13. The Limits of the Neoliberal Paradigm? Health Care Politics and the Sexual Revolutions in the United States at a Time of Crisis (1970–1992)

The period of sexual liberation of the 1970s seemed to take place in the context of the start of a major global shift in political economy often associated with the term “neoliberalism.” Yet the relationship between sexual politics and neoliberal politics becomes rather more complicated when viewed through the lens of the American health care system. From the availability of understanding and properly trained specialists to the development of dedicated LGBTQ or women’s clinics, the history of the rights revolutions of the 1970s was as much about the economic reality of community formation as it was individual rights. The privatised nature of the US health care system was a constant and not a product of the late twentieth century, and the integration of sexual rights into mainstream politics required a consistent recognition of that reality. On the other hand, sexual minorities sought access after the 1970s to a welfare state designed from the start to exclude them, predicated on notions of a heteronormative family wage and gendered understandings of dependency. The HIV-AIDS crisis, in particular, placed enormous pressure on the nation’s ramshackle social safety net during the 1980s, as large numbers of people living with HIV either lost their jobs and private health insurance or had never had insurance and had to navigate the state welfare bureaucracy for the first time. In the realm of sexual politics, the boundaries between independence and dependency, private and public, capital and welfare, became ever more blurred, calling into question the utility of considering the 1980s as a turning point in political economy and the relationship between the state and capitalism.