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Murray pushes to halt federal pilot adding AI to Medicare approvals

Murray pushes to halt federal pilot adding AI to Medicare approvals

By Elise Takahama
The Seattle Times, Dec. 15, 2025

U.S. Sen. Patty Murray plans to introduce legislation Monday in an effort to halt a federal pilot program that would add AI reviews to Medicare approvals in some states, including Washington.

The bill, co-sponsored by Oregon Sen. Ron Wyden, follows companion legislation filed in November by U.S. Rep. Suzan DelBene, D-Medina, and five other congressional Democrats, who slammed the program for its potential to exacerbate delays in care for some Medicare enrollees. Patient advocacy groups, physicians and hospital leaders have also raised concerns about bringing in artificial intelligence tools to review pending Medicare procedures, particularly because AI companies will have a financial incentive to deny care.

“The Trump administration is gearing up to use AI to delay and deny Medicare benefits for seniors — this is outrageous and should be a national scandal,” Murray said in a statement to The Seattle Times. “Make no mistake: this is a backdoor effort to privatize Medicare and cut benefits.”

The Centers for Medicare and Medicaid Services announced the new model — known as the Wasteful and Inappropriate Service Reduction, or WISeR, program — in June. CMS Administrator Dr. Mehmet Oz said at the time the goal of the pilot is to protect patients from being given “unnecessary and often costly procedures” by testing a “streamlined prior authorization process” in original Medicare plans, the federal insurance program for people 65 and older, and many younger people with disabilities.

The program is expected to run for six years starting Jan. 1, 2026 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.

If passed, Murray and Wyden’s bill would prohibit the federal government from implementing the model.

According to CMS, the model would work with third-party tech companies to decide the medical necessity of certain procedures deemed “vulnerable to fraud, waste and abuse,” including some nerve stimulators, steroid injections, spine surgeries and skin and tissue substitutes. The program would not review emergency services or inpatient stays, according to CMS.

Health care providers would still look over final denials, government officials have said.

When Robby Stern, a retired gas fitter, first heard about the federal pilot, the Seattle resident immediately felt it would be a “big deal.”

“Holy moly, this is really bad news,” Stern, 81, said he remembers thinking. “We have chosen traditional Medicare because we wanted the primary relationship to be between us and our provider of choice. Not have private corporations be inserted.”

Stern is a past president and active member of Puget Sound Advocates for Retirement Action, and quickly started helping organize presentations at senior living facilities and other community centers to educate other Medicare enrollees about the WISeR pilot.

“People were horrified,” Stern said.

According to the state, Washington has about 1.6 million Medicare enrollees. About half have traditional Medicare plans, while the other half are enrolled in Medicare Advantage, private plans financed by the U.S. government.

Several Washington physicians, both retired and practicing, have also spoken out against the program, and questioned why our state was chosen as one of the pilot sites.

CMS has not been clear about why these six pilot states were selected. According to the Federal Register, the states were chosen based on several criteria, including geographic diversity and types of claims.

CMS did not immediately respond to a request for comment.

Dr. Matt Hollon, president-elect of the Washington State Medical Association and an internal medicine and primary care physician in Spokane, called the federal program “incredibly unfortunate” and said the Murray legislation is an “important step to take.”

“We know prior authorization overall is a significant barrier for patients to adequate care,” Hollon said. “This is not allowing physicians to practice medicine; it’s allowing insurance companies to obstruct medicine.”

Hollon and other providers are well-versed in how prior authorization practices can slow care for significant medical conditions and sometimes result in more expensive treatment, he said. Dana Iorio, a retired primary care provider who worked at Harborview Medical Center, said one of the reasons he left the field in 2019 was because of the excessive documentation required by insurance providers to prescribe certain tests or medications, primarily for his patients with Medicare Advantage plans.

“It would take inordinate amounts of time,” Iorio said. “I once spent over an hour and half with a Medicare Advantage program on a particular patient, just trying to justify getting an ultrasound.”

According to a January report from the American Hospital Association, a survey found that 62% of Medicare Advantage patients had care delayed because of their insurance provider in the past two years. About 43% of patients reported their health worsened as a result.

A 2022 report from the U.S. Department of Health and Human Services’ Office of Inspector General found that about 13% of Medicare Advantage prior authorization denials actually met Medicare coverage rules, but were denied inappropriately.

Denials can not only lead to consequences for patients, but also mean an increased administrative burden and ethical concerns for health providers, said David McLanahan, a retired surgeon who worked for Pacific Medical Center.

