One of the primary campaign promises of Donald Trump was to repeal Obamacare and replace it with something “better”. In his view, Obama “is a total failure.” Of course, Trump gave few details as to why it was supposedly a failure. This is not to say that there aren’t rightful criticisms to make of Obamacare. It is merely that such criticisms are not the focus of this work. We are here to discuss the how the differing views of health care fit into the competing interests in the capitalist United States. Capitalism as a whole is made up of competing interests, this is the whole basis of competition after all.

When it comes to health care, and other aspects of capitalist society, there are different forces intertwined which make up the whole. Insurance companies work with hospitals, hospitals work with medical device suppliers, and insurance companies work with the policyholders. All of these economic actors (to use economic terminology) are out for their own interests. This collection of interests competes with each other. The sum of the struggle of all these actors is what makes up the health care industry. For example, customers try to get the best rate possible, while insurance companies try to profit maximise on policies. This places them in a struggle against each other. The customer tries to get the best coverage possible while paying the least amount. The insurance company tries to cover as little as possible while charging as much as possible. This is a simple example, but it serves its purpose to help explain what comes next.

When the Affordable Care Act (a.k.a. Obamacare) was introduced it was met with great upheaval. Conservatives and Republicans literally screamed Naziism when the idea of making health care more affordable was presented. The website “Conservatives for Patient’s Rights” actually told people to go to town hall meetings and say that the Act “read like something out of 1930s Germany.” Of course, such a claim was utter nonsense. What it was, was an expression of a contradiction in the health care field. The battle over Obamacare, in general, was a manifestation of those contradictions.

Obamacare called for employers to contribute to employee private insurance plans. Insurance companies approved of this measure because it meant they would receive more money. Companies with many employees, like Wal-Mart, were opposed to it because they would have to pay. This was a great struggle in the halls of power to see who would win out in the end: the insurance companies, or other companies that would have to pay them. Both sides wield considerable influence in these halls of power and tried their hardest to push their interests in the struggle over public policy. In the end, Obamacare won out due to its popular public support.

Other aspects of the Act were in the favour of insurance companies and others as well. Public money was funnelled into paying for private health insurance, which was also welcomed by insurers. Companies that supply medical devices knew that more people with health care meant a greater demand for their products. This would, in turn, raise the profits of such companies. There were other opponents as well. Some opposed Obamacare on the basis that taxes may or may not have to be raised in order to cover the cost.

This struggle continues today with the introduction of Trumpcare. Aspects of Trumpcare are written to specifically benefit an elite within the insurance industry, and, the wealthy policyholder. The new policy would remove restrictions on insurance companies that placed caps on how much they could charge the elderly. (Under Obamacare they could not charge more than three times what a younger person was charged.) Another aspect of it would actually shift the lion’s share of the cost onto lower income individuals while leaving those much better off paying less. Finally, the measures involved a ‘death spiral’ which would shrink the number of companies that can be signed with. This diverts customers to a few large players in the insurance industry who can now dominate the market even further, ensuring greater profits.

From this, we can see that the battle over the ability to see a doctor is dominated by competing capitalist interests, rather than the desire to provide an essential service to the American people. Healthcare is dominated by capitalist interests, not the desires and varying opinions of what health care should look like in America. The debate is dominated by capitalist profits, not public wants and needs.