Health Care Movement:
From Social Equity to Free Market Competition
Jill Quadagno and J. Brandon McKelvey
Since the defeat of President Bill Clinton’s Health Security Plan in 1994, a myriad of social movement organizations have worked to transform the financing of medical services. The most ambitious plan, advocated by Physicians for a National Health Program, would abolish the private health insurance system entirely and replace it with a single-payer government plan (Physicians’ Working Group for Single-Payer National Health Insurance 2003; Geyman 2005). Fair Share, a more modest proposal sponsored by the AFL-CIO and promoted in the states, would force large employers to cover their employees or pay into a state fund for the uninsured (Abrams 2006). Although the Fair Share movement did win a victory in Maryland, the plan was overturned in the courts. Only the consumer-directed health care (CDHC) movement, a loose-knit coalition of insurance companies, banks, advocacy organizations and conservative politicians, has seen its policy recommendations adopted by several states and inserted into federal regulations. What is CDHC and how did CDCH principles emerge as the favored conservative solution for restructuring the health care system?
The central premise of the CDHC movement is that health insurance encourages wasteful consumption, because it shields patients from the actual cost of medical care. The result is an endless cycle of rising costs and reduced coverage. The solution is to make patients more cost conscious by forcing them to pay more out-of-pocket for medical services (Pauly 1968; Gladwell 2005). If patients are spending their own money, presumably they will shop more carefully and “purchase” only those services