ENDING SURPRISE HEALTH CARE BILLING COSTS LOTS OF MONEY

The 2020 No Surprises Act set up an arbitration process so patients didn’t get huge surprise medical bills. The result was profits for corporate capitalists and huge health care costs and waste. Patients pay for this through increased premiums with no improvements in health care quality or outcomes.

SUMMARY: The federal No Surprises Act was passed in 2020 and set up an arbitration process where insurance companies and providers would negotiate the payment for out-of-network charges so patients didn’t get huge surprise bills. What happened is a classic example of how for-profit corporate capitalism creates huge costs and waste in our health care system. Ultimately, patients are paying for all of this through increased premiums, while the cost of our health care system spirals upward with no improvements in quality or outcomes.

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You probably remember the surprise health care billing problem that made headlines in 2019 and 2020 where patients were getting huge bills for “out-of-network” medical services over which they had no control, such as in the emergency room or for anesthesia or radiology. As a remedy, the federal No Surprises Act was passed in 2020 and set up an arbitration process where insurance companies and providers would negotiate the payment for out-of-network charges, so patients didn’t get huge surprise bills.

Although the Act did succeed in keeping patients from getting surprise bills, what happened is a classic example of 1) how for-profit corporate capitalism dominates and has corrupted our health care system, and 2) how the lack of a single payer system wastes time and money. With a single payer system, the surprise billing problem would never have happened in the first place because there would be no such thing as “out-of-network.”

The arbitration system created to “solve” the surprise bill problem has become another layer of bureaucratic waste. It has created two new sets of middlemen, arbitrators and consultants, who manipulate the system to maximize their own profits on the backs of our already expensive health care system. [1]

The arbitration system primarily has huge insurance companies on one side who want to pay less for medical services. On the other side, in many cases, are private equity-owned medical staffing companies trying to maximize billings and profits. The No Surprises Act instituted an arbitration system using an independent dispute resolution process (IDR).

The in-network rate for medical services is supposed to be used as a guideline for determining payments, but it is not a mandated standard. Policy makers estimated there would be 20,000 arbitration cases a year nationally, based on experience with a similar system that mandated in-network rates as the standard.

However, in 2025 there were 2.2 million arbitration cases and payments were triple those of the previous year. Providers won roughly 85% of the cases and some outrageous payments were made. For example, there were 25 payments for over $10 million each for procedures that had an in-network cost of $100 to $2,000.

One of the new middlemen, the arbitrators get a flat fee per case and took in $1.3 billion. Given their flat rate, they have a perverse incentive to want to stimulate more cases as the only way to increase their revenue. The way to incentivize more cases is to make high payment awards that create an incentive for providers to file more cases. These high payments establish precedents that are cited in subsequent cases, so the payment awards just spiral upward. By the way, five of the certified arbitrators have private equity backers.

The other new middlemen are consultants to providers and their private equity owners. One of these consultant companies, HaloMD, filed 20% of all the arbitration cases and earned over $1 billion in fees in 2025. These consultants, of course, have an incentive to maximize the payment awards and they brag about getting eight to thirteen times the typical in-network payment rate for their clients.

The insurers are fighting back in unusual ways. Across the 2.2 million cases in 2025, in roughly one million cases they simply gave up and defaulted to the providers’ requests. In another 380,000 cases, they offered to pay $1 or less. Clearly, they are not participating in the arbitration system in good faith. It appears their strategy is to fight in court to get cases thrown out en masse rather than having to fight case by case – although the No Surprises Act bans judicial review of individual billing disputes. Or their strategy may be to have the arbitration system spiral so far out of control that the insurers can argue in court that the whole system should be thrown out. A piece of the court-based strategy may be to delay payments. In some cases, providers are reporting that insurers are simply refusing to pay. A trade association for emergency medical services providers has reported that about 60% of awards were not paid within the 30-day period mandated by the No Surprises Act.

