Cliona Loughnane
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Governing healthcare
The case of Universal Health Insurance – by competition
in Reframing health and health policy in Ireland
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This chapter discusses how the trajectory of health policy in Ireland enabled the imagining of Universal Health Insurance by Competition (UHI-C). UHI-C represents both an emerging discourse for governing healthcare and a governmental technology-in-development. It also represents a particular moment in Irish health policymaking. The chapter argues that UHI-C was a rationality and technology of advanced liberal governing, masquerading in claims to social solidarity. Without UHI-C implemented in practice, the chapter uses existing policy documents to critique the proposal as an example of the rationality and technology of advanced liberal government developed by Nikolas Rose and Peter Miller. The chapter examines the UHI-C documents in terms of four elements of governing in an advanced liberal state. The four elements include seeking to govern at a distance; placing responsibility on individuals through choice; the management of risk; and the fragmentation of the social sphere into multiple communities.

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