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medicare advantage
We've Endured a Half-Century of Kleptocrats' Plunder of People's Wealth and Health
Neoliberalism has spurred 45 years of financialization, as Wall St. pillages-for-profit every sector, from healthcare to housing.
May 21, 2025
The Franklin D. Roosevelt administration prioritized a standard for economic and democratic empowerment of the people. FDR's New Deal advanced the common good and an economy for the people. The 1935 Social Security Act became the boilerplate for universal healthcare.
The post-WWII "Golden Age" of capitalism boosted economic growth, people's prosperity, and middle class expansion, lasting until 1975—subsequently displaced by global neoliberal capitalism.
Principle Political Dichotomy: Corporatists vs. Working People
Since the 1970s white supremacists, Christian nationalists, and aspiring oligarchs have converged under the Republican Party umbrella to seek deconstruction of democracy toward harnessing wealth and political power, while promoting supremacistentitlement—the presumed right to criminalize and hold hostage other people's lives based on gender, ethnicity, religion, and class wealth.
Nixon Supreme Court appointee Lewis Powell's 1971 Memorandum, termed a "capitalist coup," further galvanized corporate money toward rewrite of law, policy, and judicial precedent to consolidate corporate political power.
Since Reagan, continual huge tax cuts for wealthy corporatists have spiked national deficits, paid for with deficit-cutting on the backs of working people by cutting public and social programs.
Kleptocracy, also known as "socioeconomic thievery," describes the half-century robbery of the American people by corrupt leaders who expropriate wealth of the governed for their own gain. Contemporary Gilded Age Robber Barons continue to expropriate people's wealth. A RAND Corporation Report reveals that from 1975-2023 the top 1% robbed $79 trillion from the bottom 90%. Had earnings remained equitably distributed at pre-1975 levels, the average worker in the bottom 90th percentile would earn $32,000 more annually.
Even as the neoliberal "greed is good" ethic prioritized enhancement of shareholder profits, Reagan administration neoliberalism supercharged wealth transfer upward, crushing unions and wages, gutting antitrust law, deregulating banks and industries, enabling predatory private equity practices, and legalizing stock buybacks that continue to multiply billionaires' wealth.
Neoliberalism has spurred 45 years of financialization, as Wall St. pillages-for-profit every sector, from healthcare to housing. Kleptocrats leverage rivers of dark money to capture media and dominate lobbyist-controlled legislatures and elections, flooding the 2024 election with nearly $2 billion.
Commodification of Health for Profit Betrays the Original Intent of Medicare
The Social Transformation of American Medicine, by sociologist Dr. Paul Starr is a Pulitzer Prize-winning chronicle of corporate takeover of U.S. healthcare. Starr describes former President Richard Nixon as the first mainstream political leader to "take deliberate steps to change American healthcare from its longstanding not-for-profit business principles into a for-profit model to be driven by the insurance industry."
A 1971 video exchange between President Nixon and his aide John Ehrlichman celebrated the Kaiser CEO's prioritization of profit over healthcare. Enthused Ehrlichman, "...All the incentives are toward less medical care, because the less care they give them, the more money they make."
Ostensibly intended to cut costs and improve healthcare access, Nixon's 1973 HMO Act advanced the concept of for-profit "managed care" health models. Each manifestation of managed care, including Accountable Care Organizations and Medicare Advantage, have proved increasingly profitable for Wall St. and the health industrial complex.
With passage of the 2003 Medicare Modernization Act, former President George W. Bush spearheaded privatized, for-profit Medicare Advantage insurance, purportedly written to "compete" with Original Medicare to save costs and improve healthcare access. Failing to do either, Medicare Advantage betrays the original intent of Medicare—to universalize coverage and rein in health costs with transparent pricing. Medicare Advantage plans often lack data and compliance information, while payment rates are manipulated based on a complex "risk modeling" process.
The Center for Economic and Policy Research reports: Even as Medicare Advantage insurers' profits are inflated, quality of patient care is reduced.
The United States remains an outlier—the only developed nation lacking universal healthcare, the only nation that places profiteering middlemen between patients and their doctors.
Since Reagan, continual huge tax cuts for wealthy corporatists have spiked national deficits, paid for with deficit-cutting on the backs of working people by cutting public and social programs. The 2025 Republican reconciliation bill promotes enormous tax cuts for the wealthy, and huge cuts to Medicaid and SNAP programs.
Were House Republicans serious about cutting "waste, fraud, and abuse," instead of cutting Medicaid coverage for 8.7 million people, they would eliminate Medicare Advantage scams that bleed $140 billion in annual overpayments from the Medicare Trust Fund—invested in as a lifetime earned benefit by every U.S. worker. Fraudulent "upcoding" exaggerates patient health conditions, costing $23 billion in 2023 overpayments. Some Medicare Advantage plans employ AI or a computer algorithm to instantly deny payments—reportedly used by Cigna to deny over 300,000 requests for payments in 2022.
