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Abstract
The extraordinary growth of healthcare spending in the United States necessitates an incremental model of institutional change. Efforts to reduce social spending in the 1980s introduced strict cost controls on healthcare, yet this regulation was annually abated with temporary legislation known as ‘doc fixes’. We show that the institutions set up to control spending were slowly undermined through three mechanisms: the transformation of wider political and economic problems into technical ones, the ‘layering’ effect of repeated budgetary appropriations, and the moral arguments that sustained incremental spending growth. This case illustrates how creative responses to budget constraints may produce incremental change, driven by ideas about how markets and welfare should work.
Acknowledgements
We thank Nikkolette Lee for research assistance and Rebecca Emigh, Luca Storti and Ho-Fung Hung for feedback on previous drafts of this paper.
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No potential conflict of interest was reported by the author(s).
Notes
1 See, for example, Committee on the Budget, Republican Caucus (Citation2005, p. 1); US Congress (Citation2007f, p. H16849, pp. H16852-H16854); US Congress (Citation2008b, p. H86520); US Congress (Citation2009a, p. S13357); US Congress (Citation2009b, p. S13417, pp. S13437-S13438); US Congress (Citation2011b, p. H8806); US Congress (Citation2012, p. H5581); US Congress (Citation2013, p. H7554-H7555); US Congress (Citation2014a, pp. H2716-H2718); US Congress (Citation2014b, pp. S1844-S1847).
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Notes on contributors
Armando Lara-Millán
Armando Lara-Millán is an Associate Professor in the Department of Sociology at UC-Berkeley and a former Robert Wood Johnson Foundation Fellow. He is a faculty affiliate of UC-Berkeley’s Center for the Study of Law and Society and the Berkeley Economy and Society Initiative.
Emily H. Ruppel
Emily H. Ruppel is a PhD candidate in sociology at UC-Berkeley. Her research addresses intersections between medical sociology, labour and gender/sexuality.