The uninsured and the politics of containment in U.S. health care

Abstract

State-provided health insurance has now spread throughout much of the industrialized world. The United States is a particular exception to this trend. The U.S. uninsured represents one-sixth of its population. The uninsured exemplify those on the margins of the U.S. health care system. Based on qualitative research with 215 chronically ill, uninsured ethnic minorities, I argue that the U.S. system fosters an organized approach of containment toward the uninsured that not only marginalizes them but it keeps the problem of the uninsured in check by discouraging people from using health care services. Respondents viewed the treatment they received as an assault on their dignity and experienced discrimination, depersonalization, and disenfranchisement. They avoided using the health care system whenever possible despite chronic, life-threatening illnesses. I conclude that the uninsured, as a problem of the state, lies at its very heart, with implications for the health and well-being of the uninsured as well as for the governmental systems that attempt to manage and contain them.