"What Rights?" The Construction of Political Claims to American Health Care Entitlements

Despite a growing health care crisis, Americans remain reluctant to treat "health security" as a right or entitlement of citizenship. This article examines the effects of unmet health care needs on the beliefs that individuals hold about family, market, and state responsibility for health security. Drawing on a study of individuals caring for family members with chronic diseases, I find that when imagining solutions to unmet long-term care needs, individuals evaluate a range of alternative social arrangements, but they select the model that is most consistent with previously existing beliefs about family, market, and state responsibility for care provision. This process of discursive assimilation, of integrating new needs for public provision with more familiar ways of thinking about social welfare, produces claims for entitlements that challenge existing social arrangements but do so within a welfare state framework that conceives of only a minimal role for the state in safeguarding social welfare.