Ultimately, patients are paying for all of this – the outrageous payments for the services and the billions of dollars of administrative overhead costs. Individual patients aren’t getting huge surprise bills, rather we are all paying through increased premiums for our health insurance. And the cost of our health care system spirals upward with no improvements in quality or outcomes – just more capitalists making more money. (See this previous post for a more general overview of how capitalism has corrupted our health care system. See this previous post for how a universal, single-payer health care system would save lots of money and lives.)

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday post here.

[1] Dayen, D., 8/13/26, “Congress face-plants on surprise health care bills,” The American Prospect (https://prospect.org/2026/08/13/congress-trump-no-surprises-act-health-care-bills-insurance/)

UNIVERSAL HEALTH CARE SAVES LOTS OF LIVES AND MONEY

SUMMARY: A universal, single-payer U.S. health care system could save over 100,000 lives and $1 trillion every year. However, because capitalism has corrupted our health care system, which now puts profits before patients, the potential benefits, both in quality and in savings, won’t occur unless the corporate giants in the system are broken up or strongly regulated. Six corporations dominate Big Medicine with over $2 trillion in revenue and $34 billion in profits in 2025.

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A reformed U.S. health care system providing universal coverage could save over 100,000 lives and $1 trillion every year according to a study from the Yale School of Public Health. A universal U.S. public health insurance program, such as Medicare for All, would save over $1 trillion a year even after including roughly $300 billion for the additional care received by currently uninsured or underinsured people. [1]

The five major sources of savings are:

Reduced administrative overhead. At least 15% of U.S. health care spending, about $800 billion annually, is administrative waste. Peer countries and Medicare spend 1% to 4% on administration.
Lowered drug costs due to regulation and negotiation of drug prices.
Reduced fraudulent billing from for-profit entities working to maximize profits.
Fewer emergency room visits and hospitalizations due to earlier and less expensive treatment of medical conditions.
Standardized and capped prices for health care services.

Universal health insurance would, of course, undo the coverage cuts and other health policy changes implemented by the Trump administration since 2025. This alone would prevent about 51,300 deaths a year. Universal comprehensive and affordable health coverage would benefit the over 45 million adults who are underinsured – where deductibles and co-pays make needed care unaffordable. This would save another 29,600 lives a year. Finally, universal health insurance would, of course, insure the uninsured saving an estimated 33,300 additional lives. So, in total over 114,000 deaths per year would be averted.

The Yale study builds on and confirms estimates in a less comprehensive 2020 study that concluded that a single-payer, universal health care system in the U.S. would save at least 68,000 lives and $450 billion a year. [2]

However, capitalism has corrupted the U.S. health care system. The pursuit of profits has become the priority, rather than care for patients. Costs are high and growing fast, while outcomes are poor. (See this previous post for more details.) Big corporations (aka Big Medicine) dominate health insurance, drug manufacturing, hospitals, and doctors’ practices. Middlemen skim off profits at many points in the system. Private equity firms (vulture capitalists) pocket profits at the expense of patients, doctors, and others. Practitioners are burned out and leaving clinical practices in record numbers leading to shortages of doctors in primary care and many specialties, especially mental health. [3]

Therefore, a universal, single-payer, Medicare-for-All type system won’t achieve all its potential benefits, both in quality and in savings, unless the corporate giants in the health care system are broken up or strongly regulated. [4]

Six corporations dominate Big Medicine: huge insurer / provider conglomerates UnitedHealth, CVS, and Cigna, along with mega-wholesalers McKesson, Cencora, and Cardinal Health. They are six of the fifteen largest corporations in the U.S. They have been built by mergers and acquisitions over the last 16 years; only one of them was among the fifteen largest corporations in 2010. They had over $2 trillion in revenue and $34 billion in profits in 2025. For example, McKesson, Cencora, and Cardinal Health are the three largest wholesale drug distributors, controlling 98% of the market, giving them, as middlemen, monopolistic leverage over drug manufacturers, providers, and consumers. (See this previous post for more on corporate consolidation and concentration in health care.)

