The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

The magical transformation contest in the ancient storytelling tradition

El concurso de transformación mágica, esquema narrativo difundido en la tradición popular, se presenta en dos variantes principales: los hechiceros que compiten pueden metamorfosearse en varios seres o crear esos seres por medios mágicos. En cualquier caso el concursante ganador da a luz criaturas más fuertes que superan las de su oponente. La segunda variante fue preferida en el antiguo Cercano Oriente (Sumeria, Egipto, Israel). La primera se puede encontrar en algunos mitos griegos sobre cambiadores de forma (por ejemplo, Zeus y Némesis). El mismo esquema narrativo puede haber influido en un episodio de la Novela de Alejandro (1.36-38), en el que Darío envía regalos simbólicos a Alejandro y los dos monarcas enemigos ofrecen contrastantes explicaciones de ellos. Esta historia griega racionaliza el concurso de cuento de hadas, transfiriendo las fantásticas hazañas de creaciones milagrosas a un plano secundario pero realista de metáfora lingüística.