For the 2011 American Anthropological Association Annual Meeting, I chaired and helped organize a double panel entitled, Redefining Insurance, Redefining Governance: U.S. Health Insurance Reform in Global Perspective, with Sarah Horton and Julie Armin. Members of the Society for Medical Anthropology’s Critical Anthropology of Global Health Interest Group released a statement on Health Insurance Reform. As part of the CAGH interest group, I will be constructing a digital repository that will feature sources on global heath insurance reform. If you would like to submit a course, please contact me at firstname.lastname@example.org.
The Patient Protection and Affordability Act of 2010 was a landmark piece of health care legislation, aiming to increase the affordability of insurance premiums and thereby reduce the number of uninsured Americans. Taking what President Obama has described as a uniquely “American” approach to a national health insurance plan, the Act intends to approximate universal insurance through a continued reliance on employer-based insurance and the expansion of private insurance. Yet as the public debate has fixated primarily on whether the Act would erode the US’ long-standing employer-based system and whether its individual mandate is constitutional, a number of dimensions of the Act and its effects remain under-explored and thus ripe for anthropological analysis. Among these are the ideological assumptions that undergird the Act: its very specific formulations of “competition” and “choice,” its definition of “insurance” and “risk-pooling,” and its notions of individual, state and corporate responsibility. Moreover, despite the Act’s intention to make health insurance affordable for a broad range of Americans, its lack of emphasis on heavy state regulation and the strength of the health insurance lobby make its success an open question.
Even as the US has relied upon the expansion of private insurance as the linchpin of health care reform, nations in both the global North and South are restructuring their health insurance plans along similar lines. In the face of the mounting cost of caring for an aging population with chronic disease, industrialized nations are attempting to scale back benefits to reduce state costs. Meanwhile, developing nations are experimenting with hybrid forms of insurance—including the expansion of the reach of the state through comprehensive insurance programs while encouraging individual responsibility through conditional cash transfers. This global restructuring of health insurance amounts to no less than a worldwide reassessment of governance. As nations across the globe transform their health care systems, they are simultaneously redefining the responsibilities of the state, the private sector, and the individual in the process.
This panel takes a comparative approach to the analysis of transformations in health insurance plans worldwide. We begin with a theoretical discussion of what anthropologists can contribute to the study of health insurance and the way such analysis can illuminate transformations in governance and in ideas of “the social.” Then, taking up the PPACA as the panel’s foundation, we examine what it may mean for different sub-groups—such as Native Americans, the chronically ill, and undocumented immigrants –and for a variety of types of health care (such as mental health and complementary and alternative medicine). What does health care reform mean in practice to a variety of stakeholders—including patients and providers—and how expansive a definition of “health care” does it embrace? Finally, we place the PPACA in global context. We conclude with case studies of similar restructurings of governance in other nations—such as cash transfer programs in Mexico, Ecuador and Peru, and the transformation of universal insurance in Vietnam.