The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Welfare Effort and Poverty from the Monetary and Capabilities Approach: A Cross-Country Analysis in Latin American and the Caribbean (1990-2010)

There is abundant empirical evidence on the negative relationship between welfare effort and poverty. However, poverty indicators traditionally used have been representative of the monetary approach, excluding its multidimensional reality from the analysis. Using three regression techniques for the period 1990-2010 and controlling for demographic and cyclical factors, this paper examines the relationship between social spending per capita —as the indicator of welfare effort— and poverty in up to 21 countries of the region. The proportion of the population with an income below its national basic basket of goods and services (PM1) and the proportion of population with an income below 50% of the median income per capita (PM2) were the two poverty indicators considered from the monetarist approach to measure poverty. From the capability approach the proportion of the population with food inadequacy (PC1) and the proportion of the population without access to improved water sources or sanitation facilities (PC2) were used. The fi ndings confi rm that social spending is actually useful to explain changes in poverty (PM1, PC1 and PC2), as there is a high negative and signifi cant correlation between the variables before and after controlling for demographic and cyclical factors. In two regression techniques, social spending per capita did not show a negative relationship with the PM2. Countries with greater welfare effort for the period 1990-2010 were not necessarily those with the lowest level of poverty. Ultimately social spending per capita was more useful to explain changes in poverty from the capability approach.

La recuperación mutua en personas con trastornos psicológicos o diversidad funcional a través de la práctica creativa

En el presente artículo introducimos el concepto de “recuperación mutua” y proponemos las prácticas creativas como herramientas eficientesde recuperación de personas tanto con problemas de salud mental como con algún tipo de diversidad funcional. Frente al concepto clásico de “arte-terapia” nosotros proponemos el concepto de “práctica creativa” como más compatible con el modelo de “recuperación mutua”. Para ello, en primer lugar realizamos un breve repaso crítico a la relación del arte con la locura. Seguidamente, presentamos los conceptos hermanos de “recuperación” y “recuperación mutua” en el marco de lo que se ha venido a denominar las “health humanities”. Para finalizar, describimos dos prácticas creativas que en la actualidad están siendo evaluadas en España en el contexto de un proyecto de investigacióninternacional en recuperación mutua: Los seminarios creativos con personas con trastorno mental grave en el Museo de Arte Contemporáneo de Sevilla y el grupo de teatro con personas con diversidad funcional de la Asociación Síndrome de Down-Sevilla