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Improved Medicare for All Can Heal This Sick Country
A system that collects money from patients and employers then profits by withholding the promised care is not a business but a fraudulent, diabolical scam.
Jan 17, 2025
It’s the beginning of the end for corporate control of health care. The tsunami of outrage against the health insurance industry in the wake of the shooting of United Healthcare CEO Brian Thompson, can propel an urgent, unyielding demand for the removal of profit from healthcare and the enactment of a universal, national single payer system. That is, if the single payer, Medicare for All, national health service movement can summon the vision and audacity to rise to the occasion.
The myth, promoted by health care think tanks and policy experts, that people in the United States are satisfied with their health insurance was exploded in the social media rage unleashed in the aftermath of the killing of the United Healthcare CEO.
Fifteen years after the passage of the Affordable Care Act (ACA), our failing health care system is exposed with all its cruel denials, debt, disease, despair and death at the hands of the investor-owned companies for whom patients are merely pawns for the extraction of profit.
Health care in the United States comes in dead last when rated against comparable countries. The U. S. is at the bottom in overall performance, health outcomes, equity, access to care, and efficiency. As the Commonwealth Fund states: “In fulfilling this fundamental obligation [the ability to keep people healthy], the U. S. continues to fail.”
Health care in the United States comes in dead last when rated against comparable countries.
People in the United States aren’t living to their full potential. Already, the U.S. is 55th in life expectancy, behind Panama, Albania, and Czechia, and will fall in its global rankings by 2050 if the country continues the same trajectory. Years of life are lost to a health care system that serves profit over the value of life.
Our maternal mortality rate would be the shame of many of the poorest nations. In 2020, U.S. maternal mortality rate was higher than in Gaza. In 2022, there were 22 maternal deaths per 100,000 live births in the U.S. This is easily double, and often triple, the mortality rate in peer nations, which can be as low as 5 per 100,000 live births. Black mortality rate is criminally worse: 49.5 per 100,000 live births.
Over one million in the U.S. died in the pandemic, a rate much higher than other nations. Over 330,000 of the pandemic deaths in the U.S. were avoidable. Those lives could have been saved had we had a healthcare system that left no one with inadequate coverage.
Cancer patients must not only fight for their lives but also for the economic survival of their families. The newest treatments with so much hope are beyond the means of those who have insurance policies but no great wealth. About 30% of cancer survivors report lasting financial hardship.
Cancer patients are nearly 5 times more likely to experience bankruptcy, and the medical burden forces many to forego care.
Those who have employer-based insurance were assumed to have the gold standard in health care. Now even the highest paid workers are subjected to premiums, deductibles, and co-pays that impede their care despite the family plans that average $32,000 per year. More have insurance that covers less than a hospital gown. Gold has turned to scrap metal.
As people struggle to pay for the premiums, deductibles, and co-pays, revenues of the seven largest health insurance companies in 2022 reached $1.25 trillion and profits soared to $69.3 billion. That’s a 287% increase in profits in just one decade, when profits were $24 billion.
The toxicity of the health care profit makers that spread unnecessary suffering and death generates the hatred that is poisoning the land.
Medicare, our best health care program, publicly funded and open to all, is now strangled in the grip of the privatized Medicare Advantage plans and the Accountable Care Organizations facilitated by the Center for Medicare and Medicaid Innovation (CMMI). Medicare Advantage now controls a majority of recipients, not because it is better, but because the law that established it and the regulators that control it have allowed it to charge less in monthly premiums—plans that are also allowed to delay and deny care yet are overpaid by billions every year. CMMI issues waivers to the private plans exempting them from fraud and abuse laws and allowing kickbacks, self-referral, and illegal benefit inducement.
