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Author ORCID Identifier


Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

David Kotz

Second Advisor

Katherine Moos

Third Advisor

Dean Robinson


The U.S. economy has undergone dramatic restructuring since the 1970s. These structural changes have had profound implications for every sector of U.S. society, but their effects on the development of U.S. healthcare policy have not yet received adequate theoretical or empirical attention. My dissertation addresses this gap with a specific focus on the development of neoliberal capitalism. Using Social Structure of Accumulation (SSA) theory, I analyze three important cases of U.S. healthcare legislation: the establishment of the Medicare and Medicaid programs in 1965, the failed Clinton Health Security Act of 1994, and the recent Patient Protection and Affordable Care Act (ACA) of 2010. I argue that these reforms must be understood in relation to its contemporary SSA—the set of dominant institutions and ideas that facilitates capitalist accumulation. I show how in each period, the structures of the proposed policies, as well as their support, opposition, and ultimate legislative outcomes, all reflect the concurrent restructuring of U.S. capitalism. Chapter 1 offers an overview of the unique developments in U.S. healthcare. Chapter 2 categorizes and evaluates the existing literature on U.S. healthcare development and outlines the contributions of this dissertation. Chapter 3 presents a theoretical overview of social structure of accumulation theory and the concept of neoliberal capitalism. Chapter 4 analyzes the 1965 Amendments to the Social Security Act, which established the programs of Medicare and Medicaid and passed at the height of regulated capitalism. Chapter 5 analyzes the attempted Clinton healthcare reforms that occurred in the 1990s, when neoliberal capitalism was well entrenched. Chapter 6 analyzes the passage of the ACA, which was precipitated by the 2008 financial crisis, when neoliberal capitalism’s institutions and dominant ideology were under threat. I analyze the ways in which this crisis facilitated the passage of the ACA, a healthcare reform with features significantly more statist than those that were blocked in the 1990s. This analysis of the interplay of neoliberal capitalism and the U.S. healthcare sector fills a gap in the existing literature on when and how the U.S. healthcare system is able to resist change.


Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.