Healthy, Wealthy, and Wise: How Corporate Power Shaped the Affordable Care Act

Source: Kevin Young and Michael Schwartz, New Labor Forum, Vol. 23 no. 2, May 2014
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Among the many promises of Barack Obama’s 2008 election campaign was a thorough reform of U.S. healthcare. The radical inefficiency of the existing system was obvious: although per-capita healthcare costs were about twice as high as in other industrialized countries, at least forty-six million people still lacked health insurance and forty-five thousand died each year as a result.

The 2010 Patient Protection and Affordable Care Act (“Obamacare”) will not solve these problems. The reform does contain some positive elements, most notably its subsidies to low-income individuals, the extension of children’s insurance to age twenty-six (assuming their parents are already insured), and the ban on insurance companies denying coverage based on pre-existing conditions. But these improvements are embedded in a structure that preserves and consolidates a fundamentally flawed system administered by private insurance corporations and populated by virtually unregulated for-profit providers.

The crux of the reform is the “individual mandate” requiring everyone to purchase insurance from private companies or pay a fine, a model that is far removed from a system of genuine universal healthcare in which progressive taxation funds a government-administered, single-payer insurance plan. This latter option, often called “Medicare for All,” was never even considered by Congress or the administration, despite being far more efficient and humane than the alternatives. Even a non-compulsory government-run insurance program (the “public option”) was never seriously entertained in the Senate.

Here we analyze the healthcare reform as an illustration of the embeddedness of large corporations in U.S. policymaking. The affected industries were centrally involved in the process from the start, guaranteeing that their interests would receive priority, while public opinion and human rights considerations mattered little. The creation of Obamacare offers a lens through which to understand how and why the government embraces the class interests of the corporate elite. Yet the state is not just an instrument of domination; it is also a site of struggle. After reviewing the reform process, we offer some strategic propositions for the Medicare for All movement. …