“It’s going against physicians’ ethics — they couldn’t do for their patient what they knew the patient needed,” said McLanahan, who co-founded the Washington chapter of Physicians for a National Health Program, an advocacy organization that pushes for a universal single-payer health system.

Hospital leaders, too, are worried about the looming start date of the federal program, and still have a range of questions about how it might affect providers’ day-to-day workload.

“We already have a huge burden with [prior authorization] — that is already something that our hospitals have to hire for specifically,” said Jacqueline Barton True, vice president of advocacy and rural health for the Washington State Hospital Association, which also opposes the WISeR pilot.

“Any expansion of that is really concerning,” she added.

While the pilot is starting fairly small, Barton True said, it’s unclear what the next steps for the program might be. For example, there’s the possibility the model expands to review other types of procedures, she said.

“It starts as a pilot, but where does it go?” she said.

Stern, of Puget Sound Advocates for Retirement Action, acknowledged the desire to reduce “waste, fraud and abuse” in Medicare plans, but said the government should instead be targeting reform in Medicare Advantage plans, where there’s been more evidence of massive overpayments to health insurance companies.

“We all share concern about waste in the system,” he said. “But if you’re really concerned about waste, fraud and abuse, why aren’t you focusing on where the greatest amount of it is?”

https://seattletimes.com…

W.Va. doesn’t know what’s about to hit it

By Dan Doyle, M.D.
Charleston Gazette-Mail, Commentary, Dec. 12, 2025

There are two rural health transformations afoot in West Virginia. One is an innovation transformation being led by Gov. Patrick Morrisey. The other is a devastation transformation brought about by $911 billion in Medicaid cuts in the so-called One Big Beautiful Bill passed by Congress this summer.

As a family physician who has served Fayette County for more than 45 years, I am concerned about the impact that both transformations will have on health care in our state.

As it pertains to what I call the “innovation transformation,” Morrisey announced the concept at a news conference on Nov. 5 and has been touting it ever since. When Republican members of Congress realized the devastation that Medicaid cuts would bring to rural hospitals and rural people in their states, they demanded and got a $50 billion fund intended to prevent rural hospital closures in their state.

The idea is that every state, including West Virginia, gets $100 million per year for five years. The first check should arrive around Dec. 31. The West Virginia application calls for a variety of tech innovations hailing them as great break-throughs. Strangely, almost none of the money goes directly to struggling rural hospitals that the fund was supposed to help in the first place.

For me, this “innovation transformation” is window-dressing designed to distract attention from a greater and much more dangerous “devastation transformation.”

Nationally, the One Big Beautiful Bill cuts $911 billion from Medicaid funding over the next 10 years. About $137 billion of that will be cut from Medicaid for rural states and communities. West Virginia will lose $1 billion per year in Medicaid funding permanently going forward.

According to a study by the University of North Carolina, this puts 700 of 1,800 rural hospitals in the U.S. at risk of closure. Seven of those hospitals are in West Virginia towns and cities:

  • Grafton
  • Grantsville
  • Logan
  • Montgomery
  • Philippi
  • Ripley
  • Welch

The effect will be to create more hospital deserts throughout West Virginia.

The OBBA also cut support for Marketplace health care coverage. This affects 15,000 West Virginians starting now. Over the next decade, 55,000 more West Virginians will lose Medicaid coverage due to the OBBA. Many are ironically referring to this shift as “Capito Care,” since all four West Virginia members of Congress voted for this in July and have been praising it as progress ever since.

So, the devastation transformation takes away $l billion per year from rural health care in our state and the innovation transformation gives back $100 million per year. You do the math. It’s a bad deal for the family that loses their health care coverage. It’s a bad deal for the community that loses their rural hospital. It’s a bad deal for local economies all over the state.

In October, I dusted off my stethoscope and went to work as a volunteer at Beckley Health Right, a free clinic for people without health insurance. I’m afraid a lot of people don’t yet know what’s about to hit them.

Dr. Dan Doyle practiced family medicine in Fayette County for 45 years. He is currently senior organizer for the West Virginia chapter of Physicians for a National Health Program.

https://wvgazettemail.com…

Will the Market Cure Our Health Care System?

What does AI tell us about the competing theories of free-marketism and a leading government role in paying for health care? An exploration of the philosophies of Kenneth Arrow, Milton Friedman, Elon Musk, and Bernie Sanders.

