanning five decades, that advance the theory, organization, and research of the interactionist tradition. Harvey A. Farberman, professor emeritus of social welfare policy at Stony Brook University, wrote the fourteen essays, twelve of which were published in academic journals or annuals and two that are original to this volume. Each one focuses on some aspect of the theory of symbolic interactionist sociology, the professional and organizational development of the interactionist perspective, or empirical studies inspired by the perspective. The author highlights the emergence of the perspective from the philosophy of American Pragmatism, paying particular attention to the contributions of Charles Sanders Peirce and William James. He also examines what may be called refractions of the perspective. The latter part of the book contains four studies. Personalization in Lower Class Consumer Interactions; A Criminogenic Market Structure: The Automobile Industry; Fantasy in Everyday Life: The Intersection of Social Psychology and Political Economy; and Family Caregiving to Elders in New York State. In many ways, the essays in this volume contribute to and reflect the development of interactionist sociology as it grew from an American innovation to a robust, international social science discipline.

A provocation to reclaim our disability lineage in order to profoundly reimagine the possibilities for our relationship to disability, kinship, and carework Disability is often described as a tragedy, a crisis, or an aberration, though 1 in 5 people worldwide have a disability. Why is this common human experience rendered exceptional? In All Our Families, disability studies scholar Jennifer Natalya Fink argues that this originates in our families. When we cut a disabled member out of the family story, disability remains a trauma as opposed to a shared and ordinary experience. This makes disability and its diagnosis traumatic and exceptional. Weaving together stories of members of her own family with sociohistorical research, Fink illustrates how the eradication of disabled people from family narratives is rooted in racist, misogynistic, and antisemitic sorting systems inherited from Nazis. By examining the rhetoric of genetic testing, she shows that a fear of disability begins before a child is even born and that a fear of disability is, fundamentally, a fear of care. Fink analyzes our racist and sexist care systems, exposing their inequities as a source of stigmatizing ableism. Inspired by queer and critical race theory, Fink calls for a lineage of disability: a reclamation of disability as a history, a culture, and an identity. Such a lineage offers a means of seeing disability in the context of a collective sense of belonging, as cause for celebration, and is a call for a radical reimagining of carework and kinship. All Our Families challenges us to re-lineate disability within the family as a means of repair toward a more inclusive and flexible structure of care and community.

The Routledge Handbook of Medical Anthropology provides a contemporary overview of the key themes in medical anthropology. In this exciting departure from conventional handbooks, compendia and encyclopedias, the three editors have written the core chapters of the volume, and in so doing, invite the reader to reflect on the ethnographic richness and theoretical contributions of research on the clinic and the field, bioscience and medical research, infectious and non-communicable diseases, biomedicine, complementary and alternative modalities, structural violence and vulnerability, gender and ageing, reproduction and sexuality. As a way of illustrating the themes, a rich variety of case studies are included, presented by over 60 authors from around the world, reflecting the diverse cultural contexts in which people experience health, illness, and healing. Each chapter and its case studies are introduced by a photograph, reflecting medical and visual anthropological responses to inequality and vulnerability. An indispensible reference in this fastest growing area of anthropological study, The Routledge Handbook of Medical Anthropology is a unique and innovative contribution to the field.

In Health in Ruins César Ernesto Abadía-Barrero chronicles the story of El Materno—Colombia’s oldest maternity and neonatal health center and teaching hospital—over several decades as it faced constant threats of government shutdown. Using team-based and collaborative ethnography to analyze the social life of neoliberal health policy, Abadía-Barrero details the everyday dynamics around teaching, learning, and working in health care before, during, and after privatization. He argues that health care privatization is not only about defunding public hospitals; it also ruins rich traditions of medical care by denying or destroying ways of practicing medicine that challenge Western medicine. Despite radical cuts in funding and a corrupt and malfunctioning privatized system, El Materno’s professors, staff, and students continued to find ways to provide innovative, high-quality, and noncommodified health care. By tracking the violences, conflicts, hopes, and uncertainties that characterized the struggles to keep El Materno open, Abadía-Barrero demonstrates that any study of medical care needs to be embedded in larger political histories.

How do we find sustainable and human ways to care for people with long-term needs? This book reveals the ways in which public services squander the potential of people with long term support needs and the creativity and caring capacity of front line workers. Drawing on the ethos, practices and economics of human focused initiatives such as Shared Lives, this book outlines a new model for public services to replace the ‘invisible asylum.’ This approach, focused on achieving and maintaining wellbeing, rather than on reacting to crisis or attempting to ‘fix’ people, would both ask of us and offer us more. Responsibilities, resources, and risks would be more fairly and transparently shared. The book offers steps which we all – citizens, front line services, and government – could take to achieve this vision.