SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
5
#000000
#FFFFFF
insurance industry
For-Profit Healthcare Makes Us Sick!
The harmful behaviors of profit-driven healthcare companies—from tax dodging to insurance denials to carelessness with patient safety—stem from the same illness: a disregard for the community they serve.
Nov 02, 2025
Even though most of us think of healthcare as a human right, the reality is that in the United States the provision of healthcare is big business. It places profits over people, demonstrating that priority through tax dodging, price gouging, insurance denials, and unsafe conditions for patients, as documented in a recent joint report from our two organizations, Americans for Tax Fairness and Community Catalyst.
The report, “Sick Profits,” highlights how seven healthcare corporations have together saved over $34 billion in federal taxes thanks to the 2017 Trump-GOP tax law recently extended by the current Trump administration and Republican Congress. They paid for those corporate tax breaks in part by cutting Medicaid and jeopardizing health coverage for 15 million people, and failing to preserve the enhanced premium tax credits for people buying health insurance through the Affordable Care Act (ACA) Marketplaces.
We currently have public policy that cuts taxes on corporations while ignoring nearly two-thirds of people who believe that big companies are not paying enough. Instead, healthcare corporations have each enjoyed hundreds of millions—in most cases, billions—of dollars in tax savings thanks to the Republican tax law, the most expensive part of which was a two-fifths cut in the corporate tax rate. They have also saved taxes by exploiting loopholes that the law (and its extension) failed to close, including in the accounting for stock options and the treatment of profits shifted offshore.
Not surprisingly, the companies examined in the report did not use their tax savings to lower prices, hire more providers, or improve patient care. No, the money went instead to higher executive compensation and increased payouts to shareholders through dividends and stock buybacks.
We must demand more transparency, fairer tax policy, and better oversight of these institutions.
Additionally, companies are maximizing their profits by simply not paying for care. By demanding “preauthorization” for a dizzying number of procedures then routinely denying approval, insurers can save billions at the expense of their policyholders. High percentages of initial denials are overturned on appeal, showing that “no” is simply the initial default position, taken in the hopes that patients and doctors won’t push the issue. Claim denials often result in medical debt and can also disrupt treatment for chronic medical conditions, delay or deny access to lifesaving care, and lead to avoidable complications—or even death.
Claim denials affect the health and well-being of people every day. They are people like Little John Cupp, who began feeling short of breath and experienced swelling in his feet and ankles. His doctor recommended a catheter exam to determine whether the arteries in his heart were blocked. However, the medical benefits management company EviCore (owned by Cigna) twice denied the catheter exam while eventually approving a much lower-cost stress test. The delay in diagnosis proved catastrophic. Less than two days after Mr. Cupp received the stress test, he died of cardiac arrest.
The tragedy of the end of Mr. Cupp’s life demonstrates the incredibly real risks that the first obstacle to getting care creates. Unfortunately, clearing that hurdle and receiving approval for care does not ensure quality. You could find yourself getting treatment at a facility saving money for shareholders by reducing staff and failing to maintain safe and hygienic conditions. NBC News aired a six-part investigation of hospital-operator HCA Holdings that uncovered, in the words of our report, “roaches in the operating room, leaking ceilings, essentially unmonitored vital signs, overworked nurses, overcrowded emergency rooms, closed departments, and other threats to patient health and safety.”
Or you may receive care at a facility owned or controlled by private equity interests. One cautionary tale is Prospect Medical Holdings, which operated hospitals and other health facilities in multiple states and was driven into bankruptcy after it was acquired by a private equity firm that extracted over $650 million in debt-financed dividends from the targeted company. While the private equity partners enjoyed lucrative payouts, patients suffered from unsanitary conditions, supply shortages, insufficient staffing, and shuttered departments.
Our diagnosis is simple but serious. The harmful behaviors of profit-driven healthcare companies—from tax dodging to insurance denials to carelessness with patient safety—stem from the same illness: a disregard for the community they serve. We must demand more transparency, fairer tax policy, and better oversight of these institutions. That means closing tax loopholes, raising the corporate tax rate, curbing the routine denials of coverage, and strengthening regulatory oversight of health facilities. That’s the only way to ensure that people’s needs are prioritized over corporate profits.