CAPITALISM AND FREEDOM, by Milton Friedman, The University of Chicago Press

“The United States has continued to progress; its citizens have become better fed, better clothed, better housed, and better transported; class and social distinctions have narrowed; minority groups have become less disadvantaged; popular culture has advanced by leaps and bounds. All this has been the product of the initiative and drive of individuals co-operating through the free market. Government measures have hampered, not helped this development.”

UNCERTAINTY AND THE WELFARE ECONOMICS OF MEDICAL CARE, by Kenneth J. Arrow, The American Economic Review

“The failure of the market to insure against uncertainties has created many social institutions in which the usual assumptions of the market are to some extent contradicted. The medical profession is only one example, though in many respects an extreme one.”

Comment:

By Don McCanne, M.D.

The United States has by far the most expensive health care system in the world, and yet its performance is amongst the poorest of industrialized nations.

There is a wide difference of opinion as to what we should do about this. We have a mixture of government programs such as Medicare and Medicaid and private programs such as individually purchased and employer-sponsored private insurance. The mixture of public and private is quite complex, but obviously our high costs and poor performance confirm that we do not have a viable combination. Which way should we go?

It’s time to take an objective look at the contrasting views of two of our most noted economists – Milton Friedman and Kenneth Arrow – each the recipient of a Nobel prize in economics. Although neither totally dismissed private markets or a government role in the health system, they did definitely disagree on the degree of control that private markets should have. Friedman believed that the free market should predominate, whereas Arrow believed that in health care the laissez-faire solution is intolerable due to tne difficulty consumers have in making optimal choices, with severe consequences for errors in judgment.

We would certainly like to know their thoughts on the topic today, but since they are no longer with us, we will have to rely on an alternative source. Artificial Intelligence (AI) has made stunning advances, even with the potential for abuse. Rather than thinking of AI as a digital source of independent production of new concepts, we should consider it an accessible source of encyclopedic information to shed light on a subject as we frame it. Thus, it can be immensely helpful in providing structured summaries of complex ideas otherwise available only in long books or articles. Of course, we must note possible biases in the sources that AI relies on. In other words, we can use AI if we assess its validity based on the components we know. We then use this accessible information to advance our values, such as social justice. Such is my approach today: use AI to remind me (and us) of major contrasting economic philosophies on health insurance.

With this in mind, I submitted several questions to AI “large language models” (LLMs). This is a long post, but I think worth perusing and contemplating. I offer my interpretation at the end.

Part I

I started with a ChatGPT inquiry: “How do Milton Friedman’s concepts compare to Kenneth Arrow’s as a basis for providing health care to everyone?”

Core Philosophical Difference:

Kenneth Arrow: Health care is not a normal market because of:

  • uncertainty
  • information asymmetry
  • ethical obligations
  • social expectations of equity

Conclusion: Market forces cannot reliably or efficiently provide universal health care; public intervention is both justified and necessary.

Milton Friedman: Health care should be treated as a normal market. The main problems is U.S. health care come from:

  • government interference
  • insurance distortions
  • third-party payment
  • overregulation

Conclusion: Less government, more market choice; universal access should be achieved through individual responsibility and market-driven efficiency

What They Believe About insurance:

Arrow: Insurance is essential because illness is unpredictable. But private insurance markets fail due to:

  • adverse selection
  • moral hazard
  • risk-based pricing
  • profit motives that conflict with access

This leads naturally toward:

  • universal compulsory insurance
  • government regulation
  • single payer or NHS-like models as most coherent

Friedman: Insurance is overused and misused:

  • third-party payment drives up spending
  • employer-based insurance distorts the market
  • people should pay directly for most care
  • catastrophic insurance should be minimal and private

He opposed:

  • Medicare
  • Medicaid
  • employer tax subsidies
  • regulation of insurance markets

He favored:

  • Health Savings Accounts
  • high-deductible catastrophic coverage
  • competitive private insurance

How They Think Universal Coverage Should Be Achieved:

Arrow: Universal coverage requires:

  • compulsion (the healthy must subsidize the sick)
  • government as a primary insurer or regulator
  • community rating and standardized benefits

Single payer aligns best with his logic:

  • largest risk pool
  • lowest administrative waste
  • removal of profit-driven selection
  • protects access as a social good

Friedman:

Friedman opposed government-guaranteed universal insurance. He argued universal access could be achieved by:

  • reducing regulation
  • lowering prices through competition
  • giving individuals cash transfers or vouchers if needed

His model is:

  • universally enabled, not universally insured
  • Everyone would have access to a competitive private market, not a public guarantee

Ethics and the Role of Society:

Arrow:

Medical care is a social obligation. Society views relieving suffering as a collective moral duty. This justifies:

  • universal entitlements
  • regulated prices
  • public financing

Friedman:

Medical care is a consumer service. Equality in access is not a social right but an aspiration. The role of society is limited to:

  • charity
  • voluntary philanthropy
  • targeted subsidies

He rejected health care as a “right.”

