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medicare advantage
Obamacare Won’t Work: Time for Medicare for All
Our healthcare ‘system’—with or without the Affordable Care Act—is unsustainable: we have reached the end of the line.
Mar 14, 2026
Those without employer sponsored insurance (or Federal insurance like Medicare or the VA) in Red states, who signed up for the Affordable Care Act (aka Obamacare), are now learning what they voted for: higher premiums for health insurance, maybe unaffordable. Meanwhile, premiums continue to rise relentlessly for employers and employees.
Our healthcare "system" is unsustainable: we have reached the end of the line.
Americans pay more for healthcare (about18 percent of GDP) than any other developed country, with mediocre outcomes. Yet the other countries, with better outcomes, have universal coverage.
It is time for change. Extend traditional Medicare to all Americans (gradually, over the course of several years). Medicare is familiar; it works. Private for profit-health insurance, less than a century old, makes no sense today.
Sick and injured patients have turned to medicine—to healers—since time immemorial. Health insurance is new: Blue Cross started as a community non profit organization in 1929, to cover surgery in hospitals.
Private for profit-health insurance, less than a century old, makes no sense today.
Yes, we are a capitalist country, and markets are efficient at producing many things, like commodities: groceries, shoes, cars, even some insurance, when it is straightforward and highly regulated, like auto insurance. But for-profit health insurance does not work.
The idea of insurance is to spread risk over a maximum number of subscribers, each of whom is at the same low risk of unpredictable casualty, like fire. This was essentially the situation of Americans a century ago—illness and injury were acute and unpredictable, patients either recovered or died. Everyone was at similar risk, only surgery was expensive.
Today is different: illness is not only predictable, it can be chronic, even life long. Moreover, today’s scientific care is expensive. The social determinants of health—income security, education, adequate food and shelter, social support (your zip code, not your genetic code)—plus public health, keep healthy people healthy.
Medical care is for the sick.
For-profit health insurers maximize premiums, minimize cost (provider fees), keep the difference, and most important, avoid the sick. Insurers exclude those with “pre-existing” conditions whenever allowed (not under the ACA), deny "authorization" where they can. They tailor "plans" with carefully engineered restrictions you don’t discover until you file a claim. They are not even providing insurance: the payments from the Federal government are risk adjusted, so the insurers are paid more for riskier patients (and they are now illegally upcoding). The providers are not. Making this happen entails huge administrative expense, which adds no value for patients or providers, only massive returns to investors. United Health Group is the third largest company in the Fortune 500.
Healthy people don’t know what plan is "right for them"; they hate the annual "choice." They only know what they can afford. (Sick people know what they need.) They do want to choose their doctor.
Traditional Medicare eliminates these problems for its beneficiaries: by law, everything medically necessary is covered. The Federal government determines fees for doctors and hospitals based on cost, as it did historically when markets didn’t work. Beneficiaries pay premiums based on income.
Fee-for-service works when we pay the right fees for the right services. Today, based on 1950’s medicine, Medicare pays too little for office visits, so-called ‘cognitive’ services (versus procedures) both primary and specialized, so there are too few providers, especially as Medicare rolls expand with retiring
Boomers. No office doctor can make a living from Medicare anymore. That is, however, easy to fix: pay providers more to care for the sickest people, who need the services only highly skilled, experienced physicians can provide. Pay surgeons less.
Best of all, Medicare is simple—ask your grandmother.
But where will the money come from?
Start by eliminating Medicare Advantage (MA) and Part D, while updating Medicare to cover prescription drugs, along with vision, hearing aids, etc. MA was supposed to save taxpayers money by providing care more efficiently. Instead, Medicare pays MA companies 20 percent more than traditional Medicare for comparable patients.
Then, require all employers (including those who currently don’t provide insurance) to pay premiums to Medicare based on payroll. Require employees to pay Medicare premiums based on wages. Just like Social Security (of which Medicare is technically a provision). The Federal government continues to pay a share.
Everyone pays, everyone gets the care they need and nobody is left out. People can choose any qualified provider. Providers remain private, and are paid enough to attract and sustain the clinicians we want and need.
We have tried every kind of private for profit health insurance there is: employer sponsored, government subsidized, market based, capitation, value-based, catastrophic, health savings accounts—it no longer works for employers, taxpayers, or the sick. This year premiums will go up, coverage will go down.
Americans’ health will suffer.
Americans need care, not coverage. We clinicians have dedicated our lives to providing it. Medicare has served millions of us well for 60 years. We cannot allow opportunistic capitalists to stand in the way for the rest.
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'Medicare Advantage Is Not Medicare': Democrats Proposal Would Unmask For-Profit Fraudsters
"We don't allow banks to call themselves the U.S. Treasury Investment Fund," said Rep. Mark Pocan. "We don't allow anyone to call themselves USPS Plus. So why allow insurance companies to call private insurance Medicare Advantage?"
Mar 05, 2026
A group of Democratic lawmakers on Wednesday reintroduced legislation aimed at reining in for-profit insurance companies who use the Medicare name to market their plans.
The "Save Medicare Act," being reintroduced by US Reps. Mark Pocan (D-Wis.), Ro Khanna (D-Calif.), and Jan Schakowsky (D-Ill.), bars private insurers from using the word "Medicare" in marketing their plans, imposing "significant fines" for any insurer that doesn't comply.
At issue, the lawmakers said, is that insurers are flooding the airwaves with ads for Medicare Advantage plans during open enrollment periods. The ads are deceiving Americans into thinking their plans are just variations of Medicare services offered by the federal government, they said.