Big Medicine now employs 80% of doctors. This exemplifies the major changes in our health care system since the early 1980s when 80% of doctors owned their own private practices. Big Medicine (as with big retailers and big tech) also pushes manufacturing of drugs and medical supplies to low-cost sources overseas. This makes supply chains brittle and results in shortages if there’s any disruption.

For patients, Big Medicine means unaffordable coverage, doctor shortages and long wait times, longer trips to doctors and hospitals, administrative barriers to care and payments, worse health, and medical debt for 40% of American adults. For doctors and other practitioners, it means decreased pay and benefits, increased pressure to produce billings, decreased time with patients, delayed payments for services, and worsening working conditions. Big Medicine has pushed both patients and practitioners into frustration and anger, and, as a result, only 28% of patients trust the health care system and practitioners are leaving the field at unprecedented rates.

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday post here.

[1] Kristoffersen, M., 8/13/26, “Universal health coverage could save $1 trillion and 114,000 lives every year, Yale study projects,” Yale School of Public Health (https://ysph.yale.edu/news-article/universal-health-coverage-could-save-one-trillion-dollars-and-114000-lives-every-year/)

[2] Galvani, A. P., et al., 2/15/20, “Improving the prognosis of health care in the USA,” The Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/abstract)

[3] Freer, E., & Harper, M., August 2026, “Break up Big Medicine: A health care agenda to restore power to patients and practitioners and save families $6,000 a year,” American Economic Liberties Project (https://www.economicliberties.us/wp-content/uploads/2026/08/AELPHealthcareAgenda.pdf)

[4] Dayen, D., 8/27/26, “Health care reform needs more than universal coverage,” The American Prospect (https://prospect.org/2026/08/27/health-care-reform-universal-coverage-medicare-for-all/)

CAPITALISM HAS CORRUPTED HEALTH CARE

Capitalism and its pursuit of profits have corrupted our health care system, resulting in the most expensive system in the world, but one that delivers poor outcomes. Three elements have driven this corruption: corporate consolidation, private equity, and privatization.

SUMMARY: Capitalism and its pursuit of profits have corrupted our health care system. Oligarchs have been allowed to reap huge rewards resulting in the most expensive health care system in the world but one that delivers poor outcomes. Three essential elements that have driven this corruption are corporate consolidation, private equity, and privatization. Some remedies are clear but require dramatic changes in our federal elected officials.

(Note: If you find a post too long to read, please just skim the bolded portions. Thanks for reading my blog!)

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Capitalism has corrupted our health care system. My previous two posts described more generally 1) how corporate America’s current brand of capitalism is corrupt and undermines democracy, while abetting oligarchy and fascism; and 2) how large, profitable corporations avoid paying taxes while paying their employees so little they have to rely on government assistance to survive.

The U.S. health care system does not provide high-quality health care and is not accessible and affordable because it has been corrupted by the pursuit of profits. As a result, Americans have the worst health outcomes among peer countries. Moreover, they face high costs for insurance and care, resulting in huge amounts of medical debt and many bankruptcies. Individual health care providers are burned out and have low morale because their managers are focused on maximizing profit.

The U.S. health care system has been corrupted by the “free market” revolution that began in the 1970s, took off under President Reagan in the 1980s, and has dominated the U.S. economic system ever since. This laissez-faire, deregulated, no-holds-barred brand of capitalism has been championed by wealthy “conservatives” and Republicans, and abetted by some Democrats. It has been dubbed neo-liberalism. It is a turbocharged version of capitalism that promotes deregulation of business and privatization of public goods and services. [1]

Oligarchs have been allowed to reap huge rewards from our health care system through financial manipulation, mergers and acquisitions, and what amounts to bribery of elected officials. The result has been huge mega-hospitals and vertically integrated insurers / providers, along with pharmaceutical giants and a mind-boggling number of middlemen. All these entities are focused on squeezing as much profit as possible out of the health care system, while patient outcomes and the well-being of individual providers are sacrificed.

The result is the most expensive health care system in the world but one that delivers poor outcomes.

