I have spent decades studying the American health care system. I was part of the drafting process that led to the Affordable Care Act, the landmark health care legislation enacted by President Obama in 2010. And I have been a professor at Harvard for years. From what I\u2019ve seen, all of those disparate problems trace their origins back to a single source \u2014 neoliberalism, the radical free-market revolution that transformed American society starting in the 1970s and 1980s. <\/p>\n
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The neoliberal ideas of figures such as economist Milton Friedman and President Ronald Reagan have gotten a bad rap on both the left and the right in recent years, and for good reason. Reagan\u2019s obsession with cutting taxes and repealing regulations encouraged laissez-faire policies that damaged families and communities, supercharged income and wealth inequalities, and wreaked havoc on the environment, just for starters.<\/p>\n
But while these outcomes have been recognized for years, neoliberalism\u2019s damage to our health care system has not been as well understood. <\/p>\n
The hallmarks of neoliberal excess, though, are all there: Elite players have reaped vast rewards through financial gamesmanship, stock manipulation, corporate takeovers, and political bribery. Huge megahospital systems (for-profit and nonprofit), vertically integrated insurers, pharmaceutical giants, and a dizzying array of invisible financial middlemen have come out on top \u2014 all resulting in the most expensive health care system in the world. <\/p>\n
I could write a book on all of neoliberal\u2019s disastrous effects on our collective health. And in fact I have: \u201cAmerica\u2019s Wrong Turn: US Healthcare in the Neoliberal Era.\u201d But here, I\u2019ll offer a brief on just three of them:<\/p>\n
Corporate consolidation. In his influential 1978 book \u201cThe Antitrust Paradox,\u201d neoliberal activist Robert Bork \u2014 best known for his later failed US Supreme Court nomination \u2014 called for abandoning nearly a century of US antitrust enforcement. Government, he argued, should greenlight any takeover or merger that resulted in lower prices for consumers. In 1982, the Reagan administration rewrote the nation\u2019s federal antitrust guidelines to implement his ideas.<\/p>\n
His views came to dominate health care, just as they did in many other sectors of the US economy. Today, roughly 90 percent of hospital markets<\/a>, 74 percent of health insurance markets<\/a>, and 65 percent of specialized physician markets<\/a> are categorized as \u201chighly concentrated\u201d according to one common measure of market concentration<\/a>. As antitrust expert Phil Longman told the news site Axios<\/a>: \u201cAmerica\u2019s health care crisis is brought to you by monopoly.\u201d This sort of concentration can now be seen in just about every corner of the health care industry. For example, more than 90 percent<\/a> of all US dialysis provider revenue goes to just two companies. <\/p>\n Private Equity. It\u2019s not just mergers. The neoliberal affinity for private equity has invaded medical care. Though private equity emerged in the 1990s, the sector mostly avoided health care until the 2000s. Since then, its penetration has been astonishing<\/a>: from $41.5 billion in activity in 2010 to $120 billion in 2019<\/a>, according to researchers at the American Antitrust Institute; the University of California, Berkeley; and the University of California, Los Angeles, with a total of $750 billion in investments over the course of that decade. Only recently have researchers documented the impacts<\/a>: higher prices, poorer quality, closed facilities, disempowered and discouraged workers.<\/p>\n Privatization. Neoliberalism\u2019s impact is also evident in the privatization of public goods. Medicare is the New Deal-era pillar that provides health insurance to 65 million seniors and persons with disabilities. But 55 percent of beneficiaries are enrolled in its privatized part, called Medicare Advantage. That program\u2019s principal \u201cadvantage\u201d accrues to vertically integrated private insurance giants such as UnitedHealth Group and Humana, which together enroll 46 percent<\/a> of all Medicare Advantage enrollees. <\/p>\n