Less is More: Understanding the Proclivities of Private Health Delivery

Health care systems throughout the advanced industrial worlds take varying public-private forms. In the overwhelming majority of cases, financing and purchasing of health care is sustained either through a universal purchaser or universally-mandated regulatory structure. As is well known, in the case of the United States, purchasing structures are routed, to a substantial degree, through private channels. While advocates insist that this arrangement affords the greatest degree of societal efficiency, one glaring and contradictory fact remains: huge segments of the American population lack health care coverage. The task of this paper is not merely to decry the gap in coverage which appears to accompany privatized forms of health insurance. Instead, it seeks to explain why and how privatized insurers are able to opt for segmental coverage of the population. In this, the paper will seek to position health purchasers within the broader class and consumption relations of American society, with an eye to illuminating selective coverage. To what degree, in other words, do the overall spending and consumption patterns of American society -- determined largely by class relations -- encourage providers to limit the purview of their coverage? The value of such research is that it potentially offers greater predictability of behaviour among health care insurers, once statutory incentives exist to expand coverage to wider segments of the US population.