Bottom Line:

Arrow: Health care is inherently non-market – needs universal public funding.

Friedman: Health care should be a market – government financing distorts incentives.

Part II

Next, I turned to Gemini (Google’s AI) to explore the contrasting views of a modern free-marketeer and a democratic socialist. The richest man in the world, Elon Musk, noted for his strong belief that manipulating society to bring greater personal wealth, might be expected to support markets as a method to fund health care. In contrast, a popular senator, Bernie Sanders, has been quite outspoken in support of single payer as a means of making health care accessible to absolutely everyone at a price each can afford.

Hence, my Gemini inquiry: “Contrast the outcomes of our health care system in the United States that we would see under the guidance of a person such as Elon Musk who values wealth as a determinant in our outcomes as opposed to Bernie Sanders who values social justice in our outcomes.”

Wealth-Driven Outcomes (Elon Musk-aligned Values):

Access and Equity:

Highly stratified access. Premium, personalized, and rapid care for the wealthy; basic, minimized, and technologically lean care for others.

Worsening health disparities. The poor and low-income populations would see reduced coverage for non-essential or high-cost care (e.g., long-term care, some chronic disease management).

Quality of Care:

Elite, high-tech quality for those who can pay. Focus on disruptive technology (AI diagnostics, novel therapies, bio-engineering) accessible primarily to top-tier clients.

A two-tiered system where the most advanced life-saving treatments are a luxury item, not a basic right.

Cost and Efficiency:

Driven by a push for extreme efficiency and cost-cutting in government programs (like Medicare/Medicaid) through technological solutions, aiming to eliminate “waste” and “fraud.”

Lower overall government spending but higher out-of-pocket costs for the majority. Increased financial stress for low- and middle-income families facing medical crises.

Innovation:

Rapid, commercially viable innovation focused on high-profit-margin specialities or luxury-level concierge medicine.

Research and development would be highly concentrated in areas with the clearest path to monetary returns, potentially neglecting low-profit public health issues.

Overall Health:

Increased life expectancy and health for the high-income bracket, potentially widening the gap with lower-income groups.

Poorer population-level health outcomes as preventive care and treatment for social determinants of health (housing, nutrition) are defunded or minimized.

Social Justice-Driven Outcomes (Bernie Sanders-aligned Values):

Access and Equity:

Universal access and comprehensive coverage (e.g.,dental, vision, mental health) for all residents, aiming to eliminate financial barriers to care.

Reduced health disparities across income and race/ethnicity. Poorer Americans and those in rural areas would gain access to services currently unaffordable or unavailable.

Quality of Care:

A single standard of high-quality care for everyone, from primary care to specialty treatments. Focus on preventive care and addressing social determinants of health.

Improved average health and longevity across the entire population as people seek care earlier and manage chronic conditions better.

Cost & Efficiency:

Driven by systemic cost control through federal negotiation of drug prices and standard reimbursement rates for providers, eliminating the fragmented, high-cost private insurance overhead.

Significant reduction in medical bankruptcy and overall household healthcare spending for most families. Higher taxes for wealthy individuals and corporations.

Innovation:

Innovation would be focused on what improves public health and is cost-effective for the entire system, potentially including streamlined processes and primary care improvements.

Drug and device development might be slower or focused less on blockbuster drugs and more on essential, widely accessible medicine.

Overall Health:

Decreased infant mortality, reduced rates of treatable chronic disease, and a narrower life expectancy gap between the richest and poorest citizens.

Improved national health statistics that align more closely with other developed nations that have universal healthcare systems.

Central Contrast: The Guiding Principle

The core difference lies in the guiding principle of the system:

Wealth-Driven: Individual liberty and market efficiency are paramount. The market is seen as the best allocator of resources, and health outcomes are ultimately the individual’s financial responsibility.

Social-Justice Driven: Equality and equity are paramount. Healthcare is a social responsibility and a fundamental right, and health outcomes should be decoupled from an individual’s financial status.

Back to the original question: Will the market cure our health care system?

