...This introductory chapter explores the changes made to the national health care system of Puerto Rico as a result of the passing of the Medicare Modernization Act (MMA) in 2003—a legislation that extended the role of private contractors in the federal Medicare program. Specifically, the Act vastly...

...This concluding chapter argues that the privatization of the Medicare and Medicaid programs in Puerto Rico failed despite promising more efficient care management and expanded access to pharmaceuticals and specialists. Rather than producing a health system that was rational and easy to navigate...

...This chapter examines the role of quality measurement within market-based health policies. Quantifying quality is supposed to unite regulators, health plans, and health care consumers in a circuit of constant improvement. Additionally, the production of quality data is important in the Medicare...

... dissatisfaction through purchasing decisions like opting to join a higher-performing health plan or to visit a better-rated doctor. Members of private Medicare plans can and do complain but with more significant regulations in place for Medicare health plans that govern the receipt and processing of consumer...

...This chapter discusses the everyday nature of health regulation through audit, performance management, and corrective action in Puerto Rico. It sheds light on the unstable side of private enterprise by retelling the stories of former employees of Acme—one of the leading Medicare managed care...

...The chapter discusses how two market values—partnering and choice—were utilized in Puerto Rico's Medicare and Medicaid programs. It views these values as they were discussed in policy circles and then interrogates ethnographically whether those market values lived up to their promises. Partnering...