Rigged to maximize government overpayments to pad shareholder and CEO profits—ultimately to privatize Original Medicare—Medicare Advantage overpayments are funded by taxpayers and Medicare Advantage and Traditional Medicare enrollees, who pay, among other costs, increasing Medicare Part B premiums annually—totaling $13 billion higher premiums in 2024.
A physician-authored report advises: "The time has come to declare Medicare Advantage a failed experiment and abolish it." Taxpayer overpayments to Medicare Advantage should instead go to boost an economy and healthcare for the people by eliminating profit-maximizing insurance middlemen. At least 22 studies report annual $600 billion Medicare for All administrative savings, enough to extend comprehensive health coverage to all ages.
A 2018 economic analysis by UMass Amherst Economists concluded that Medicare for All would significantly improve healthcare outcomes, and reduce healthcare spending by nearly 10%—from approximately $3.24 trillion to approximately $2.93 trillion. Additional projected annual prescription drug savings total $200-$300 billion.
Washington Complicity in Half-Century Privatization of Medicare
Further boosting privatization of Medicare, the Centers for Medicare and Medicaid Services' (CMS) "innovative payment" experiments, modeled on "Managed Care" Accountable Care Organizations, were written into the Affordable Care Act. The Congressional Budget Office reported in 2023 that CMS experiments with "value-based" ACO payments failed to control costs, improve quality, or increase equity, costing Medicare $5.4 billion more than it saved during its first decade.
Medicare for All Would Vitalize an Economy for the People
The United States remains an outlier—the only developed nation lacking universal healthcare, the only nation that places profiteering middlemen between patients and their doctors. U.S. healthcare spending since 1980 outpaces other nations, and demonstrates "by far the worst overall health performance."
Only Single-Risk-Pool Medicare for All can leverage cost-savings of global health budgets to achieve financially sustainable, universal, comprehensive healthcare, while greatly reducing the 30% administrative costs of thousands of fragmented Medicare Advantage plans. The newly introduced Medicare for All Act of 2025 would eliminates out-of-pocket costs—premiums, copays, and deductibles—and unnecessary supplemental plans—Medicare Parts A, B, C, D, and Medigap.
For the first time in almost a century prioritization of universal health coverage would eliminate profiteering middlemen, boosting an economy that serves working people—not the ballooning billionaire kleptocracy.
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Medicare Advantage Bribery Scheme Highlights 'Bad Behavior' Trump Wants to Reward
"The Trump administration recently announced it would substantially increase payments to private Medicare Advantage plans in 2026, rewarding their bad behavior."
May 02, 2025
Healthcare advocates have long condemned the for-profit insurance companies that manage Medicare Advantage plans for overbilling the federal government by hundreds of billions of dollars per year, using artificial intelligence and algorithms to deny patients' claims, and tricking patients with disabilities via deceptive marketing practices—and a lawsuit originally initiated by a whistleblower is accusing three such private insurance giants of taking part in overt bribery.
The U.S. Department of Justice filed a complaint Thursday under the False Claims Act, accusing three of the largest Medicare Advantage insurers—Aetna, Humana, and Elevance Health—of paying brokers hundreds of millions of dollars to steer beneficiaries toward their plans, and to steer disabled seniors away in an effort to keep them more profitable.
The American Economic Liberties Project (AELP) noted that the lawsuit comes from an unlikely place—the Trump administration, which last month announced it would substantially increase payments to the privately run plans, increasing rates to the tune of $25 billion in additional funds next year despite their history of defrauding the government and patients.
While applauding the DOJ for cracking down on the bribery scheme, the group noted that "despite its promises to crack down on such wasteful spending, the Trump administration recently announced it would substantially increase payments to private Medicare Advantage plans in 2026, rewarding their bad behavior."
Dr. Mehmet Oz, who President Donald Trump appointed to lead the Centers for Medicare and Medicaid Services, has also advocated for a proposal called Medicare Advantage for All—further expanding the for-profit plans that now cover more than half of Americans who are eligible for Medicare.
"For years, these firms have driven seniors into worse care with deceptive marketing and discrimination, but now it's clear they're crooks too."
The lawsuit filed Thursday also named three brokers—eHealth, Inc., GoHealth, Inc., and SelectQuote Inc.—and said that between 2016-21, the companies "paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers' Medicare Advantage plans."
The brokers are accused of directing beneficiaries to the plans that paid them the most in kickbacks, regardless of the suitability of the plans. They also allegedly provided their employees with incentives to sell plans based on the payments from the three insurers and refused to sell Medicare Advantage plans for the three companies if they didn't pay the brokers sufficiently.
Aetna and Humana are also accused of conspiring with the brokers to "discriminate against Medicare beneficiaries with disabilities whom they perceived to be less profitable," threatening to withhold payments unless brokers enrolled fewer disabled senior citizens.
"Private Medicare Advantage plans routinely fail to deliver quality care—especially for seniors and the most vulnerable—and are among the most wasteful, fraudulent, and abusive actors in our healthcare system," said Emma Freer, senior policy analyst for healthcare at AELP. "For years, these firms have driven seniors into worse care with deceptive marketing and discrimination, but now it's clear they're crooks too—bribing brokers behind closed doors because they know no one would choose these plans on a level playing field."
