New Books Network

Daniel Skinner

Medical Necessity

Health Care Access and the Politics of Decision Making

University of Minnesota Press 2019

New Books in American StudiesNew Books in MedicineNew Books in Peoples & PlacesNew Books in Political ScienceNew Books in PoliticsNew Books in Politics & SocietyNew Books in Public PolicyNew Books in Science & TechnologyNew Books Network February 24, 2020 Stephen Pimpare

The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients,...

The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In Medical Necessity: Health Care Access and the Politics of Decision Making (University of Minnesota Press, 2019), Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives.

From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity.

Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.


Stephen Pimpare is Senior Lecturer in the Politics & Society Program and Faculty Fellow at the Carsey School of Public Policy at the University of New Hampshire. He is the author of The New Victorians (New Press, 2004), A People’s History of Poverty in America (New Press, 2008), winner of the Michael Harrington Award, and Ghettos, Tramps and Welfare Queens: Down and Out on the Silver Screen (Oxford University Press, 2017).