Millions on fixed incomes cannot afford the alternative of traditional Medicare plus a prescription drug plan and a supplementary Medigap plan. Those who have managed to escape the clutches of Medicare Advantage can still find themselves assigned, without their knowledge, to “value-based” payment schemes such as ACO REACH and other Accountable Care Organizations (ACOs) which privatize traditional Medicare. “Value-based” payment models are touted, without evidence, as reducing costs for Medicare, yet encompass a multitude of for-profit entities and subject patients to physicians incentivized to deny care. There is ample evidence that “value-based” payment schemes do not lower costs for Medicare. Nevertheless, the privatization of Medicare, through Medicare Advantage or ACOs, is now official policy.
The hoax of “value-based” payments, promoted by CMMI, is exposed by the fact that, despite all the assertions of promoting equity, the inequities of health care are expanding.
Medicaid, the program for children and adults with low income, is almost completely privatized, subjecting the recipients to delays, denials and restrictions imposed by the private managed care organizations that control it.
The Center for Medicare and Medicaid Services (CMS) is hurtling down the wrong track. They invite venture capital and health care investors into the Health Care Payment Learning and Action Network (LAN) that they created. CMS holds conferences, seeking advice and collaboration from the very profiteers that are the cause of high cost, low-quality care. The “value-based” payment scheme promoted by CMS has advanced the power of the profit makers, raising costs, cutting care, and pretending to promote equity for minorities and low-income patients.
It’s time to end the chaos. No more foxes in the hen house, no more poison in the system, no more profit in health care.
The toxicity of the health care profit makers that spread unnecessary suffering and death generates the hatred that is poisoning the land.
It’s time to end the chaos. No more foxes in the hen house, no more poison in the system, no more profit in health care. The nation has rejected the insurance company health care model that delays and denies care, demands skin in the game, asserts that there is massive unnecessary care, throws up barriers against care, and walks away with billions. A system that collects money from patients and employers then profits by withholding the promised care is not a business but a fraudulent, diabolical scam.
This system built on profit cannot be tweaked or regulated into better performance. Runaway trains are not deterred by guardrails.
There is one way to heal the nation. Put single payer on the nation’s table and focus the steaming rage to move the engine of change. Raise the demand for removal of profit and enactment of an Improved Medicare for All free from profit to a level commensurate with the damage that our current failing system is causing the patients’ and the country’s goodwill.
Some look at the current Congress, make the assessment that it’s not possible to pass single payer, then change their demand to a lesser proposal. But incremental changes are at the root of the privatization and profit schemes we are locked into now. Fifteen years after the ACA we have a failing health care system. We have witnessed that more incrementalism does more harm than good. Power concedes nothing without a demand, and the demand must be equal to the solution needed.
There is one way to heal the nation. Put single payer on the nation’s table and focus the steaming rage to move the engine of change.
As Marcia Angell, former editor of the New England Journal of Medicine, taught us, in our current private profit-based system, proposals that lower costs also decrease care, and proposals that increase care, raise costs. To improve care and control costs, we must turn to national single payer, free from profit or a national health service.
The status quo is deadly, and people are demanding a stronger more effective fight. We must organize and educate, locally and nationally with a new determination. In every town hall, classroom, union, organization, and neighborhood, people must hear the message and join the fight. Redirect the rage into a positive force for change.
The new anger in the nation makes possible what we could not do before. Many are now discussing the possibility of setting a National Day of Action in 2025 to demand freeing health care from corporate profit and covering everyone under a national single payer plan. That’s a great idea. Actions across the country lifting up that demand could inspire the movement we need.
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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Patients, Advocates Push Biden to 'Reclaim Medicare' From Privatized Medicare Advantage
"If Medicare Advantage has it their way, they're going to deny me care and delay me care until I'm dead," said one patient.
Mar 15, 2024
Patients on Medicare Advantage spoke out against the privatized plans this week as part of a coordinated campaign to shed light on the program's care denials, treatment delays, and overbilling—and to pressure U.S. President Joe Biden to rein in the insurance giants raking in huge profits from such abuses.
