The Dynamic Welfare State by Stoesz David;

Author:Stoesz, David;
Language: eng
Format: epub
Publisher: Oxford University Press, Incorporated
Published: 2016-05-15T00:00:00+00:00

CONCLUSION

MMA and ACA represented a fundamental shift in the American welfare state. As conceived by its originators, government would provide services to citizens; however, with the rise of corporate healthcare, an industry spawned by Medicare and Medicaid, commercial providers became the basis for medical care. As markets evolved in hospital management, nursing care, health insurance, HMOs, and hospice during the later decades of the twentieth century, trade associations were well positioned to shape subsequent healthcare policy. Thus, the pharmaceutical industry fashioned MMA to its benefit, and healthcare professionals, hospitals, and insurers crafted ACA similarly. The amount of money dedicated to healthcare reform was unprecedented, as was the number of lobbyists hired to influence members of Congress. These investments in social policy made by trade associations paid off handsomely: by 2014, fifty health corporations reported revenues at or above $1 billion, with many claiming employees in the tens of thousands. Management of such corporate colossi was well rewarded: CEOs typically received pay in excess of $1 million.

Whether or not this advanced the public’s health remained in dispute. Marcia Angell, an ardent critic of the commercialization of healthcare, noted, “instead of a social good, [ACA] has produced the most expensive, inequitable, and wasteful health system in the world.”53 Like MMA, ACA was constructed primarily according to the specifications of healthcare corporations, with citizens and taxpayers a secondary consideration.

Just as the medical-industrial complex was instrumental in healthcare reform, investors eyed other sectors that might be suitable for market conversion. Corrections, higher education, and financial services would prove viable in this respect, following the same policy script: companies established trade associations, which hired lobbyists, who trod the halls of Congress, convincing lawmakers of the value of their industry. While these industries proved adept at lobbying elected officials, public policy remained the province of lawmakers, elected officials who, at the federal and state levels, were constitutionally responsible for representing citizens in the legislature. If established interests could also influence who became an elected official, they would have further secured their control over social policy and therein the American welfare state. By the beginning of the twenty-first century, the convergence of private capital, evident in wealthy individuals and giant corporations, and politics, manifested in political action committees and “dark money,” empowered a plutocracy that was increasingly shaping public policy to its requirements.

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