Health care for some: rights and rationing in the United States since 1930

Abstract

The 2010 Affordable Care Act (or Obamacare, as its detractors like to call it) is a sweeping reform to the US health care system. Despite the fact that nearly every other developed country in the world considers health care a right, the passage of the act in the United States was hard fought, due to a staunch and vocal opposition to universal health care among many American lawmakers. Why has the United States been so continually divided on this issue? In Health Care for Some, Beatrix Hoffman offers an explanation in the form of an engaging and in-depth look at America's long tradition of unequal access to health care. Hoffman argues that two main features have characterized the US health system: a refusal to adopt a right to care and a particularly American type of rationing. Health Care for Some shows that the haphazard way the US system allocates medical services - using income, race, region, insurance coverage, and many other factors - is a disorganized, illogical, and powerful form of rationing. And unlike rationing in most countries, which is intended to keep costs down, rationing in the United States has actually led to increased costs, resulting in the most expensive health care system in the world. While most histories of US health care emphasize failed policy reforms, Health Care for Some looks at the system from the ground up in order to examine how rationing is experienced by ordinary Americans - from soldiers' pregnant wives to survivors of Hurricane Katrina - and consequently reveals how experiences of rationing have led to claims for a right to health care. The story of the Affordable Care Act is still being written, and its ultimate success or failure has yet to be determined. To understand how we got here and what might be to come, you could have no better primer than Health Care for Some.