"These corporations do nothing to increase positive outcomes in medical care. So don't fall for their bullshit," Jenn Coffey, a retired EMT from New Hampshire, said during a livestream hosted by People's Action on Wednesday night.
The stream featured testimony from several patients who have experienced the kinds of delays and denials for which Medicare Advantage is notorious.
Rick Timmins of Puget Sound Advocates for Retirement Action said it took five months and "multiple calls and emails" for his insurance company to approve his referral to a dermatologist for a suspicious lump on his earlobe that turned out to be malignant melanoma. The delay stemmed from a byzantine process known as prior authorization, whereby doctors are required to prove a treatment is necessary before an insurer will cover it.
By the time his referral to a specialist was approved, Timmins said, the previously tiny lump "had tripled in size" and was "quite painful."
MA insurance companies find it financially beneficial to delay essential care to patients.
Medicare (Dis)Advantage plans take the problems of private health insurance and import them into Medicare. @PplsAction #CareOverCost pic.twitter.com/V21nKlkyLj
— Social Security Works (@SSWorks) March 14, 2024
Coffey, for her part,
ended up on a UnitedHealth Medicare Advantage plan after she was diagnosed with breast cancer in 2013. She later developed two rare diseases—including complex regional pain syndrome—and required expensive treatments that her Medicare Advantage plan refused to cover.
"If Medicare Advantage has it their way, they're going to deny me care and delay me care until I'm dead," Coffey, a healthcare advocate, said in a video published Thursday by the advocacy group Be A Hero as part of a social media day of action against the for-profit plans.
"They only make money when they don't have to spend it on you," said Coffey.
Once enrolled in a Medicare Advantage plan, patients often find it difficult to get out.
"They like to tell you: 'Medicare Advantage numbers are so high, can't you tell people love it?'" said Coffey, alluding to the fact that more than half of all eligible Medicare beneficiaries are now enrolled in a Medicare Advantage plan. "No, we don't. We're stuck. It's the Hotel California: You can check in, but you can't get the hell out."
“If Medicare Advantage has it their way, they’re going to deny me care and delay me care until I’m dead.” — Jenn
The greedy health insurance corporations that run Medicare (Dis)Advantage will always put profits above patients. That’s why we’ve got to #ReclaimMedicare. pic.twitter.com/0ED1iHBu0u
— Be a Hero (@BeaHero) March 14, 2024
Next month, the Biden administration is expected to finalize 2025 payment rates for Medicare Advantage, which is funded by the federal government. Medicare Advantage plans frequently overbill the government by making patients appear sicker than they are.
An analysis released last year by Physicians for a National Health Program estimated that Medicare Advantage plans are overcharging U.S. taxpayers by as much as $140 billion per year—an amount that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare's prescription drug program.
Patients and advocacy groups are calling on Biden to "not fork over more money for insurance companies like UnitedHealthcare," as Coffey put it during Wednesday's livestream.
A petition sponsored by Social Security Works urges Biden to "reclaim Medicare" from Medicare Advantage providers, which "have delayed and denied care to millions of Americans in order to turn a massive profit."
"Medicare Advantage isn't really Medicare, and it isn't an advantage to the seniors and people with disabilities who rely on the program," reads the petition, which has over 22,800 signatures as of this writing. "In the 25 years that it has existed, it’s clear that Medicare Advantage is riddled with the same problems as the rest of private insurance: Opaque bureaucracy and extraordinary fees. Seniors who enroll in these for-profit plans are being price-gouged by massive corporations."
The Biden administration has proposed a 3.7% payment increase for Medicare Advantage in 2025—a change that insurers have portrayed as a cut. But Social Security Works noted in response to the industry's complaints that "MA companies are not hurting for profits."
"In 2022 alone, seven healthcare companies that comprise 70% of the MA market brought in over $1 trillion in total revenue and over $69 billion in profits, and spent $26.2 billion on stock buybacks," the group observed. "These same companies claim that if the government doesn't increase their already bloated payment rates, they will have no choice but to slash benefits for patients. This is false, and should be seen for what it is—MA plans holding patients hostage to extort the government for profits."