There are three essential elements that have driven this corruption of our health care system: [2]

Corporate consolidation: Deregulation and lack of antitrust enforcement over the last 40 years have led to huge health care corporations that have monopolistic power, which allows them to maximize profits at the expense of patients and individual providers. Almost every component of our health care system is rated as “highly concentrated.” [3] For example, 90% of dialysis is performed by just two companies, while 90% of hospital markets, 74% of health insurance markets, and 65% of specialized physician services are rated as highly concentrated.
Private equity: Private equity firms (which I referred to as vulture capitalists [see background here]) invaded health care starting in the 2000s. In the decade from 2010 to 2020, private equity firms spent $750 billion buying health care entities. While these purchases have produced big returns for the private equity financiers, the results for patients have been higher prices, poorer quality, and less access due to the closing of facilities, while doctors and other personnel are disempowered and discouraged. (This is consistent with the standard practice of private equity firms in all sectors of our economy. See more here.)

Steward Health is perhaps the poster child for private equity’s harmful impact on health care. Among other negative outcomes, it delivered poor care as it cut corners to maximize profits. By filing for bankruptcy, patient malpractice awards (among other debts) won’t be paid or will be paid with pennies on the dollar, while executives and private equity owners walked away with fortunes.
Privatization: Privatization and profits are the hallmarks of our neoliberal health care system. Notably, Medicare, which provides health insurance coverage for 65 million seniors and people with disabilities, is being increasingly privatized to the detriment of taxpayers and patients. A growing portion of Medicare enrollees are being seduced by slick advertising and short-term benefits to sign up for privatized Medicare Advantage plans, which now have 55% of the population.

The only long-term advantage of the plans is to the profits of private insurers, such as the giants UnitedHealthcare and Humana, which between them have 46% of all Medicare Advantage enrollees. Recently, these two corporations announced plans to boost their profits by dropping some “under-performing” markets and kicking more than a million seniors off their insurance plans.

Medicare Advantage (MA) plans cost the government over $500 billion a year and more per person than non-privatized, traditional Medicare, despite serving a healthier population. MA companies are notorious for denying payments for necessary care and for overbilling the government. Nonetheless, the Trump administration recently approved a substantial increase in payments to MA plans. [4]

Not surprisingly, another result of this corruption of our health care system has been that trust in the system has dropped dramatically from 79% in 1975 to 28% in 2026. [5]

Some of the remedies for our health care system’s dysfunction are clear but obviously would require dramatic changes in our federal elected officials:

Strong enforcement of antitrust laws (as the Biden administration started to do for the first time in 40 years). The high concentration in many parts of the health care system will require breaking up some of the huge, monopolistic corporations that have been created.
Banning private equity ownership from our health care system.
Regulating drug prices, as they are in every other peer country.
Implementing a single-payer, Medicare for All type system, like those in every other peer country.
Establishment of a new patient bill of rights.

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday post here.

[1] McDonough, J. E., 8/30/26, “The little-understood roots of the American health care catastrophe,” The Boston Globe

[2] McDonough, J. E., 8/30/26, see above

[3] Highly concentrated is defined in the merger guidelines of the Federal Trade Commission. More on its application to health care is in this American Medical Association publication: https://www.ama-assn.org/health-care-advocacy/access-care/95-us-health-insurance-markets-are-highly-concentrated

[4] Johnson, J., 9/10/26, “To boost profits, Medicare Advantage giants move to kick over a million seniors off their plans,” Common Dreams (https://www.commondreams.org/news/medicare-advantage-benefit-cuts)

[5] McDonough, J. E., 8/30/26, see above

CORPORATE AMERICA IS WRECKING CAPITALISM

SUMMARY: The Trump regime has cut a corrupt deal with corporate America, which most of the corporate elites have readily gone along with despite its corruption and undermining of democracy. This is what oligarchy and fascism are all about. Everyday citizens pay financially and with their freedom as these corrupt government and business people get richer and richer, as well as more and more powerful. Recently, Gerard Baker, editor-at-large (and former editor-in-chief) of The Wall Street Journal wrote two columns that make a powerful statement about the damage America’s corporate elites and their style of capitalism have done.

