You know what to expect from the Affordable Care Act the moment you realize where it came from and who designed it.
In 2008, Sen. Max Baucus, D-Montana, chairman of the Senate Finance Committee, took the lead in drafting the ACA. The legislation was written in Baucus’ committee, and the senator liked to boast that the architect of the legislation was his chief health counsel, Liz Fowler. This was the second time that Elizabeth Fowler, Ph.D., J.D., had worked for Baucus on health care finance legislation.
In 2003, during her first stint in the Finance Committee, Fowler played a major role in the development of the Medicare Prescription Drug, Improvement and Modernization Act.
In 2006, Fowler left the Finance Committee to take the position of vice president of public policy and external affairs at WellPoint Inc., the nation’s largest health insurance corporation.
In 2008, Barack Obama was elected president on a campaign platform that promised sweeping health care reform, and that same year WellPoint Vice President Fowler returned to the Senate to work on health policy for Baucus.
During the health reform debate, Fowler was chief health counsel, and senior counsel to Baucus, and it was she who supervised the drafting of the Senate version of the ACA.
Two of Fowler’s greatest concerns were making sure that an individual mandate would be included in the ACA, and that a public option would not. The individual mandate became a centerpiece of the ACA, and in 2009 Baucus announced there would be no public option. President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010.
Just weeks after the signing, the Obama administration created the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. Its purpose was to implement the insurance market reforms in the ACA. The president appointed Fowler deputy director for policy at the OCIIO, which put her in charge of carrying out the insurance market provisions in the Affordable Care Act.
Shortly after that, Fowler was promoted to special assistant to the president for health care and economic policy at the National Economic Council. The NEC coordinates domestic and international economic advice and policy for the administration.
Before she resigned from that position, the Obama administration cut a deal with the pharmaceutical industry’s lobby arm, the Pharmaceutical Research and Manufacturers of America, to limit the government’s ability to negotiate for cheaper drug prices. That made Big Pharma the biggest winner in the ACA.
Then, in December of 2012, Fowler once again stepped through the revolving door and became vice president for global health policy in the government affairs and policy group of the pharmaceutical giant Johnson & Johnson.
The ACA was conceived, designed and implemented by America’s insurance industry. It is the direct result of a blatant merger of corporate and state power. The role of the state has undergone a fundamental change.
Instead of putting the interests of its citizens first, the U.S. government has become the primary broker for the health insurance industry. Federal law now compels every citizen to purchase private health insurance at whatever price the industry sets, and to buy those policies on insurance exchanges whose administrative expenses are paid for with our tax money.
What should we expect when the ACA is fully implemented? More of the same, but worse. Why? Because the financial interests of our private insurance industry are aligned exactly opposite to the medical interests of our families.
Insurance companies increase their profits not by improving the health of their policy holders, but by eliminating benefits, restricting treatments, limiting doctor’s options, shifting costs to patients, and delaying or denying payment to providers. And now, the full weight and might of the federal government exacerbates the contradiction between the interests of the industry and the interests of our families.
The Affordable Care Act is not affordable, and it does not improve care. Americans will still pay the highest health care costs, and will still get the worst health outcomes, of any industrialized nation on earth. That’s because we are the only nation that persists in putting the interests of our insurance industry before the interests of our families. The ACA enshrines that inequity in law.
It’s time for the people of the United States to choose a totally different model for financing their health care — one without sales commissions, profits, dividends, CEO salaries, multimillion dollar bonuses, expensive perks and mountains of unnecessary paperwork. An expanded and improved Medicare for all would be an excellent choice.
Bob Fischer of Bandon is a retired professor of sociology at California State University.
