ABSTRACT
The story of health and healthcare in the United States has always been controversial and contradictory. The prime movers of US healthcare are corporate, while to the extent that government has become more heavily involved, it fails to form an effective counterweight to corporate agency. The US is generally taken as the ongoing neoliberal baseline, against which other health systems are compared. This chapter suggests that the US state has, indeed, gone further than other countries to foster market-led health but that, more recently, neoliberal growth has paradoxically involved stepped-up government intervention, enabling corporations as quasi-public actors. Corporate actors engage in ‘adaptive accumulation’, securing private revenue at the crossroads between public policy objectives, a disjointed health system, and government funding. The chapter begins by pointing to evolutionary moments that have laid the groundwork for public-private interactions in the contemporary era. It then explores component parts of US health delivery that exhibit attributes of adaptive accumulation, including the growing Medicare Advantage program; Medicare’s prescription drug program; and select attributes of the Affordable Care Act (ACA) – particularly its expansion and subsidization of the commercial insurance market. Finally, the chapter closes with a discussion of ACA-centered healthcare in post-Trump America.