(Note: If you find a post too long to read, please just skim the bolded portions. Thanks for reading my blog!)

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The Trump regime has cut a corrupt deal with corporate America, which the corporate elites have all too readily been happy to accept. It is based on greed and corruption by both these parties: the government will let the corporations and their executives do whatever they want to grow their profits and wealth as long as they pay homage to Trump and his regime verbally and financially. That everyday Americans will suffer from unaffordable costs of daily living and from poor pay and working conditions does not concern either of these parties.

What’s surprising is that so few members of the corporate elite have been willing to call out the corruption and the undermining of democracy. A group calling themselves Patriotic Millionaires has been highlighting the harm of the high and growing levels of economic inequality for some time. They have been promoting policy solutions through changes in tax and employee pay laws. Patriotic Millionaires has proposed “The Money Agenda,” a set of policies that would reduce economic inequality and “permanently stabilize the economic lives of working people, stimulate wide-spread economic growth, and ensure prosperity and stability.” (See this previous post for more details.)

Recently, Gerard Baker, editor-at-large (and former editor-in-chief) of The Wall Street Journal (WSJ) wrote two columns that make a powerful statement about what America’s corporate elites and their current style of capitalism have done wrong. I don’t imagine that I have to tell you that the WSJ and Baker previously have been stanch proponents and, when necessary, defenders of American capitalism. Baker’s recent columns in the WSJ (paywall) are titled How to Cure What Ails American Capitalism (8/17/26) and Socialism Is the Wrong Answer, but the Questions Are Real (8/10/26). Robert Reich provides a nice summary of Baker’s points in this blog post.

Baker writes that, “The widespread popular dissatisfaction with the working of modern American capitalism may be the product of some real, objective problems in the way American capitalism is working.” The problems he notes include the high level of economic inequality, the unaffordability of daily life for many, and the corruption and lack of accountability of the political and corporate elites. He points out that this is harming social solidarity and leading to demands for a radical replacement of American capitalism.

Baker further writes that, “Most of the causes of America’s economic dysfunction are the result of a capitalism that has mutated into a system run by and for large corporate interests.” The dysfunction he highlights includes oligopoly-level concentration in almost every business sector; regulation, legislation, and policy that benefit big companies; and a privatized healthcare system that operates to generate profits for providers, insurers, and pharmaceutical companies while producing poor outcomes for patients and very high costs. He states that the overall result is a concentration of “market, economic and political power by a business-political class that promotes its own well-being at the expense of competition, the market and ultimately the people.”

The fact that this is coming from a career-long proponent and advocate for American capitalism is striking and underscores how poorly capitalism is working. It also highlights how shocking it is that other supposed leaders in corporate America aren’t standing up both to call this out and to support remedies – not to mention speaking out against the corruption and undermining of democracy.

The current Trump regime and its allies among the corporate elite are what oligarchy and fascism are all about. There’s a corrupt deal among government and business people that “I’ll scratch your back if you scratch mine.” Everyday citizens pay financially and with their freedom as these corrupt government and business people get richer and richer, as well as more and more powerful.

Some of the remedies are clear but obviously require a seismic change in our elected officials:

Strong enforcement of antitrust laws (as the Biden administration started to do for the first time in 40 years). American capitalism has gone so far down the road of eliminating actual market place competition by allowing monopolies and oligopolies that remediation will requiring breaking up some (if not many) of the huge corporations that have been created.
Strong worker protection laws and agencies, including support for unions and unionization.
Strong consumer protection laws and agencies for all consumer goods and services, especially financial services.
A total revamping of our health care system to remove the corrupting profit motive that puts profits before patients. A single payer Medicare for All system is the remedy, like what every other peer country has.
Dramatic reform of the American campaign finance system to prevent wealthy individuals and corporations from effectively buying elected officials and policies. Matching public funds for small campaign contributions from people within a candidate’s district, tied to strict limits on other campaign funding, are the most immediate solution in the context of the Citizens United and related Supreme Court decisions. New York City and State and numerous other jurisdictions have such systems in place and they’ve produced very positive results. (See previous posts here and here for more information.)