Keep ReadingShow Less
Hard Lessons From Katrina We’re Still Learning 20 Years Later
Hurricane Katrina not only exposed the vulnerability of communities to extreme weather events exacerbated by climate change, but also systemic injustices and a deeply flawed US insurance system.
Aug 29, 2025
It’s been 20 years since Hurricane Katrina struck the Gulf Coast of the United States, wreaking havoc in Louisiana, Mississippi, and Alabama. An estimated 1,833 people died in the hurricane and the flooding that ensued. The storm destroyed or damaged more than a million housing units and more than 200,000 homes, causing one of the largest relocations of people in US history.
In the months and years that followed, entrenched inequalities, questionable policy choices, and predatory practices by private insurers decided who could return home and rebuild. For instance, countless residents impacted by the hurricane learned too late that their standard homeowners’ insurance offered no protection against flood damage, leaving them to shoulder devastating repair costs themselves. In cities such as New Orleans, these dynamics further marginalized Black residents, who were more likely to live in flood-prone neighborhoods. The result was widespread and often permanent displacement, with longtime communities effectively erased from the map.
Hurricane Katrina not only exposed the vulnerability of communities to extreme weather events exacerbated by climate change, but also systemic injustices and a deeply flawed US insurance system. Private insurers pour billions of dollars into the fossil fuel industry, which is the main contributor to climate change. Thus, insurers help fuel the very crisis that is driving more frequent and severe climate disasters like Hurricane Katrina. Meanwhile, they are passing the financial risk of the escalating impact of climate change onto policyholders and forcing them to bear the costs of the crisis the industry itself helps perpetuate.
As climate-driven storms grow more frequent and increasingly destructive, the same insurance failures, housing crises, and inequitable recovery that followed Katrina now threaten communities nationwide. Two decades later, Katrina’s hard lessons cannot be ignored. Everyone deserves to live in safety and the opportunity to stay in the place they call home. Corporate greed and government negligence cannot continue to undermine these rights.
The Hurricane
On August 29, 2005, Hurricane Katrina made landfall with winds that reached 140 miles per hour. These high-velocity winds drove a storm surge that raised sea levels 25 to 28 feet above normal along parts of the Mississippi coast, and 10 to 20 feet along the southeastern Louisiana coast. The surge breached protective levees, causing catastrophic flooding. Two days after the hurricane struck, 80% of the city of New Orleans was underwater. Other coastal towns and cities in Louisiana, Mississippi, Alabama, and along the western Florida panhandle also experienced significant storm surges and destructive winds, which caused widespread flooding and damage to homes.
The Great Displacement
Approximately 1.5 million people aged 16 years and older had to leave their residences in Louisiana, Mississippi, and Alabama because of Hurricane Katrina. In New Orleans, where the mayor issued a mandatory evacuation order, a population of around 500,000 was reduced to a few thousand people within a week of the storm.
As water was pumped out of the flooded areas and basic services and infrastructure were restored, New Orleanians were allowed to return. But tens of thousands were not able to do so. One year after Katrina, approximately 197,000 residents had not come back to the city; many relocated to the relatively close cities of Houston and Baton Rouge, but others as far away as Alaska and Massachusetts. Still today, many of those who evacuated the city, hoping to return, remain displaced. New Orleans’s metropolitan area population remains 20% below pre-Katrina levels.
The Impact On Black Communities
The development of New Orleans has been fraught with injustices. Racial segregation, redlining, and chronic underinvestment in Black communities pushed residents and renters into areas with crumbling infrastructure, poorer-quality homes, and greater exposure to environmental hazards and contaminants.
When Katrina hit, Black residents were concentrated in the most vulnerable parts of New Orleans, located well below sea level and poorly protected by inadequate levees. Accordingly, neighborhoods with the highest percentages of Black residents saw greater housing destruction from the storm.
Did You Know?
The disparate impact of climate disasters on property and infrastructure in US minority communities is the result of nearly a century of discriminatory home lending and insurance policies.
