Embracing Risk: The Changing Culture of Insurance and Responsibility (review)

A more precise, if less flashy, title for this collection might have been Responses to Moral Hazard. The problem of moral hazard, whereby "insurance actually increases the occurrence of adverse events through its incentives to people who have insurance" (52), has long been significant for economists and policymakers, but goes mostly unnoticed by historians and sociologists. These essays move moral hazard to the center of modern history, by presenting the numerous guises under which it has driven social and cultural practice. They explore this theme from at least three different perspectives: identifying how insurance institutions restrict people's choices and eligibility in order to minimize the impact of moral hazard; viewing such policing efforts alongside more positive norms that have accompanied the rise of insurance; and analyzing neoliberal attacks on social insurance, which often claim that the costs of moral hazard outweigh any possible benefits that come from spreading risk.

Many of the essays in this volume focus on insurance institutions' strategies for protecting themselves from moral hazard, such as restricting risk pools, gathering intelligence, and modifying human behavior. Using the concept of "governmentality," they make a strong case for the insidious extent to which insurers affect everyday life. Richard Ericson and Kevin Haggerty show how police officers spend more time pushing paper for the insurance industry than solving crimes, and Nikolas Rose argues that risk assessment in mental health services often has more to do with liability concerns than with assisting patients. Carol Heimer offers a more general version of this approach, presenting private insurers as "gatekeepers who can provide or withhold the calling card that gives people access to other goods and services" (118). Citing examples ranging from auto coverage to malpractice insurance, she convincingly argues that being deemed "uninsurable" in Western bureaucracies is the worst possible form of deviance.

A second set of essays insists that insurance has always had the potential, at least, to do more than play the role of Big Brother in a modern dystopia. Geoffrey Clark presents eighteenth-century England as the place where the genie of moral hazard was first let out of the bottle (in the form of wagering on inferior lives), but also where wishful thinkers tried to use insurance as a vehicle for solving wider social problems. Deborah Stone argues that insurance's egalitarian and "caring" components have survived into the present day as vital cultural resources. She presents a "two steps forward, one step back" view, whereby no amount of neoliberal backsliding will ever fully erode the public's commitment to basic universal rights (such as access to hospital treatment) that insurance originally made possible. In a fine essay on the changing discourses surrounding workers' compensation and global investment, Martha McCluskey tempers Stone's optimism by clearly linking the variable moral meanings of insurance to the divergent systems of distributive justice in which it is practiced.

A final group of essays focuses on the "recognition of the limits of risk spreading" that has marked much recent social policy and cultural practice (6). Jonathan Simon's impressionistic foray into the moral economy of mountain climbing makes the suggestive point that "extreme sports" fads indicate deeper cultural shifts toward "embracing risk." Pat O'Malley provides a schematic view of the rise of neoliberal perceptions of risk in his survey of British social policy from the 1850s to the present. In an essay entitled "the Social Construction of Responsibility," Tom Baker usefully recalls the two-faced nature of embracing risk, as both a luxury to be enjoyed by social elites and a necessity to be endured by society's most vulnerable members. Other contributors make this case more strongly. Heimer speaks of the impact of neoliberal policies as "more insurance for some, less for others" (117), and McCluskey refers to embracing risk as "embracing subordination" (164). [End...