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday post here.

Is Trump the Real Communist in American Politics?

SUMMARY: Trump is the only politician calling for and taking government control of private companies and resources. At his direction, the government has taken stakes in at least nine companies. On the other hand, democratic socialists in the U.S. today are in the mainstream of our history, not outliers, let alone communists.

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(Note: Please follow me and get notices of my blog posts on Bluesky at: @jalippitt.bsky.social. Thanks!)

Despite Trump and the Republicans calling Democrats communists, – especially the progressive ones and the ones who identify as democratic socialists – Trump is the actual communist. Really. [1] Let’s review definitions of socialism and communism, and then look at Trump’s actions.

Democratic socialism was eloquently defined by Senator Bernie Sanders in the fall of 2015 when he was running for president. You can watch and listen to his two-minute definition here. (My post about Sanders’ speech with more detail is here.)

His definition builds on President Franklin D. Roosevelt’s (FDR) proposed economic bill of rights and notes that true individual freedom cannot exist without economic security. Democratic socialism includes:

Decent jobs at decent pay with time off and the ability to retire with dignity;
The ability to have adequate food, clothing, health care, and housing;
A right to a good education; and
The opportunity for small businesses, including farmers, to operate without domination by large corporations.

Sanders noted that Martin Luther King, in 1968, echoed FDR’s call for economic rights and stated that the US provides “socialism for the rich and rugged individualism for the poor.” By the way, while “socialism” may be a politically negative label to older Americans, 67% of young Americans have a positive or neutral association with the word “socialism” compared to 40% who are positive or neutral about “capitalism.”

Historian Heather Cox Richardson states that the democratic socialists in the U.S. today are in the mainstream of our history. Their policy proposals echo the 1860s, when the Republicans established public colleges; the 1900s, when Theodore Roosevelt called for public health insurance; the 1930s with FDR’s New Deal and proposed economic bill of rights; Eisenhower Republicans of the 1950s; and Republican President Nixon in the late 1960s and 1970s. (See my previous post for more details.)

Cox Richardson notes that today’s American democratic socialists are not communists or even hardcore socialists. [2] Communists and some hardcore socialists advocate for eliminating all private property. Today’s American democratic socialists call for a robust system of private ownership and enterprise, alongside government control of essential societal functions required for people to survive and for the economy to work for the good of everyone. (See my previous post for more details.)

Communism calls for government or communal ownership of all resources as well as all means of production, meaning the state, rather than private individuals or corporations, owns factories, farms, mines, etc. None of the Democratic or Democratic Socialist candidates is proposing anything akin to this.

The only politician calling for state takeover of private industries and resources is Trump. At his direction, the government has taken stakes in at least nine companies at a cost of at least $10 billion in taxpayer money. These companies are in the steel, minerals, nuclear energy, and semiconductor industries. [3] Trump claims he’s done this for national security reasons, but increasing his power, control, wealth, and influence seem to be the real reasons. Notably, the arrangements his regime has made leave power and control, as well as money, in his hands, not under the control of some group or entity that is committed to the public good. Trump has used tariffs (and exemptions from them), regulatory actions (e.g., approval or denial of mergers and acquisitions), and trumped-up lawsuits (no pun intended) to coerce business leaders into complying with his requests for control of their businesses.

For example, in August 2025, the Trump administration converted $9 billion in federal grants to Intel into a 10% ownership share in the company. The grants were made under President Biden’s 2022 CHIPS and Science Act to boost domestic semiconductor manufacturing and research. The U.S. government is now Intel’s biggest shareholder. Intel had been struggling financially and this, along with other actions by Trump requiring other companies to buy Intel products or invest in it, bailed Intel out. (Imagine what Trump and Republicans would have said if the Obama administration had converted its bailouts of Wall Street and automakers in the 2008 Great Recession into government ownership of those companies!)

Apple got an exemption from Trump’s 100% tariffs on semiconductor imports (essential to iPhones and many other Apple products) by promising to buy Intel chips and collaborate with it.