In the 1930s, the US federal government used a rating system in its low-cost home loan program to assess lending risk. Assessors created maps ranking the perceived risk of lending in certain neighborhoods, with race often used as the determining factor in assessing a community’s risk level. Black and immigrant neighborhoods were typically rated as “hazardous” and outlined in red, warning lenders that the area was a perilous place to lend money. Known as redlining, these and other discriminatory practices led to a lack of investment in minority communities.
This lack of financial access resulted in shoddy construction and poor infrastructure that have made minority neighborhoods less resilient to climate disasters and more prone to other financial risks. For instance, insurers are more likely to increase premiums if they determine that properties are less resilient to climate damage. This new financial practice is known as bluelining, and it occurs when insurers raise their prices or pull out of areas that they perceive to be at greater environmental risk.
Reconstruction: A New Pathway to Segregation?
For Lousina’s Black residents, Katrina’s damage was compounded by discriminatory recovery policies that deepened inequalities. After the storm, the federally funded Road Home program was launched to help residents repair or rebuild damaged homes. It offered grants of up to $150,000 per homeowner, but payments were based on whichever was lower—the home’s pre-storm value or the cost to rebuild.
Because property values in Black neighborhoods were often far lower than in white neighborhoods, this meant many Black homeowners would receive only a fraction of what they needed to rebuild. In one case, a woman had rebuilding costs of over $150,000, but because the estimated value of her home pre-storm was much lower, she would’ve received an essentially useless grant of $1,400. As a result, the program was alleged to discriminate against Black homeowners, and a federal class action suit was filed on November 12, 2008, on behalf of 20,000 homeowners. The litigation settled with Louisiana agreeing to reward approximately 1,300 homeowners with $62 million in additional compensation.
The Blow to Affordable Housing
Renters fared no better. Hurricane Katrina damaged or destroyed 82,000 rental units in Louisiana, 20% of which were affordable to extremely low-income households. The impact on public and federally subsidized rentals was especially severe. In New Orleans, public-housing residents were displaced at a rate of nearly 90%. And reconstruction policies only exacerbated the disparities these residents faced.
Consider this.
Before the storm hit and floodwaters rose, the Housing Authority of New Orleans evacuated all residents living in its 7,379 public housing units. After the waters receded, residents were allowed to return to approximately 1,600 units. Most other units were sealed off with steel doors and barbed wire—officially due to storm damage—before being slated for demolition. Yet, the redevelopment that followed included far fewer mixed-income apartments. By 2010, five years after the hurricane, less than half of the original 7,379 units were open in any form. The dramatic decrease in public housing contributed to the permanent displacement of many of New Orleans’ longtime residents.
After Katrina, renters faced a range of economic pressures. Many landlords delayed repairs or rebuilding, especially in low-income areas, which are seen as less profitable. Some used the disaster as an opportunity to renovate and target higher-paying tenants, further shrinking the supply of affordable rentals. Within five years of the Hurricane, the stock of mid-priced housing units in New Orleans had declined by more than two-thirds, pushing the median rent from $689 in 2004 to $876 in 2009. These rising costs hit Black residents hardest, forcing many to leave and permanently altering the city’s character.
Even those who could afford to return to New Orleans and buy a new home after Katrina faced soaring prices—up 14% in the first year alone—as demand outpaced the reduced housing supply. In addition, homeowners’ insurance premiums jumped 22% in Louisiana between 2005 and 2007, adding yet another barrier to homeownership.
The Flood Exclusion Trap
Then, as now, and to the surprise of many victims of the Hurricane, standard home insurance policies in the US did not protect homeowners from floodwater damage. This means residents must buy additional flood insurance to be protected in the event of a disaster like Katrina.
New Orleans residents had among the highest participation rates in the country in the National Flood Insurance Program (NFIP), a federal government program that provides flood insurance to homeowners, renters, and businesses. However, the majority of residents in areas affected by Katrina had not purchased flood insurance. Uninsured property losses due to flooding were economically devastating, exceeding an estimated $41.1 billion (USD 100 billion in 2024 prices). In addition, the NFIP incurred some $16.1 billion in losses and a deficit exceeding $18 billion as a direct result of the flooding caused by Katrina.
