Like Mao Tse-tung’s fabled Long March in the 1930s to solidify leadership of the Communist forces that ultimately took over China a decade later, corporate America is on an inexorable long march of its own. Its objective: the reorganization of the American healthcare system under a fully privatized, highly concentrated and corporatized umbrella based on profit making.
The process is under way right now, although most Americans are probably only dimly aware of it. This slow-motion transformation is highly ironic, given that our cousins, the British, are in the midst of celebrating the 75th anniversary of their socialized National Health Service (NHS), which is government-run, funded by taxes, and famously free at the point of delivery or use.
Such universal public systems as the UK’s (and Canada’s equally cherished single-payer program) are tantamount to national religions; those who fathered them, the British Labour Party’s Aneurin Bevan and the Canadian New Democratic Party’s T.C. “Tommy” Douglas, are civic heroes. (Douglas was chosen not long ago as most admired Canadian in an opinion poll evaluating historical figures.)
Both the UK and Canadian systems are admittedly in need of financial bolstering and organizational adjustments coming out of the economic trauma of the worldwide pandemic, as are all the developed world’s healthcare systems. Britain’s NHS has also suffered from a decade’s worth of budgetary austerity imposed by the ruling Conservative Party. Nevertheless, the populations that depend on these programs would never trade them for what we have: a patchwork quilt of dysfunctionality — and that’s before the change that’s coming makes things worse, as it most certainly will.
Corporate America wants to reorder our convoluted healthcare system, not by shifting it fully into the public sphere (where it belongs), but by making it a totally private market-based system that will be “business friendly.” Evidence of the looming change is all around us just over a decade after the Affordable Care Act (ACA) supposedly put the US on track to achieve universal coverage without systemic disruptions.
Most immediately noticeable is what’s happening to the Medicare program, which is well on its way to privatization, courtesy of the pro-corporate Medicare Advantage reforms wrought by successive administrations. (See “Medicare is Dying: Where are the Democrats?”, 1/1/23 TPP). But that’s only part of the story.
Healthcare in this country is now considered an “industry” worthy of inclusion in the annual Fortune 500 listing of the largest US corporations as measured by revenue, with 77 medically related firms included for fiscal 2021. The Forbes companion list of the world’s richest individuals for 2022 includes 33 American billionaires who’ve made their money in healthcare.
Much of that money is being made in the hospital sector, which for decades remained outside the grasp of corporate business. American hospitals have traditionally operated as independent nonprofits, or as state and local government entities serving their communities at cost. That’s rapidly changing; nearly a quarter (24%) of hospitals nationwide are now run by profit-making corporate chains like the aggressively acquisitive HCA Healthcare, compared to only 15% in 2001.
Worse, the largest nonprofits have begun emulating the for-profits, scooping up smaller regional hospitals and independent physicians’ practices in a frenzy of empire building; this creates highly concentrated, vertically integrated operations that increase costs through monopolistic pricing power, limit patient choices, and leave rural areas medically threadbare. Between 2010 and 2019, nearly 700 hospital mergers contributed to corporate consolidation, encouraged by such ACA mandates as the expensive changeover to electronic medical records that takeover targets could not afford.
Another expression of creeping corporatization has been the conversion of doctors from independent professionals to clinic-based employees of either the hospitals themselves or other corporate entities, such as health-insurance companies. From 2019 to 2022 alone, according to the Physicians Advocacy Institute, the percentage of doctors’ practices owned by hospitals or corporations increased from 39% to 54% of the total; no fewer than three-quarters of all US physicians are now salaried employees.
The foregoing changes are directly traceable to the Obama administration’s decision to pursue expanded health coverage by working hand-in-glove with private special interests to develop a healthcare plan (the market-oriented ACA) that would avoid the corporate resistance a single-payer or public-option reform would have engendered. The ACA passed, but at a cost that is only now becoming starkly apparent.
This must be belatedly evident even to President Biden, who’s based his health policy on reaching universal coverage incrementally via the ACA. In 2021, corporate America coalesced around his American Rescue Plan, which called for increased Obamacare marketplace subsidies directly beneficial to private insurers and private provider organizations. Having gotten that desired federal largesse (on top of the estimated $400 billion in annual Medicare Advantage subsidies insurers already get), corporate America is now asserting itself and expanding its control of healthcare.
Pharmaceutical giants Merck and Bristol Myers Squibb, along with drug-industry lobby PhRMA, are suing the federal government to invalidate negotiated Medicare drug pricing under the just-enacted Inflation Reduction Act. And the Biden administration has also run afoul of corporate medicine’s desire to use privatized Medicare Advantage to milk the overall Medicare system. Federal attempts to reign in rampant corporate fraud in the program have elicited a massive propaganda ad campaign and unleashed an army of corporate lobbyists in Washington.
Additionally, a New York Times exposé (5/9/23) has uncovered how corporate America is simultaneously moving to take over the nation’s primary-care practices, revealing the nature of our new medical-industrial complex. For example, CVS Health, a pharmaceutical company, now owns Aetna, a health-insurance firm, and a chain of primary-care centers. Corporate octopus Amazon now owns One Medical, a large doctors’ practice. UnitedHealth Group, an insurer, owns Optum, a health-plan administrator, which in turn owns a network of 70,000 doctors. Walgreen’s, the drug firm, owns Village MD, a primary-care group, and will shortly team with insurer Cigna to purchase another group practice.
So, has business “efficiency” lowered US medical costs? Hardly. American health spending as a percentage of GDP is still the world’s highest, and it’s higher than it was prior to the ACA. Meanwhile, doctors are discouraged — some, now corporate employees, are unionizing — and patients are being denied recommended procedures and needed drug therapies.
The creeping national experiment in corporatized healthcare is proving an expensive failure. It’s past time to end it.
Wayne O’Leary is a writer in Orono, Maine, specializing in political economy. He holds a doctorate in American history and is the author of two prizewinning books.
From The Progressive Populist, August 15, 2023
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