Nvidia got Trump’s approval to sell its artificial intelligence (AI) chips to China (which he had said and others believe is a national security risk). Nvidia agreed to give 25% of the profits from Nvidia’s China sales to the government and to invest $5 billion in Intel.

The U.S. government has also become the largest shareholder in MP Materials, the only rare earth mining company in the country, after a $400 million investment of taxpayers’ money.

When the Japanese company, Nippon Steel, acquired U.S. Steel in 2025, Trump conditioned government approval on his receiving a “golden share” in U.S. Steel. This golden share allows him to veto key business decisions including decisions on changing U.S. Steel’s name, moving its headquarters out of Pittsburgh, or closing production facilities. [4]

These actions are not capitalism. Establishing government control over private companies is nationalized socialism or communism. Nothing at all close to this has happened in U.S. history except during the true national emergency of World War II. This is oligarchic communism in that it’s making Trump and wealthy executives and investors in these companies even richer. And it’s concentrating ever more power over a broader range of the U.S. economy and society in Trump’s hands. That’s authoritarianism.

For lots of good news see Jess Craven’s Chop Wood Carry Water blog’s most recent good news Sunday posts here.

[1] Sonnenfeld, J.A., Pepper, J., Mulcahy, A., George, B., and Tyson, L.D., 8/21/25, “MAGA’s march toward a command economy,” Yale Insights (https://insights.som.yale.edu/insights/magas-march-toward-command-economy)

[2] Cox Richardson, H., 7/5/26, Letters from an American blog (https://heathercoxrichardson.substack.com/p/july-5-2026)

[3] Cox Richardson, H., 6/26/26, Letters from an American blog (https://heathercoxrichardson.substack.com/p/june-26-2026)

[4] Kimball, S., 11/24/25, “Trump appoints two Commerce officials to oversee U.S. Steel under ‘golden share’ agreement,” CNBC (https://www.cnbc.com/2025/11/24/trump-us-steel-nippon-golden-share.html)

THE AMERICAN STRUGGLE BETWEEN OLIGARCHY AND DEMOCRACY

An American oligarchy has battled for control of our country since its founding. In 1980, the American oligarchy re-emerged and has been undermining democracy and skewing government policy. Defenders of democracy are fighting back, including with growing protests against and resistance to King Trump and his administration. Please find and participate in an Oct. 18 No Kings protest near you.

SPECIAL NOTE: We need millions of Americans at the No Kings protests on October 18 in defense of democracy. Please support this however you can. You can find an event near you here.

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(Note: Please follow me and get notices of my blog posts on Bluesky at: @jalippitt.bsky.social. Thanks!)

An American oligarchy based on wealth and privilege, with race and religion lurking behind them, has battled for control of our country since its founding. The southern plantation owners were the first American oligarchy. The businessmen and industrialists of the late 1800s and early 1900s, who were dubbed the Robber Barons, were the second American oligarchy.

The first American progressive era from the 1890s through 1945 pushed back against oligarchy and the Great Depression, which was caused by the greed of the oligarchs. President Franklin D. Roosevelt’s New Deal and the growth of government and government power due to World War II relegated and regulated the oligarchy to the back seat. This put democracy and we the people in the driver’s seat and in control of America.

The period after World War II, from 1945 to 1980 was the second progressive era. An unwritten post-war social compact framed American society and the economy. It was based on three pillars:

Corporations served all stakeholders: workers, customers, communities, and shareholders;
Workers had a right to unionize and receive fair wages and safe working conditions; and
Government provided a safety net, managed capitalism, and leveled the playing field.

The result was an economy and society where, from 1945 to 1980, the rising tide did lift all boats. Economic inequality narrowed and America moved toward its promise of equal opportunity for all. Workers’ wages increased in accordance with their increases in productivity. The middle class grew along with economic security. Each generation was better off than the previous one. Democracy was working well.