There is no question that a well-designed single payer system would cure the problems we see, making our system comprehensive, universal (covering everyone), and affordable for each one of us. The evidence from wealthy nations definitively supports Arrow & Sanders: the best-performing systems, on efficiency and outcomes, rely on universal insurance (a single payer or mandated standardized coverage).

What about the free market? Our current system is highly dependent on the market, and, except for the wealthy, it fails on almost every measure, in spite of being by a large margin the most expensive in the world. The only logical conclusion is that we can no longer cite “the Market” as the solution to repairing our highly dysfunctional health care system. Friedman’s and Musk’s predominantly free markets don’t work well in health care.

We need to oppose solutions that are designed primarily to increase the personal wealth of those who are already wealthy, and move to solutions wherein we all take care of each other – solutions wherein we all get the care we need at a price each of us can afford. The market is not and cannot ever be crafted to accomplish that. Single payer would do precisely that.

Market enthusiasts: Silence!

Health care justice advocates: Get to work!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Dismal Health Care Experience Across All US States

National polling of adults finds, remarkably and sadly, that all 50 states and DC get Cs and Ds for the health care experience – cost, quality, and access. Every one. The problem is pervasive, and demands a national solution.

The 10 states with the best health care, according to patients, Medical Economics, November 18, 2025, by Austin Littrell

A West Health-Gallup survey of nearly 20,000 U.S. adults finds large differences in health care affordability, access and quality across the country.

#1. Iowa

Iowa ranks first in the nation for overall health care experience, earning an overall grade of C+, with D+ for cost and C+ for both quality and access.

Iowa is among the states where fewer than 21% of residents say they skipped a recommended medical test or procedure in the past 12 months because of cost, compared to rates above 40% in  several bottom-ranked states. In addition, 12% of Iowans report that someone in their household could not afford prescription medications in the past three months, one of the lowest rates highlighted in the analysis and well below the national figure of 20%.

#51. Alaska

Alaska sits last in the national rankings at 51st, with an overall grade of C-, and receives a D for cost. C for quality and C- for access.

Alaska is grouped with other bottom-ranked states like Texas, New Mexico and Nevada that report “widespread challenges,” including higher rates of delayed or foregone care, more difficulty accessing services and lower confidence in available care.

Although national-level figures show affordability pressures rising everywhere, Alaska’s combination of weak cost and access grades within the Scorecard helps explain why it trails the rest of the country on overall health care experience.

Comment:

By Don McCanne, M.D.

West Health and Gallup have a reputation for developing reliable surveys in health care. This one, which ranks the health care systems of the fifty states and D.C., is remarkable because the first ranking state and the last one are strikingly similar in their performance grades: Cs & Ds.

It is not that the lowest ranking state ranked nearly as high as the highest one, instead the highest one ranked nearly as low as the lowest. It’s stunning. All states are bunched together with very high costs and extremely poor performance.

Many advocate for enacting health system reform state by state, just as Canada did by starting in one province (Saskatchewan). The fact is, we need comprehensive reform in all states, and prior experience demonstrated that many state governments will be unresponsive to the needs of citizenry (none will be, according to this survey).

Thus reform should be universal, including all residents in the nation, regardless of state of residence. A well-designed single payer program does precisely that. It would be simple, generous, equitable, efficient, and health enhancing – for everyone. As this West Health-Gallup survey indicates, no state should be left out. And we need to do it now.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Gratitude for Parody that Inspires Reform

The New Yorker, with its inestimable wit, published a wonderful list of absurd health insurance plans. It made me smile. But collectively they make a sadly sane point: it’s time to abandon our ludicrous health insurance mess in favor of universal publicly funded coverage.

Which of These Updated Health-Care Plans Is Right for You?, The New Yorker — Shouts & Murmurs, November 26, 2025, by Eli Grober

Thrilling news: it’s time to decide what health-care plan you’ll be opting in to for the coming year. Given the feedback we’ve received about how limited and expensive health care has become in this country, we’ve made some updates to our available offerings. Please choose from the following options.

The Basic Plan

This is our most popular plan. It covers things like breathing (allowed, no co-pay), sleeping (hint: you must pretend to sleep in order to fall asleep), and eating (you pay for your own food). No other coverage is provided. This is an ideal choice if you are immune to all diseases, and are also immortal.

The Catastrophic Plan

If the San Andreas Fault opens up, we’ll send Dwayne (The Rock) Johnson to help. Not to help you, specifically—he’ll just generally lend a hand in California. Maybe he’ll leap from one building onto another building. Very cool stuff.

