Wayne O'Leary

Score Two for Wall Street

Things are going well these days in the United Corporate States of America. Within the space of a few days in late June, the Supreme Court saved the embattled Affordable Care Act (ACA) from a potentially fatal legal challenge, and Congress more or less guaranteed eventual enactment of the Trans-Pacific Partnership (TPP) by fast-tracking the massive trade agreement. It was Christmas six months early for the corporate sector.

Both developments, significant policy victories for the centrist Democrats of the Obama administration, were engineered by Republicans, so we now know what bipartisanship looks like. In the King v. Burwell case, it was GOP appointees Chief Justice John Roberts and Associate Justice Anthony Kennedy who split conservative ranks to support the president and provide the pro-ACA majority; in the passage of fast track, it was Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker John Boehner (R-Ohio) who rallied their troops and used congressional maneuvers to push the trade pact through over majority Democratic opposition.

The TPP is not quite a done deal; it must yet endure public scrutiny for 60 days (after years of secret negotiations) and wait several months for final passage -- albeit by a mere 51% majority, since fast-track precludes Senate filibusters. The pact can still be derailed in Congress, but only by an up-or-down vote with no amendments allowed. And its excruciating details must be finally ironed out to the mutual satisfaction of the 12 participating nations. Nevertheless, this train, as the saying goes, appears to be ready to leave the station.

The TPP, we are told, is important to President Obama's legacy, which seems in retrospect to have been a primary White House motivation; a significant president must "get big stuff done," irrespective of his party's concerns. In the American system, modern chief executives are essentially lone rangers. This is particularly true for Democratic presidents, who routinely throw their party under the bus, figuratively speaking, as Obama did with the TPP. Nor do Democratic presidents engage in party building; it's all about the imperial president and his place in history as he sees it.

President Obama, cheered on by corporate America and the mainstream media, thinks the TPP will enhance his stature, and that's really all that matters at this point. The president's Wall Street advisors have convinced him the TPP will eventually be beneficial. By the time it's proven otherwise, most people will have forgotten how it came into being, and the next president will be working on another bipartisan trade deal desired by the multinationals.

The Supreme Court's preservation of the ACA (for the second time since its inception) is at once different and the same as Congress’ fast-tracking of the TPP. It’s different in that Democrats, who mostly opposed the TPP, overwhelmingly supported the Court's health-care decision. But it's the same in that corporate America has been on board from the start, as it was with the trade deal.

Regardless of the questionable merits of the ACA or demands to improve it, the Democratic party's predominant attitude since passage of the health-care law has been to declare victory and move on: Been there, done that; mission accomplished. The irony, of course, is that the ACA is a Republican reform, partially designed by a conservative think tank and initially previewed by a GOP governor of Massachusetts (Mitt Romney) prior to its adoption by the Obama administration in 2009.

That, in a nutshell, is why Chief Justice Roberts, a pragmatic corporate conservative, was willing to desert his more ideologically inflexible right-wing colleagues (Scalia, Alito, and Thomas) to ensure the ACA's continued survival, as he did in 2012. Here's his rationale for joining the 6-3 majority in upholding the law: “Congress passed the Affordable Care Act to improve health insurance markets [my italics], not to destroy them.”

The key word is “markets.” Roberts is intelligent enough to know the ACA is a triumph for mainstream business conservatism, because it enshrines market-based corporate health care rather than introducing “government-run” health care in the form of, say, a single-payer system. He not only voted to uphold the market principle, he wrote the majority opinion.

If there’s any lingering doubt that the ACA primarily benefits corporate America, consider that health-care stocks rose sharply in the wake of the favorable Supreme Court ruling. Humana went up 7%, HCA Holdings (Hospital Corp. of America) 9%, and Tenet Healthcare 12%. Meanwhile, mergers among medical insurers and hospitals, aimed at cutting costs and increasing profits within the ACA framework, are being consummated rapidly. Consolidation is expected to shortly reduce the nation's five largest health insurers to three: Anthem, Aetna, and UnitedHealth Group. Large hospital chains, seeking economies of scale and competitive advantage, are following suit, with little objection from efficiency-minded federal regulators.

The future effect on health-care consumers is predictable; a 2007 Nevada merger involving insurer UnitedHealth produced, according to an academic study cited by the New York Times, a 14% increase in annual premiums. The arrival of Obamacare has not changed things in this respect. Indications are that insurers on the federal health-insurance exchange will seek premium increases of 15 to 25 percent in 2016.

Despite a wave of self-congratulatory commentary among ACA supporters -- the law has, indeed, reduced the number of uninsured Americans by perhaps a third -- we are nowhere near universal health coverage under Obamacare. And many who found the Affordable Care Act unaffordable, subsidies notwithstanding, have dropped out, including one-fifth of those who initially signed up in 2014. Even assuming modest progress in extending coverage, the ACA has only replaced uninsurance with what's been called “under-insurance,” a tradeoff made inevitable by a health reform designed to preserve the hegemony of the private medical establishment’s so-called stakeholders.

Obamacare's real impact was evaluated in the July issue of Harper’s in a scathing report by respected health analyst Trudy Lieberman, a contributing editor at the Columbia Journalism Review. Lieberman’s indictment details the ACA's role in accelerating American health care's full conversion into a corporatized, market-driven system marked by patients (consumers) forced to become bargain-hunting shoppers in search of the best insurance deal, while assuming an increased share of the system's costs themselves. Thus, the proliferation of high-deductible (catastrophic) health plans, limited provider networks, rising copayments, and expanding coinsurance schemes.

Lieberman calls this the Great Cost Shift, and it couldn't make corporate interests happier. Yes, more Americans are insured than before health reform; the question is, What kind of insurance and for whose ultimate benefit?

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, September 1, 2015


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