The public utility of healthcare across OECD countries enjoys substantial political support, save in one peculiar case: the United States. US healthcare, in this regard, has always been an outlier, infiltrated as it is with market actors in both the purchasing and provision components of health delivery. Typically, this has been explained through US political culture, with its heavy validation of individualism, deep suspicion of government and allergy to anything involving tax increases. At the same time, the actual costs of this reality have been heavily reported: absolute and per capita health care spending that far exceeds other countries. Ultimately, American citizens, when they have healthcare, pay far more for their healthcare and have relatively weaker health outcomes. Building on previous research, the proposed paper seeks to explore the degree to which this can be understood as a function of adaptive accumulation (Loeppky 2017). The latter entails corporate actors seeking out arenas of government intervention, in order to capitalize on the state’s organization (or even procurement) of market demand while also benefitting from the ideological cover of delivering a ‘public utility’. In the context of ongoing debates regarding the future of ‘Obamacare’, disparaging over the prospects for healthcare reform within American political culture seem fatalistic. On the other hand, assessing the strategies of adaptive accumulation throughout the US health industry may reveal far more about the unwieldy nature of US health delivery, as well as its exorbitant costs. More importantly, such an assessment potentially highlights the critical elements in need of restructuring, such that more efficacious and socially just policies might be reasonably conceivable, even reachable.