The Become-a-Doctor Plan

This plan costs sixty grand a year and includes a residency at a local hospital, where you’ll learn everything you need to know in order to eventually become the primary-care physician to yourself, and everyone you know. 


The “Looney Tunes” Plan

If a piano falls on your head, or you run off a cliff, because you thought that a painting was a road, you will be tended to by a cartoon rabbit in scrubs.

The Plan Within a Plan

You have to sign up for this plan to read what the actual plan is.

(more in the article)

Comment:

By Jim Kahn, M.D., M.P.H.

This week, befitting the Thanksgiving holiday, many blogs include “Gratitude” in the title. Us too. I’m truly grateful that the New Yorker put a smile on my face with this hilarious run-down of fantastically innovative health plans 
 that seem almost plausible alternatives to the crazily dysfunctional insurance we actually have.

Indeed the last “plan” listed above is largely true: we don’t really know what our insurance covers until we need it. There are far too many limited networks with fictitious provider lists, over-crowded clinical practices, uncovered services, incorrectly denied prior authorizations, and huge (often unmanageable) financial obligations for beneficiaries. Ouch – too much truth.

Let’s make this kind of parody archaic, with single payer. THAT will assure an enduring smile on my face – the economist’s dream of efficiency merged with quality. Indeed, it’s everyone’s dream of health care when you need it, without financial barriers. THAT will justify a truly grateful Thanksgiving, every day of the year, for all the years in our lives.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Dismantling Health Insurance = Increasing Support for Real Reform

GOP cuts to ACA subsidies and Medicaid are stoking widespread fears about the affordability and dependability of health insurance. Their tentative solutions are unworkable. We can, indeed must, use the crisis to grow support for public, universal health insurance.

Republicans Will Never Find a Health Care Replacement, The American Prospect, November 18, 2025, by Ryan Cooper

Republicans, for once, are sounding downright squeamish about onrushing massive cuts to Obamacare subsidies, with premiums on the exchanges expected to more than double on average starting next year. GOP House committee chairs are reportedly having some “brainstorming sessions” about what to do, and House Speaker Mike Johnson claims that they will “be rolling out some of those ideas” at some point.

So far, the genius idea in the lead is Trump’s pitch to reroute subsidies from health insurance companies to the American people, so they can buy health care. (House Republicans have already filed a bill that looks like this.) When asked whether people wouldn’t then just use that money to buy health insurance, Trump replied, “Ahh 
 some may. I mean, they’ll be negotiating prices.” Congratulations, folks, you now get to be your own private dealmaker with the health care system, and with your purchasing power and risk pool of one household, I’m sure you’ll get the best price!

The stupidity is the point. For decades now, the Republican Party has been dedicated to the proposition that rich people are too highly taxed and the working and middle classes get too many benefits from the government. With the passage of the One Big Beautiful Bill, they have finally caught the car. Medicaid and Obamacare have been slashed to free up budget headroom for tax cuts heavily slanted to the wealthy. Republicans don’t have a “health care plan” per se because this is their plan: to take your health care funding and give it to Elon Musk, Donald Trump, and the rest of the fascist billionaire class. 


But it’s a much more practical problem for a Republican trying to write a health care policy. Health insurance is straightforwardly impossible to square with capitalist morality for reasons a child can understand. Most obviously, people routinely get very sick or injured through no fault of their own, and require care that is far more expensive than they can afford out of pocket. Sometimes people have chronic conditions that cost many multiples of what they could ever possibly earn. Therefore, unlike the market for car or home insurance, where each person is charged exactly what they are statistically expected to claim (plus a margin of profit), any functioning health insurance scheme must have systematic transfers from the young and healthy to the elderly and sick. 


Their replacement “ideas” consist of either shifting the [ACA premium] subsidies to people, who will then find out that they’ll have to use the money to buy health insurance. As some Freedom Caucus members recently floated, that could translate into pre-Obamacare fake insurance, which does nothing for people when care is actually needed.

Panic Tears Through U.S. as Health Insurance Costs Spike, The American Prospect, November 21, 2025, by Whitney Curry Wimbish

Open enrollment is under way for 2026 insurance coverage, and millions of Americans are facing extreme sticker shock thanks to the end of expanded Affordable Care Act subsidies, which capped Obamacare premiums for a “benchmark” insurance plan at 8.5 percent of income. Twenty-two million people relied on that funding, at a cost of about $35 billion annually.