"Let’s be clear: Medicare Advantage is not Medicare," said Schakowsky. "These private insurance plans use Medicare’s trusted name while too often denying medically necessary care, restricting providers, and overcharging taxpayers by billions. That is unacceptable. We have seen insurers exploit the system to boost profits at the expense of seniors."
Khanna noted that Medicare Advantage is "a private insurance program that too often boosts profits by limiting coverage," even as it "misleads seniors into thinking it's traditional Medicare."
"That's wrong," Khanna emphasized. "This legislation will stop private insurers from cashing in on the Medicare name. We should be working to protect and expand real Medicare instead."
Pocan declared that "only Medicare is Medicare," adding that Medicare Advantage plans "often leave patients without the benefits they need while overcharging the federal government for corporate profit."
"This bill makes clear what is—and what is not—Medicare," added Pocan, "and ensures this essential program will continue to serve seniors and other Americans for generations to come."
Pocan also posted a video on social media where he talked about his elderly mother being unable to see the physician that came to her assisted living home because she relied on Medicare Advantage and the doctor in question was out of network.
"She would have had to go all the way across town to get that care," Pocan explained. "The problem is, she wasn't very mobile and she never got the medical care."
We don't allow banks to call themselves the U.S. Treasury Investment Fund. We don't allow anyone to call themselves USPS Plus.
So why allow insurance companies to call private insurance Medicare Advantage?
I’m reintroducing the Save Medicare Act with @RepRoKhanna and… pic.twitter.com/c6dAXpEJqY
— Rep. Mark Pocan (@RepMarkPocan) March 4, 2026
"We don't allow banks to call themselves the U.S. Treasury Investment Fund," said Pocan. "We don't allow anyone to call themselves USPS Plus. So why allow insurance companies to call private insurance Medicare Advantage?"
Many progressive critics have for years pointed to Medicare Advantage as a legitimate example of wasteful spending by the federal government.
A report released in January by the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises lawmakers on Medicare, estimated that overpayments to Medicare Advantage plans could total $76 billion in 2026.
One major factor in the overpayments is that patients using Medicare Advantage plans tend to be healthier than patients on traditional Medicare, with the result being that private insurers charge the government more than is necessary to meet these patients' needs.
On Wednesday, Schakowsky said that the "crucial legislation" she joined Khanna and Pocan in introducing "will end deceptive marketing and ensure beneficiaries understand the difference between traditional Medicare and private insurance plans."
"Seniors deserve transparency, accountability, and the full benefits they have earned," she said.
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A $1.2 Trillion ‘Rip Off’: Report Spotlights Massive Scale of Medicare Advantage Fraud
"These private insurer-run plans are more expensive AND lead to worse outcomes for patients," said Rep. Pramila Jayapal. "It’s time to rein in Medicare DisAdvantage and protect traditional Medicare."
Jan 28, 2026
A report released earlier this month to little fanfare estimated that federal overpayments to privately run Medicare Advantage plans could total $76 billion this year—or potentially a staggering $1.2 trillion over the next decade if current trends persist.
The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises lawmakers on Medicare, calculates overpayments by comparing spending on Medicare Advantage (MA) plans to what the federal government would have spent if MA enrollees were on traditional fee-for-service Medicare.
In a report published earlier this month, MedPAC showed that overpayments to MA plans this year are projected to be around $76 billion. Roughly $22 billion of that total is due to coding practices by MA providers, which are notorious for making patients appear sicker than they are to receive larger payments from the federal government. MA plans are paid lump sums to cover expected future healthcare services for patients based on their risk scores.
Another factor driving overpayments to MA plans—which now cover 55% of eligible Medicare beneficiaries—is a phenomenon known as favorable selection. MA enrollees tend to be healthier on average than recipients of traditional Medicare, resulting in higher payments to Medicare Advantage plans than are necessary based on patients' healthcare needs.
According to MedPAC, favorable selection will account for $57 billion of the expected overpayments to MA plans this year. The Trump administration gave Medicare Advantage plans a more than $25 billion boost in federal payments for 2026, even amid mounting bipartisan concerns about fraud in the program.
The National Committee to Preserve Social Security and Medicare (NCPSSM) said the MedPAC analysis "confirms that these private plans are bleeding taxpayers for billions of dollars more than traditional Medicare would cost for comparable enrollees."
US Rep. Pramila Jayapal (D-Wash.) wrote in response to the MedPAC findings that "Medicare DisAdvantage will rip off American taxpayers to the tune of $76 billion in 2026."
"These private insurer-run plans are more expensive AND lead to worse outcomes for patients," Jayapal, a leading supporter of Medicare for All legislation in the House, wrote in a social media post. "It’s time to rein in Medicare DisAdvantage and protect traditional Medicare."
The MedPAC analysis was released days after Republicans on the Senate Judiciary Committee published a report revealing how UnitedHealth Group, the largest provider of MA plans in the US, "has turned risk adjustment into a major profit-centered strategy," reaping massive payments from the federal government through upcoding.
NCPSSM noted that "while UnitedHealth... has emerged as the worst offender, it’s abundantly clear that many MA insurers are engaged in these shady practices."
"Look no further than insurers’ reliance on prior authorizations for procedures and treatments that normally would be automatically covered in traditional Medicare," the group said. "This includes denying skilled nursing care that jeopardizes older patients who have nowhere else to turn."
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