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Unmanageable CareAn Ethnography of Health Care Privatization in Puerto Rico$
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Jessica M. Mulligan

Print publication date: 2014

Print ISBN-13: 9780814724910

Published to NYU Press Scholarship Online: March 2016

DOI: 10.18574/nyu/9780814724910.001.0001

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New Consumer Citizens

New Consumer Citizens

Life Histories

(p.89) 3 New Consumer Citizens
Unmanageable Care

Jessica M. Mulligan

NYU Press

This chapter describes the life histories of particular citizen consumers who struggled to obtain care from the privatized health system under the MMA. It argues that the aspirations of neoliberal health policies never managed to transform patients into calculating, health-seeking consumers. The chapter offers four explanations for why this is so. First, compared to mainland U.S., market reforms came relatively late to Puerto Rico and the government had a larger symbolic and functional role in caring for the sick and poor. Second, the model of the decision-making consumer does not account for the moral and social criteria that people actually employ when making decisions about their health care. Third, the able-bodied, individualistic assumptions underwriting the notion of the health care consumer are out of place in describing how people react to and experience illness, disability, and dependency. Fourth, the “choices” that consumers can actually make regarding their care are quite limited.

Keywords:   citizen consumers, health care, privatized health system, MMA, neoliberal health policies, market reforms, Puerto Rico

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