Private dilemmas of public provision: The formation of political demand for state entitlements to long-term care

In a political context unfavorable to welfare state expansion, commentators acknowledge that the United States is unlikely to extend public provision for newly-emergent social needs without significant public demand for state intervention. The convergence of several distinct social trends---aging populations, changing household structures and systems of health care provision, and shifting patterns of labor force participation---has resulted in a "crisis in care." Today, demand for care of the young, the old, and the infirm is growing while the supply of private care within the family is substantially contracting. But notably, despite the well-documented social risks associated with these trends, American families have demonstrated little inclination for translating their private care dilemmas into political demands for state intervention. Claims for new social entitlements do not emerge whole cloth in response to new social conditions, but are the product of shifting norms and beliefs about the interface between family, market, and state.;In this dissertation, I analyze the development of political consciousness among Americans caring for adult family members with chronic diseases. Drawing on a tripartite methodology involving nonparticipant observation, focus groups, and interviews, the dissertation traces how family caregivers navigate between traditional conceptions and new realities of family life, and how their experiences with caregiving shape their expectations for state intervention. I find that caregivers do develop interpretations of their care circumstances that challenge norms about care as exclusively a family responsibility, but the development of such oppositional understandings depends on a political logic that bridges their normative commitments to family care with an understanding of care as a public or social responsibility. Such a political logic is derived from experiences with existing social services and public policies, and yet the emergent claims for state intervention correspond with neither the structure of the existing American welfare state, nor the terms of contemporary political discourse. The novelty of these claims for state intervention, I argue, constrains the capacity of caregivers who do develop oppositional understandings of care provision to communicate their care needs as political demands for public policy reform.