Even for New Orleanians with flood insurance, coverage likely fell short. Policies typically covered about $152,000—the city’s median house price at the time. But this was rarely enough to replace the damaged household contents or to pay residents for temporary housing while their home was uninhabitable.
More and more, whether people hit by climate-driven storms get anything from their insurers depends not on the fact that their homes were damaged, but on how they were damaged.
While the standard home insurance policy does not cover water damage from a hurricane, it does cover wind damage. This gap left residents and insurers arguing about whether Katrina’s destruction to their homes was caused by its high-velocity winds or the flooding that followed, with multiple lawsuits challenging the validity of flood exclusions in insurance policies. Even before the flooding receded and residents of Louisiana and Mississippi could start to rebuild their lives, courts were inundated with litigation, with about 6,600 insurance-related lawsuits being instigated in the US District Court. Yet, Katrina’s destructive flooding was driven by a storm surge powered by the hurricane’s high winds—the very peril homeowners’ policies are supposed to cover.
On September 15, 2005, Mississippi’s Attorney General Jim Hood filed a case against five of the largest homeowners’ insurers in the state. Attorney General Hood sought a court declaration that the flood exclusion provision in standard home insurance policies was “void and unenforceable” and in violation “of the public policy of the State of Mississippi.” However, in that case and others, courts ruled that the flood exclusions were spelled out clearly in homeowners’ insurance policies and did not violate public policy.
The exclusion of water damage from insurance coverage remains a present issue for existing homeowners. According to the Federal Emergency Management Agency, since 1996, 99% of US counties have been impacted by flooding, but only 4% of homeowners have flood insurance. And, more importantly, over half (56%) of American homeowners don’t know that their home insurance policy excludes flood damage. As hurricane season intensifies, many homeowners will be shocked to learn that their insurance does not cover flood loss.
Insurers’ Favorite Loophole: Wind vs. Water Damage
After Katrina, some insurers exploited the false dichotomy between wind and water damage, classifying losses as water damage to shift liability onto homeowners or the NFIP.
In 2013, a federal jury in Mississippi found that State Farm Fire and Casualty Co. defrauded the NFIP after avoiding covering a policyholder’s wind losses from Katrina by blaming the damage on storm surge, which is covered by federal flood insurance. Almost 10 years later, in August 2022, State Farm settled the case, agreeing to pay $100 million to the federal government.
State Farm was not the only insurer engaged in nefarious behavior, attributing Hurricane Katrina damage to flooding instead of wind. In oral argument before the Mississippi Supreme Court in 2009, insurance company USAA publicly admitted that it shifted its own costs to the NFIP and thus taxpayers.
The false dichotomy between the wind and water damage resulting from a hurricane remains nebulous. The damage caused by Hurricane Ian in Florida, North Carolina, and South Carolina in 2022, with its record-high wind speeds, generated $63 billion in private insurance claims. In contrast, 2018’s Hurricane Florence primarily caused water—not wind—damage in North and South Carolina, leaving uninsured flood losses estimated at nearly $20 billion and letting private insurers largely escape liability. More and more, whether people hit by climate-driven storms get anything from their insurers depends not on the fact that their homes were damaged, but on how they were damaged.
Regulators Must Act: People over Profit
Hurricane Katrina exposed widespread gaps in home insurance coverage that persist today. In the 20 years since Katrina, unmitigated climate change has fueled rising temperatures and made extreme weather events such as hurricanes both more frequent and more severe. As storms grow costlier and more destructive, insurers have raised home insurance premiums and declined to renew many policies, leaving households with fewer options for protection. This escalating cycle has produced today’s insurance crisis.
Federal and state lawmakers must respond. The federal government must reform the NFIP to improve federal flood insurance and ensure it provides affordable coverage for more hazards. At the same time, the NFIP should do more to support community-based mitigation. States, meanwhile, must use their regulatory authority over insurance markets to address skyrocketing insurance costs and growing coverage gaps resulting from mounting climate change impacts.
