Reproducing Race by Khiara M. Bridges

Author:Khiara M. Bridges
Language: eng
Format: epub
Publisher: University of California Press
Published: 2012-01-22T16:00:00+00:00

MAKING THE “ALPHA PATIENT POPULATION”

The program of prenatal care provided to persons receiving Medicaid coverage of their prenatal health care expenses exists, in all of its specificity, prior to its implementation on any individual body. That is to say, the physicians, epidemiologists, and legislators who are the program’s authors designed it for a woman who was only imaginary when the program was conceived; the embodied women to whom the program is presently provided are inheritors of a course of treatment that is suited to satisfy not their particular needs, but rather their generically anticipated needs. The fact that an elaborate apparatus of quantifications, examinations, screenings, and preventive efforts was erected for a theoretical, disembodied subject does not necessarily threaten the ability of the apparatus to successfully deal with material women’s actual needs, but what is required is a high degree of similarity between the imagined woman and her embodied heir. When we consider that the architects of the prenatal course of treatment knew only that the women for whom they designed the program were 1) uninsured, 2) pregnant, and 3) sufficiently impoverished such that their incomes did not exceed the limitations set for Medicaid, we might be skeptical about the likelihood of similarity between the hypothesized subject and her actual successors. Accordingly, the program of prenatal care for Medicaid recipients may say relatively little about the needs of the women who have come to compose the “Alpha patient population,” yet speak volumes about what the authors of the program believe about poor, uninsured, pregnant women. In essence, one can understand the course of prenatal care provided by Alpha Hospital as a representation of the poor, uninsured pregnant woman through the eyes of the persons and institutions empowered to construct programs to suit her needs.

Moreover, although Alpha providers, administrators, and staff members use “Alpha patient population” as if the term is self-evident and determinate, there nevertheless is great indeterminacy in the phrase. Although “Alpha patient population” refers to the considerable numbers of actual women who bring themselves within the physical space of the clinic to receive prenatal and postpartum care, it also refers to women who have never set foot within the hospital, women who are not presently pregnant, and even women who may not yet be born. Indeed, like the imaginary woman for whom the Medicaid architects designed the prenatal care program, there is a certain, disembodied, hypothetical and imagined quality to “Alpha patient population.” The parlor trick of the Medicaid apparatus is that, however the specific constellation of the “Alpha patient population” may be in any particular moment, it is always already anticipated with an elaborate apparatus specifically “designed” to meet its needs.

The most salient characteristic of the course of medical treatment designed for the “Alpha patient population” is its excess: a distortion of the prenatal care program offered to women with private insurance is provided to Medicaid-insured patients insofar as certain aspects of the private program are distended and bloated (such as the screenings provided for sexually transmitted

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