With the expanded subsidies set to expire at the end of the year, reverting back to a less generous subsidy level last in place in 2021, patients around the country are facing premium increases that are so extreme, they’re either reducing health insurance coverage or dropping it altogether. Some are facing price hikes many multiples higher than they paid last year; those whose costs only doubled told the Prospect they considered themselves lucky by comparison.

A retiree in Colorado, Jeff Rowan, described how this year’s open enrollment is driven by a sense of fear. His 2026 premium for a health plan on the state insurance exchange went from $350 a month to around $900. So he switched to a plan offered by his pension, which is $700, still a 100 percent increase. Last year, Rowan concluded that was “an outrageous amount.” Not anymore.

At one point, Rowan seriously contemplated dropping health insurance completely, he said. “But the fear of something unexpected happening and my moderate savings being wiped out is forcing me to pay the piper. It’s a completely fear-based decision.” 


Republican lawmakers are reportedly coming up with a fix, such as giving people money directly via flexible savings accounts or health savings accounts, which they would then use to “negotiate prices” with health care companies. Fellow Prospect-er Ryan Cooper notes that this won’t work. Even Trump himself acknowledged that most people would send that money right back to insurance companies, the only entities in the economy with the leverage to negotiate with hospitals under the current system.

THE END OF ACA SUBSIDIES WITH NO PLAN IN PLACE means that people who believe they’re healthy will simply not get coverage, said Dr. Vikas Saini, president of the Lown Institute, a nonpartisan think tank focused on the health care system. The remaining population on insurance will be sicker on average, a condition that doctors and economists sometimes refer to as a worse “risk pool.” That makes it costlier for companies to insure the average policyholder. So the result of millions dropping unaffordable health insurance, as the Congressional Budget Office has forecast, will be that insurance subsequently gets more expensive.

What happens on ACA exchanges doesn’t just stay there. Because major insurance companies are the ones providing the ACA coverage, this means one way they’ll make up the loss caused by the worse risk pool is by raising premiums on their clients who get their insurance through their employer. 


Like others navigating the horror show, Sam said the cost-of-living crisis is frightening. He wonders, if Republicans are going to make health care unaffordable, will they also roll back other Democratic policies, like allowing insurance companies to deny coverage because of pre-existing conditions? Indeed, one of the options Republicans are pitching for patients without insurance is enrolling in “short-term” or “junk” insurance plans, which are not required to cover pre-existing conditions. Officials in five states have barred these products. But the Trump administration relaxed the rules governing them in August.

Comment:

By Jim Kahn, M.D., M.P.H.

Two articles in “The American Prospect” describe vividly how recent federal funding cuts are driving ACA insurance premiums to unaffordable levels and reducing Medicaid coverage for low-income populations. They also highlight the unworkability of GOP ideas to offer a few thousand dollars to individuals to negotiate with insurers for policies that likely will no longer comply with fairness rules instituted by the ACA.

It is, to adopt a slightly profane formulation, a cluster-f*ck. The changes will increase the ranks of the un- and under-insured by tens of millions, and shortchange other critical household needs to scrape up insurance premiums and out-of-pocket costs.

I hate it, for the inhumanity. The silver lining is that many voters – including in the MAGA base – are harshly affected, and know where to cast the blame.

Taking away something good – i.e., ratcheting back health insurance – is easier to recognize than never having received that good in the first place. So, those losing insurance or paying far more for it understand what’s going on and how it’s causing them pain. And they know whom to blame.

And 
 they will be increasingly open to permanent solutions built on a foundation of (familiar refrain now) – public, universal health insurance that is simple, generous, equitable, efficient, and health-enhancing. Single payer.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Health System Insanity Explained to Epidemiologists

A short primer for experts in health and disease (epidemiologists) describes the fundamentally poor health of our health care system. Underlying cause: an excess of monetary incentives. Cure: expunge those incentives.

5 ways our health care system has become utterly insane, Your Local Epidemiologist, Nov. 12, 2025, by Katelyn Jetelina & Hayden Rooke-Ley

To me (KJ), the debate in Washington is far too small. The real story isn’t just whether subsidies stay or go – it’s how completely insane our health care system has become, and whether there will be a serious effort to address underlying costs in the system.

I know juuusssttt enough to get in trouble, so I partnered with the incredible Hayden Rooke-Ley, who is a leading national policy expert in this area, to break down the five ways the entire system has gone off the rails.

1. Costs vs. wages: A 20-year disconnect.

Over the past two decades, the cost of employer-sponsored health insurance has skyrocketed. Premiums, deductibles, and out-of-pocket costs have all soared – far faster than wages. More than half worry they’ll fall into debt any time they use the health care system.  More than 60% of those in medical debt have insurance.