Regulators should adopt legislation, like New York’s Insure Our Future bill, to prohibit insurers from underwriting new fossil fuel projects, require them to phase out support for existing projects, and force insurers to divest from fossil fuel companies.
The insurance industry cannot ignore its role in fueling the very crisis it now faces. Climate change-induced disasters are indisputably driven by fossil fuel emissions. And insurance companies facilitate climate change by investing in fossil fuel companies and underwriting fossil fuel projects. US insurance companies have investments of more than $500 billion in fossil fuel-related assets, including coal, oil, and gas. In 2022 alone, insurers worldwide collected $21 billion in premiums for underwriting fossil fuel projects—directly enabling their expansion.
Regulators should adopt legislation, like New York’s Insure Our Future bill, to prohibit insurers from underwriting new fossil fuel projects, require them to phase out support for existing projects, and force insurers to divest from fossil fuel companies. Without bold action, insurers will continue to profit from climate destruction while leaving families and communities to bear the costs.
Keep ReadingShow Less
If the Dems Want to Beat Trump, They Should Embrace Medicare for All
If Democrats want to convince voters that they will make their lives better, they need to be identified with policies that will make their lives better.
Aug 24, 2025
At a time when we don’t know if we will have real elections in 2026 and 2028, it may seem a bit absurd to be plotting an agenda for Democrats, but it is essential. While polls show approval for US President Donald Trump and Republicans is plummeting, people are not flocking back to the Democrats.
A major reason is that people don’t know what Democrats stand for, other than not being Donald Trump. While that is an important credential, democracy does still mean something to many people, and that alone is not likely to convince voters to come out and pull the Democratic lever.
Most people do feel they are being screwed by the rich. They have a good case, which has gotten a lot better in the seven months Donald Trump has been in office. His endless tax breaks for the rich and corporations, coupled with all sorts of government giveaways from his crypto scams to giving the right to dump their crap on our lawns (i.e. pollute without constraints), should convince any doubters that we have a government by and for the rich.
But the Democrats need to make the case that they are something different. That will be hard when so many are openly in bed with crypto scammers and other Wall Street high rollers.
Moving to universal Medicare will be difficult both politically and practically, but it can be done.
If they want to convince voters that they will make their lives better, they need to be identified with policies that will make their lives better. Some of these should be obvious.
Raising the minimum wage to $18 an hour is a straightforward one. Minimum wage hikes always poll well, and when referendums have appeared on the ballot, they win even in heavily Republican states like Arkansas. And there is now extensive research showing that modest increases in the minimum wage do not result in job loss.
Workers want to join unions but are stifled by current labor law. Strong protections for worker rights should go a long way here. Suppose we not only had a worker-friendly National Labor Relations Board, but we also had serious sanctions for violations. I suspect fewer bosses would break the law if they were looking at jail time.
That would at least be symmetric. A union official faces jail time if they ignore a court’s back to work order. It seems an employer who continually breaks the law to obstruct workers’ efforts to organize should face similar consequences.
But an item that really should be top of the list is universal Medicare. This had seemed like a big lift to me and many others, which would require a long phase-in period. But Trump and the Republicans’ radical attack on the current hodgepodge system of providing healthcare, coupled with Trump’s extreme uses of executive power, convinced me that we can move quickly in this direction.
The Budget and the Resources for Universal Medicare
In moving toward universal Medicare, it is important to recognize the distinction between the budgetary implications and the real demands on resources. There is no doubt that a universal Medicare program will require a large amount of additional spending, although the increase can be exaggerated.
We will save at least $400 billion a year (5% of the federal budget) on what we pay the insurance industry to shuffle papers and deny people care. Prescription drugs and other pharmaceutical products would also be cheap if the government didn’t give out patent monopolies for these items. We will spend over $700 billion this year for drugs that would likely cost around $150 billion in a free market. The difference of $550 billion comes to $4,400 per household annually.
Contrary to what is often asserted, government makes drugs expensive. We need less government to make them cheap, not more. The same is true for medical equipment, like scanning machines.
We do need to provide incentives to develop new drugs and equipment, but there are alternatives to granting patent monopolies. We can pay people. The National Institutes of Health and other government agencies used to spend over $50 billion a year on biomedical research.