In 1980, with the election of President Reagan, the American oligarchy re-emerged. For the last 45 years, it has been undermining democracy and skewing government policy in its favor. (See this previous post for more details.) Although Republicans have been the driving force, Democrats have contributed to this shift by supporting business deregulation and unconstrained globalization. Democrats also failed to support unions and failed to reform our campaign finance system. Moreover, they have come to rely on campaign contributions from wealthy individuals and corporations.

All this has led to 45 years of dramatically growing income and wealth inequality. The middle class has shrunk, and workers’ wages have increased much less than their increases in productivity. Many Americans have lost their economic security. The public’s faith in government and democracy has declined dramatically.

However, there are signs that a third American progressive era and a resurgence of democracy may be emerging. There is increasing acknowledgement and public awareness that:

Wealth and income inequality have grown to unacceptable levels.
Huge corporations tend to engage in monopolistic behaviors such as price fixing and price gouging; decreasing quality, choice, and customer service; and poor treatment of employees in terms of compensation and safety.
Unrestrained capitalism is not good for consumers, workers, communities, or our planet.
The oligarchs have rigged our economic system in their favor so that the rising tide is lifting only their yachts.
Oligarchy is anti-democratic and tends to turn into authoritarianism and fascism, i.e., white, male, Christian nationalism.

Bob Kuttner, a long-time, very astute and thoughtful observer and analyst of American politics and policies, has concluded that American democracy’s efforts to balance capitalism are doomed to fail. The incentives and power of huge corporations and huge wealth are too great and will inevitably overwhelm America’s brand of democracy. He concludes that significant public ownership of key sectors of the economy, i.e., democratic socialism, is necessary to keep capitalism in check. [1]

As Bob Reich recently wrote, “Capitalism is compatible with democracy only if democracy is in the driver’s seat. … [Otherwise] It fuels despotism.” [2] This is reminiscent of the quote from Supreme Court Justice Louis Brandeis back in the 1930s: “We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can’t have both.”

In many sectors of our economy there’s a clear need for strong regulation or public ownership including in health care, communications (including media and the big technology platforms), utilities and energy, the transportation system, banking and finance, housing, and food and agriculture. In these areas, a publicly owned option would be more effective and efficient because it wouldn’t have to cover the costs of profits, big executive pay packages, and advertising. For example, in the health care sector, when the Affordable Care Act (ACA, aka Obama Care) was being developed, health care providers and insurance companies vehemently opposed a public option in the health care market place (basically Medicare available to everyone) because they knew it would be more effective and efficient. This is also why they oppose Medicare of All and are working feverishly to undermine Medicare with their privatized Medicare Advantage plans. We need public Medicare for seniors and a public option for everyone else to stop the rapacious, for-profit health care businesses that put profits before patients. (See previous posts here, here and here for more details.)

The growing protests against and resistance to King Trump and his administration’s actions and policies are signs of a resurgence of democracy and an emerging progressive era. The successes are many, on the streets and in the courtrooms, sometimes small but nonetheless important, and are underreported by the mainstream media. Forcing media executives to put the Jimmy Kimmel show back on the air was a huge and very visible success. (For lots of current good news see Jess Craven’s Chop Wood Carry Water blog here.)

In this vein, please find an October 18^th No Kings event near you here and participate and support it in whatever way you can. We, the American public, as citizens, consumers, and workers, must stand up for democracy, otherwise, we’ll continue down the slippery slope to oligarchy, authoritarianism, and fascism. We can stop the anti-democracy slide, as we did in the Jimmy Kimmel case.

We need millions of Americans engaged in the No Kings protests and in the many, many other smaller protests that are occurring daily. Thank you for all you’re doing! Please keep up the great and important work to save our democracy!

My next post will identify additional signs of a resurgence of democracy and the beginning of a third progressive era, including a surge in unionization, campaign finance reforms, and actions and elections at the state and local levels.

[1] Kuttner, R., 12/1/21, “Capitalism vs. liberty,” The American Prospect (https://prospect.org/politics/capitalism-vs-liberty/)

[2] Reich, R., 9/26/25, “Why are we so polarized? Why is democracy in such peril?” Blog post (https://robertreich.substack.com/p/why-are-we-so-polarized)