In addition to cracking down on the bribery scheme, Freer called on Trump's DOJ to "move swiftly on its ongoing monopolization and fraud investigations in the largest Medicare Advantage plan provider, UnitedHealth Group."
The DOJ opened an investigation in February into UnitedHealth's effect on competition in insurance, pharmacy benefit management, physician networks, and other sectors of the for-profit healthcare industry.
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Heal This Sick Country: ‘Hands Up’ for the National Day of Action for Single Payer
Over 70 local and national organizations have endorsed the National Day of Action. On May 31, focus the outrage to move the engine of change and put single payer on the nation’s agenda and remove profit from healthcare.
Apr 27, 2025
On Jan 17, 2025, on the heels of the shooting of UnitedHealthcare CEO Brian Thompson, we wrote about the failed system of our corporate controlled healthcare and the outrage against the health insurance industry the shooting spawned. We mentioned the possibility of setting a National Day of Action in 2025 to demand freeing healthcare from profit and covering everyone under a national single payer plan.
Today, we call on people across the country to gather on May 31, 2025, to put their “Hands Up” for:
- The recognition by our government that healthcare is a human right;
- The elimination of private health insurance and the banning of for-profit delivery of care;
- The enactment of a publicly financed, national single-payer program that would provide comprehensive coverage to everyone; and
- The transformation of care delivery from profit-seeking ventures into services organized to serve the people of our country, a system in which all caregivers are freed from corporate control.
President Donald Trump’s inauguration has introduced the prospect of severe hardships to working class and low-income people, people with disabilities, the elderly, and children with proposed cuts to Medicaid, Medicare, and Social Security necessary to fund tax cuts for the wealthy. This moment demands more than the protection of our public programs; it demands a national, single-payer healthcare program, free from profit, for everyone. One people, one plan.
The complicity of our government in the profit-making enterprise of health insurance has been exposed once again when, on Monday April 7, the Trump administration raised payment rates for Medicare Advantage insurers by 5.1%, significantly more than the Biden administration’s proposed increase of 2.2%, which was bad enough. This rate increase has the potential to increase payments to MA by $25 billion next year. However, the final sum will be closer to $60 billion, when the impact of gaming the system through risk scoring is included.
Paying health insurance premiums to a for-profit company that has been given permission to restrict and withhold necessary care is the great scam of modern U.S. healthcare.
As predicted, Medicare Advantage continues to gain enrollment because they offer lower premiums compared to Traditional Medicare. Now they can expect payment from the Medicare trust fund at a higher rate as they have almost every year under Democrat and Republican administrations since 2016. Early this month, while the rest of the market spun out of control due to the announcement of tariffs, insurance stocks soared after the Centers for Medicare and Medicaid (CMS) announced the Medicare Advantage rate hike.
Despite rate increases, Medicare Advantage will continue to operate within narrow networks that often don’t include specialty care, such as Cancer Centers of Excellence. Unlike Traditional Medicare, beneficiaries in Medicare Advantage must accept pre-authorization requirements to receive care that create the delays and denials of care. Many seniors are unaware that in all but four states, once they have enrolled in a Medicare Advantage plan, they cannot change to Traditional Medicare without being subjected to underwriting and the potential of very high premiums if they have preexisting conditions. Paying health insurance premiums to a for-profit company that has been given permission to restrict and withhold necessary care is the great scam of modern U.S. healthcare.
Medicare is only one part of the privatization of government sponsored health insurance: Medicaid is now largely privatized in 42 states, subjecting children from low-income families and low-income adults to the delays and denials that are the mainstay of cost controls in managed care private insurance plans. Seventy five percent of all Medicaid beneficiaries now are enrolled in a Medicaid Managed Care Organization (MCO), and Medicaid MCO denials are twice as high as denials in Medicare Advantage. Five Fortune 500 health insurance companies enroll 50% of all Medicaid beneficiaries, all publicly traded and high performing profit makers.
Over 90 million Americans eligible for government supported healthcare, both Medicaid and Medicare, are now captives of private insurance managed care schemes that control their access to healthcare. Many more millions on Traditional Medicare are being “aligned” by CMS into profit-seeking Accountable Care Organizations. The underlying profit extraction inherent in these schemes prevents critical services from reaching the right people at the right time.
The same can be said for employer-based insurance where workers are paying excessive premiums to health insurance companies to be given the privilege of paying deductibles and coinsurance that make accessing care so expensive that many forgo needed services. According to the Commonwealth Fund, premiums and deductibles consume 10% of the median household income in the U.S. This means that every household with employer health insurance making $80,610 per year or less is underinsured. Employers are faced with increasing insurance premiums for their employees that challenge their ability to stay in business, or in the case of public schools, the ability to keep schools open.
Enough is enough! Over 70 local and national organizations have endorsed the National Day of Action. On May 31, join an action or plan an action in your community. Focus the outrage to move the engine of change and put single payer on the nation’s agenda and remove profit from healthcare. On May 31, put your “Hands Up” for National Single Payer—an Improved Medicare for All free from profit with everybody in and nobody out. Nothing less can heal the nation.
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