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The U.S. healthcare system is in crisis, marked by soaring costs, inefficiencies, and stark disparities in health outcomes. Or at least, this is how U.S. policy makers have predominantly narrated and justified healthcare policy interventions since the 1970s. This dissertation examines how, starting in the 2010s, U.S. policymakers and politicians have turned towards data infrastructures – including new protocols and standards for exchanging clinical, billing, and administrative health data – as the newest site for reforming healthcare markets. Drawing on 24 months of multi-sited ethnographic research in the U.S. healthcare industry, I trace how federal regulations, particularly the 21st Century Cures Act (2016), position data interoperability, or standardized data sharing, as a means to realign a fragmented, profit-driven healthcare market with the efficient production of population health outcomes. I describe this mode of governance, which merges market-solutionism and techno-solutionism, as “computing care.” Through a close examination of “value-based care” policies, social determinants of health data, and the automation of prior authorization, I show how computing care helps to depoliticize the failures of for-profit healthcare markets to produce equitable, accessible, affordable care. The failures of healthcare markets are instead narrated by policymakers as technical problems - of insufficient information and sub-optimal market design. I argue that intensified computation and continually evolving capacities to collect, analyze, and store data help reproduce this depoliticized, market-solutionist mode of governance. Through this project, I interrogate the banal violence of computing care as a mode of governance and point towards the possibility of alternative modes of governance beyond market- and techno-solutionism. I also reflect specifically on the potential role of data infrastructures in advancing alternative modes of care governance. This project contributes to the fields of critical data studies, science and technology studies, and feminist political economy, highlighting the reconfigurations of data and governance necessary to achieve an equitable and just future of healthcare. 

Data interoperability—or standardized data sharing and use across organizational boundaries—is central to the production of value from big data. Using emerging health data regulations in the United States as a case study, this commentary demonstrates the importance of interoperability as a fulcrum in the governance of data-driven value production in the platform economy. Specifically, I explore how data governance of interoperability data governance: (1) is a foundational enabler of value production from data; (2) shapes processes of value production toward particular ends; and (3) intervenes in the accumulation of power through data. 

In crucial sectors like healthcare, education, and housing, policymakers are turning to the tools ofmarket designto incentivize public and private actors to more efficiently and effectively produce the public good. Although market design has been a key policymaking tool for decades, datafication is increasingly central to this technocratic tinkering. This article explores a project of datafied market redesign in the U.S. healthcare industry, demonstrating that emerging federal health data regulations are designed to enable the state to more precisely quantify, and thereby incentivize, the production of “valuable” care. This case study demonstrates how both the public good and crucial data infrastructures are constrained through their enactment within market-based modes of governance. As this data-solutionism for extractive markets becomes a more prevalent mode of governance—particularly in areas like climate change—we must find alternative mechanisms for collectively defining the public good, and for achieving corporate accountability beyond financial incentive structures. 

Abstract This article explores platform workers’ strategies for producing sustainable, quality services within platform structures that simultaneously over- and under-determine their work. We present findings from interviews with U.S.-based mental health professionals (n = 48) working on teletherapy platforms. These therapists describe navigating both the presence of platformic controls and the absence of features supporting professional best practices and regulatory requirements. We describe this absence as the “empty shell” characteristic of platforms and argue that it is a central technique through which platforms create scale. Our findings detail the communicative strategies therapists employ to navigate the empty shell and provide quality care to their clients. These strategies can be seen as a form of “articulation work,” a concept drawn from the sociology of work. Attending to articulation work in an emerging platform labor context, such as teletherapy, contributes to our understanding of the politics of platforms. 

Platform labor and gig work have become key sites for understanding a nascent future of work hallmarked by informalization and digitization. A growing body of research emphasizes how experiences of platform work are mediated not only by algorithms and user interfaces, but also by gender, race, local cultures as well as labor hierarchies. Drawing from ongoing ethnographic research on the digital transformation of healthcare, we show how therapists' experiences of platform labor are centrally shaped by the historical and ongoing feminization of mental health work. Platforms reinscribe feminized labor conditions that are pervasive in the healthcare industry, and yet platform labor appears as 'useful' to some therapists as they navigate a set of precarious career choices fundamentally structured by feminization. We use the analytic of the stopgap to describe platforms' two-fold reproduction of the status quo: first by offering an approximation of freedom to individual workers, helping to forestall a crisis of unsustainable work conditions; and second by reinscribing the same logics of exploitation in order to make labor scalable. This stopgap analytic reorients the focus away from the impact of the platforms technologies as such, towards the conditions that make stopgap solutions necessary for survival. It also points towards the importance of intervening in the conditions of exclusion and exploitation that help to create a market for platform stopgaps.