Actually, I bet it's a lot more bilateral than either configuration. The mutual scratching of the backs while they pretend to squabble for the proles.
There is no disputing the incredible piles of cash that the insurance industry invested into Washington over the past several decades. Other than that capital investment (which helps to keep the "right" elected officials elected to office) what did the government have to gain by giving this giant gift to the insurance industry?
From my vantage point this was a killer ROI for the industry. And a massive anal probe for the people.
It takes a large state to build tyranny, whether its strings are pulled by a bunch of ideological loons, or by runaway corporate interests.
I guess that depends on how one defines large. For example few people would argue against Saddam Hussein being a tyrant, but neither his kingdom nor his government were that large. Now, if you were to instead define large in terms of what fraction of the country's wealth is consumed by the state, then I would certainly agree that his state was enormous. And indeed pretty much every highly militarized state in recent history could be qualified as large in that way.