In an op-ed for STAT last month, former insurance industry insider Wendell Potter—who is now an outspoken critic of private insurers—and John A. Burns School of Medicine professor professor Philip Verhoef wrote that "private plans have no business administering Medicare benefits."
"Traditional Medicare is already more efficient than its private counterpart, in large part because the approval process is much simpler and there aren’t the same incentives to upcode," the pair wrote. "Traditional Medicare spends far less of its funds on administrative overhead, and overall it spends less money per patient than Medicare Advantage while providing far superior access to doctors, hospitals, and treatments."
"Medicare Advantage isn't working for any group: the government, patients, taxpayers, and now even investors," they added. "It's time to turn to what we already know works. We need to support and strengthen traditional Medicare."
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Biden DOJ Launches Antitrust Probe Into Medicare Advantage Behemoth UnitedHealth
"For years, UnitedHealth has unfairly and illegally leveraged each of its businesses to strategically squeeze out competitors and monopolize all corners of healthcare," said one researcher.
Feb 28, 2024
The U.S. Justice Department has launched an antitrust investigation into UnitedHealth Group, the world's largest health insurance company and a major provider of private Medicare Advantage plans that are notorious for
denying necessary care and bilking taxpayers.
The probe, first reported by The Examiner News and confirmed by The Wall Street Journal on Tuesday, drew applause from anti-monopoly campaigners who argue that healthcare industry consolidation has harmed patients through higher costs and worse care.
Matt Stoller, research director at the American Economic Liberties Project, said in a statement Tuesday that the Department of Justice is "right to investigate UnitedHealth Group for monopolization, and we hope to see enforcement action taken soon."
"For years, UnitedHealth has unfairly and illegally leveraged each of its businesses to strategically squeeze out competitors and monopolize all corners of healthcare, from insurance and pharmaceuticals to home healthcare," said Stoller. "In the process, UnitedHealth has degraded patient care, demoralized and devalued doctors and nurses, put independent pharmacies out of business, and ripped off taxpayers."
"United gained its foothold on the system through its relentless path of acquisitions."
The Examiner News reported that the DOJ notified UnitedHealth last October that it had launched a "non-public antitrust investigation into the company." According to the Journal, Justice Department investigators "have in recent weeks been interviewing healthcare industry representatives in sectors where UnitedHealth competes, including doctor groups."
Optum, a subsidiary of UnitedHealth, is the largest employer of doctors in the U.S., and the company is currently working to acquire the home healthcare provider Amedisys in a $3.3 billion deal that has drawn scrutiny from the Justice Department.
As Krista Brown and Sara Sirota wrote last year for the newsletter HEALTH CARE un-covered, "It's not hyperbole to describe UnitedHealth as the bulk of our country's healthcare system—and its $85 billion in publicly disclosed acquisition spending played a big part."
"United gained its foothold on the system through its relentless path of acquisitions," they added, "and each additional business it purchases is, and has been, used to leverage its control of the healthcare industry."
UnitedHealth is currently the nation's largest provider of privately run, publicly funded Medicare Advantage plans, which have faced growing criticism from the Biden administration and Democratic lawmakers for dramatically overcharging the federal government and denying care claims that likely would have been approved under traditional Medicare.
Last year, UnitedHealth ditched the brand name naviHealth, a technology-focused subsidiary that faced backlash after reporting by STAT detailed the company's use of artificial intelligence algorithms to deny essential care to elderly patients.
Additionally, as Brown and Sirota noted, UnitedHealth employees alleged that company executives " pressured them to deny coverage or lose their jobs," sparking a class-action lawsuit.
"In short, naviHealth was transformed from a company meant to better manage post-acute care to a machine that maximizes profits," Brown and Sirota added. "It was UnitedHealth-ified."
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