Insofar as it is necessary to raise revenue, Trump has shown us how easy it can be.
We can triple this sum and make all findings fully open source so that new drugs can be produced as generics the day they are approved. This would both make drugs cheap and eliminate most of the motivation for corruption in the pharmaceutical industry.
It’s also worth pointing out that a major reason insurers are so determined to limit care is the high prices of drugs and medical equipment. If a year’s treatment with a drug costs $100,000, as is the case with some new cancer drugs, an insurer will try to avoid paying it. If the cost were around $1,000, which would likely be the case in the absence of patent monopolies, there would be little concern about using the drug, if a doctor determined it to be the best treatment.
But even moving quickly to bring costs down in the healthcare sector, we will still need considerably more money to pay for a universal healthcare system than what the government pays for our current system. This is a place where Trump’s erratic policies have done us a great service.
First, we need to remember that the actual constraint to the government’s spending is not revenue, it is the availability of real resources. In the case of universal Medicare that means the doctors, physicians’ assistants, nurses, medical technicians, home healthcare aides, and other people who directly provide healthcare to patients.
We currently have over 18 million employed in these jobs. We would need considerably more to adequately meet the country’s healthcare needs. We already have shortages in many occupations, and there is a huge problem of access in rural areas and some inner-city neighborhoods.
We can’t immediately fill this shortfall since many of these fields require years of training. If the country moved to universal Medicare, radically ramping up training programs in healthcare fields should be a top priority. We need to go the Immigration and Customs Enforcement route here and offer huge recruitment bonuses. People can be paid tens of thousands of dollars for entering and then completing programs in physical therapy, nursing, and other health-related fields.
We also should be turning to foreign countries for assistance. There already are large numbers of immigrants working in healthcare in the United States. The Trump administration is hard at work deporting many of them. That will make it more difficult to attract foreign healthcare workers in the future, but hopefully a progressive Democratic administration can convince the world that the United States has returned to sanity.
There is an issue that by bringing large numbers of healthcare workers to the United States, especially doctors, we will be depriving poorer countries of desperately needed healthcare providers. There is a simple answer to this. We pay these countries to train two or three healthcare workers for every one that comes here.
This is a classic story of the winners from trade compensating the losers that economists always talk about when pushing trade deals through Congress, but never actually happens after they take effect. The logic is actually solid; the problem is the political will. Anyhow, we can give this compensation and create a win-win situation, if there is political support for it.
Getting back to the budget situation, the problem from large deficits is that they can push the economy beyond its capacity and lead to inflation. That doesn’t seem to be the problem at present, where the economy is showing considerable weakness. It’s hard to say what the world will look like if and when a progressive Democratic administration comes into power.
Insofar as it is necessary to raise revenue, Trump has shown us how easy it can be. He set the country on a course to raise close to $400 billion a year in taxes (more than $4 trillion over a decade), without even getting approval from Congress.
His method of ad hoc tariffs is probably about the worst way to raise revenue, but it does show that it is possible to raise large amounts of revenue. The better routes would be raising income taxes on high-end earners and a corporate income tax that we actually collect. (Either mandate companies give the government non-voting shares of corporate stock, or make returns to shareholders the basis for the income tax; proposals that are too simple for great policy minds to understand.)
We also should apply a modest sales tax to stock trades of say 0.1%. This will hugely reduce the bloat in the financial sector and cost the vast majority of households nothing. The politicians whining that a middle-class family with $400,000 in a 401(k) could end up paying another $100 a year in taxes should be told to eat shit and die. They are shilling for Wall Street: full stop.
Anyhow, the dire budget calculations showing that if we never do anything about deficits, in 2040 or 2050 we will have an incredibly high interest burden might be a good way to employ budget wonks, but they should not be treated as serious basis for policy. We can and do change budgets all the time, and if we do face problems where deficits are pushing the economy beyond its capacity, we know how to raise taxes and, if need be, cut less useful spending.
Moving to universal Medicare will be difficult both politically and practically, but it can be done. Democrats really should have it at the center of their political agenda.
Keep ReadingShow Less
Most Popular