In yet another confirmation that Washington works for Wall Street, Elizabeth Fowler, architect of the 2010 Affordable Care Act, was rewarded for her exemplary service to the capitalist class with a lucrative position as head of global health policy for Johnson & Johnson. Fowler and the corporate giant had previously developed a close working relationship though the Pharmaceutical Researchers and Manufacturers of America, a major lobbying group that emphatically backed the health care reform.

During the heated negotiations in the run-up to the passage of the ACA, Fowler was the chief health care advisor to Montana Sen. Max Baucus, who held the decisive position of chairman of the Senate Finance Committee. In an article published before the passage of the final legislation, Politico reported that she “directs the Finance Committee health care staff, enforces deadlines on drafting bill language and coordinates with the White House and other lawmakers.”

A top advisor to former Senate Majority Leader Bill Frist commented, “People know when Liz [Fowler] is speaking, she is speaking for Baucus.” What qualifications did Fowler have that convinced Baucus to let her be his voice on health policy? Prior to this stint in Washington, Fowler was the vice president for public policy and external affairs for Wellpoint, the largest health insurance corporation in the country.

Baucus and by extension Fowler are widely credited with defeating the “public option”—a government-run not-for-profit insurance plan that would have provided care at significantly reduced rates. Even the public option, a weak alternative to a single-payer health care system that would guarantee access, or a socialist health care model like Cuba’s that focuses exclusively on human needs, was unacceptable to Wall Street and their loyal political operatives.

When the Affordable Care Act that Fowler had worked so hard to craft was finally passed, its main feature was a provision that forces everyone to purchase coverage from a private insurance company, winning it the enthusiastic approval of the major health care corporations that can look forward to millions of new customers and billions more in profits in the years to come. The legislation does contain some progressive reforms relating to denial of coverage based on pre-existing conditions, but it falls far short of respecting poor and working people’s right to decent medical care.

And who better to oversee the implementation of this law than Elizabeth Fowler? Before returning to a much more lucrative position in the private sector, she went to work in 2010 for the Obama administration to help make sure the health care reform was put into practice.

Although Fowler played a critical role, she did not deliver this victory to the health care capitalists single-handedly. An army of lobbyists directed $380 million towards influencing the debate over health care reform, including $1.5 million to Max Baucus and $49.7 million to the Senate Finance Committee, which he chaired.

However, this did not, as some left-liberal commentators would have us believe, constitute a takeover of “our” government. From its foundation, this has been a government of, by and for the exploiters, whether slave-owners or modern-day capitalists. Lobbyists simply allow the big banks and corporations to communicate their priorities to their loyal servants in Washington.

Mass outrage over the “revolving door” between political and corporate positions is absolutely warranted. To turn this outrage into effective action, it should be coupled with the realization that whenever there are extreme concentrations of wealth and misery, as is certainly the case under capitalism, the exploiters will use their wealth to maintain a political system that protects their interests. In place of this perpetual injustice, poor and working people need a whole new system that allows us to democratically direct the wealth of society towards meeting human needs rather than lining the pockets of big business and their lobbyists.