Ungovernability as Market Rule
This concluding chapter argues that the privatization of the Medicare and Medicaid programs in Puerto Rico failed despite promising more efficient care management and expanded access to pharmaceuticals and specialists. Rather than producing a health system that was rational and easy to navigate, privatized managed care created new barriers to accessing care through eligibility requirements, enrollment processes, and administrative procedures. The chapter provides four reasons why privatized managed care failed to deliver. First, privatized for-profit managed care is far better at making and managing money than managing health (or people). Second, neoliberal health programs are based on asocial and ahistorical understandings of human subjects and behavior. Third, these programs are undermined by their own hubris. And lastly, in Puerto Rico, colonial relations of rule have contributed to the failures of managed care and the creation of a health system that is largely unmanageable.
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