The Neoliberal Turn in American Health Care

By A.W. Gaffney for Jacobin

The failings of the Affordable Care Act are rooted in a long shift away from the idea of a truly universal health care.

Last year’s three-ring Congressional shutdown circus — for many little more than a desperate rearguard action by an isolated rightwing fringe to undo the fait accompli of Barack Obama’s health care reform — reinforced with each passing day the gaudy dysfunction of the American political system. But we miss something crucial if we construe the perseverance of Barack Obama’s 2010 Affordable Care Act (ACA) as nothing more than the overdue victory of commonsense health care reform over an irrelevant and intransigent right, or, even more, as the glorious culmination of a progressive dream for American universal health care long deferred.

For many commentators, though, this is precisely what the ACA represents. With the law’s passage in March 2010 and its survival in the face of a constitutional review by the Supreme Court, they have concluded that the battle “over universal health coverage,” as one writer for the Washington Post put it, “is basically over.” Unfortunately, the evidence does not permit such a sanguine conclusion.

Most plainly, when we consider the provisions and limitations of the law, it becomes clear that though it may help many, the ACA fails fundamentally to create what so many had hoped for: a system of universal health care. Leaving millions still uninsured and many more “underinsured” — a well-described and researched phenomenon in which the possession of health insurance still leaves individuals and families with dangerous financial liability when illness strikes — the ACA falls well short of the standard of universal health care as it is understood elsewhere in the social democratic world.

But more broadly, when we consider the ACA through the lens of political economy, an even more concerning narrative emerges, one that says even less about the triumph of social democracy and more about the sharp shift of the political center and the disintegration of the New Deal left. For the law fundamentally leaves intact a system of health care predicated, as we shall see, on key neoliberal health care beliefs, for instance the “moral hazard” of free care, the primacy of health consumerism, and the essentiality of the private health insurance industry.

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  1. Bill Todd on April 21, 2014 at 5:30 pm

    Really good article, though it’s far to forgiving of Obama for his proactive capitulation on single-payer before a single shot had been fired and his active subversion of the public option even while publicly still supporting it – all this despite the massive mandate he was given for ‘change we can believe in’ and ‘and end to business as usual’.

    It’s also a bit light on the strong economic reasons that favor single-payer over the current mish-mash, but the description of the rise of neoliberal attitudes toward this major element of American life and economy is very much worth reading.

  2. Ronald on April 21, 2014 at 7:09 pm

    Agree with Bill Todd. Well said! But again we will not get true universal care until we build a real movement for it independent of these silly capitulationist Democrats. My senior Senator, Sherrod Brown of Ohio has been hugely disappointing on the issue and in an email compared advocates for single-payer to the Tea Party Repealers. Brown was a few years ago all over the map on single-payer and co-sponsored it with Senator Sanders before ACA was voted on. Before that he was only for the “public option” and against single-payer. Now he will not even support a “public option.” I think the Single Payer Now in mailing post cards to Obama shows their hopeless desperation instead of a real movement.

  3. John Barker on April 25, 2014 at 2:23 pm

    Interesting information on Sherrod Brown and similar to the Senator I have supported, Tammy Baldwin, who once cosponsored HR676 now embraces ACA. Its a dilemma, just when you think you have voted for progressives to support the issues you favor you find that they were corporate lackies in sheep’s clothing. Retired Supreme Court Justice Stevens put it beautifully about money in politics, “Its not about your representative, its about financing the election of representatives of other people”