Anthropologies of American Medicine

Winner, 2020 Eileen Basker Memorial Prize, given by the Society for Medical Anthropology The troubling dynamic of the American home care industry where increased independence for the elderly conflicts with the well being of caregivers Paid home care is one of the fastest growing occupations in the United States, and millions of Americans rely on these workers to help them remain at home as they grow older. However, the industry is rife with contradictions. The United States spends a fortune on medical care, yet devotes comparatively few resources on improving wages, thus placing home care providers in the ranks of the working poor. As a result, the work that enables some older Americans to live independently generates profound social inequalities. Inequalities of Aging explores the ways in which these inequalities play out on the ground as workers, who are disproportionately women of color and immigrants, earn poverty-level wages and often struggle to provide for themselves and their families. The ethnographic narrative reveals how two of the nation's most pressing concerns-rising social inequality and caring for an aging population-intersect to transform the lives of older adults, home care workers, and the world around them. The book takes readers inside the homes and offices of people connected to two Chicago area home care agencies serving low-income and affluent older adults, respectively. Through intimate portrayals of daily life, Elana D. Buch illustrates how diverse histories, care practices, and social policies overlap and contribute to social inequality. Illuminating the lived experience of both workers and their clients, Inequalities of Aging shows the different ways in which the idea of independence both connects and shapes the lives of the elderly and the working poor.

The Affordable Care Act's impact on coverage, access to care, and systematic exclusion in our health care system The Affordable Care Act set off an unprecedented wave of health insurance enrollment as the most sweeping overhaul of the U.S. health insurance system since 1965. In the years since its enactment, some 20 million uninsured Americans gained access to coverage. And yet, the law remained unpopular and politically vulnerable. While the ACA extended social protections to some groups, its implementation was troubled and the act itself created new forms of exclusion. Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status. Unequal Coverage documents the everyday experiences of individuals and families across the U.S. as they attempted to access coverage and care in the five years following the passage of the ACA.It argues that while the Affordable Care Act succeeded in expanding access to care, it did so unevenly, ultimately also generating inequality and stratification. The volume investigates the outcomes of the ACA in communities throughout the country and provides up-close, intimate portraits of individuals and groups trying to access and provide health care for both the newly insured and those who remain uncovered. The contributors use the ACA as a lens to examine more broadly how social welfare policies in a multiracial and multiethnic democracy purport to be inclusive while simultaneously embracing certain kinds of exclusions. Unequal Coverage concludes with an examination of the Affordable Care Act's uncertain legacy under the new Presidential administration and considers what the future may hold for the American health care system. The book illustrates lessons learned and reveals how the law became a flashpoint for battles over inequality, fairness, and the role of government. More books on the health care debate