2. We pay the most and get the least.

Outcomes: Despite record spending, Americans live shorter, sicker lives than peers. We underinvest in prevention, such as primary care and social supports like housing and nutrition.

Access: More than 100 million Americans live in a primary-care desert, while almost 60 million live in a pharmacy desert.

Clinician workforce: Health care workers are burning out or leaving the profession altogether.

3. Americans don’t “over consume” health care. Prices and private bloat drive costs.

Americans don’t visit the doctor more, we don’t go to the hospital more, and we don’t stay in the hospital for longer. The real difference is price.

Our system is drowning in private-sector bloat and bureaucracy, more so than any other country. Roughly one in four dollars spent on health insurance goes to something other than care, like marketing, billing, profits or middlemen.

4. Corporate and financial firms have taken over care.

Perhaps the most underappreciated transformation of the past 40 years is the corporate consolidation and financialization of medicine.

Private-equity firms now own everything from nursing homes and hospices, to emergency departments and physician practices. Their model is simple: buy up fragmented practices, cut labor costs, raise prices, and resell for profit.

5. Existing approaches have failed – and the latest proposals are more of the same.

The idea was to embrace more free market principles in health care.

  • Private insurers compete for patients: managed competition, pharmacy benefit managers, etc.
  • Over-reliance on economic incentives: pushing physicians into value-based care, and patients rationing through higher deductibles
  • Commercialization – converting public hospitals to for-profit chains

The current debate recycles the same logic: more private control, higher out-of-pocket costs, and less regulation of prices or profits. The latest idea is that deductibles need to be higher and patients don’t pay enough. 
 This approach has failed for 40 years. 


Bottom line

The U.S. health care system is uniquely dysfunctional. A different approach is entirely possible – if we have the will to boldly govern the health care system in the interests of patients, clinicians, and taxpayers. That means directly tackling prices, eliminating middlemen, and breaking up behemoths. It also means returning ownership of care delivery to clinicians and communities and pursuing a strategy that builds the workforce and capacity to meet America’s needs.

Health care touches everyone, and we need a system that works for us, not one that makes us work for it.

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Epidemiologists are sophisticated in thinking about the prevalence and spread of disease. However, they don’t understand much about health system financing and function. So this essay is a terrific primer for them. It’s an insightful status check on the unhealthy state of our health system. Impression (a medical term): Imbalanced, with excess money and a care deficit – especially for those short on money. High costs and poor performance make it obvious that we need a transformed approach. Treatment plan: Radical shift from money focus to medical care.

It’s clear what policies are needed — providing access to care for all, while keeping the system affordable overall and for each of us. This will require major shifts in approach. Ownership should be shifted to improve access and affordability for everyone, instead of increasingly guiding profits to the wealthy while impairing access and affordability for those with lower incomes – workers and especially the indigent.

The policies we need seem obvious, so it is consensus and collective action that is needed. We actually mainly share core values. We almost all agree that everyone should have the health care that they need. Likewise, that a financing system should be distributed to ensure that the system is affordable for everyone, even if this means that the very wealthy pay a larger amount (that they would never miss), in order to avoid extracting sums from lower income individuals that are needed to meet their most basic needs.

Step back and think about it. If we worked together, we could meet the goals of accessible, affordable health care for everyone without anyone suffering adverse consequences. We are not asking the wealthy to suffer the pains of poverty.

Hayden Rooke-Ley (this time with Katelyn Jetelina) explains how to get the health system to work in favor of everyone. Isn’t it time that we listened to them, to all of the other advocates for health care justice for all, and indeed to our clear collective values?

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

US Poll: Health Care Affordability Is Pervasive Concern

New national polling confirms widespread concerns about health care costs and access, and majority support for a leading federal government role in paying for health care. It’s time for a universal, public solution: single payer.

What Americans think about rising health care costs, according to a new AP-NORC poll, Associated Press, Oct. 21, 2025, by Ali Swenson & Linley Sanders

Most U.S. adults are worried about health care becoming more expensive. About 6 in 10 Americans are “extremely” or “very” concerned about their health costs going up in the next year, the survey from The Associated Press-NORC Center for Public Affairs Research finds.

The poll found that about 4 in 10 Americans are “extremely” or “very” concerned about not being able to pay for health care or medications they need, not being able to access health care when they need it, or losing or not having health insurance. Federal policies have left millions of people at risk of skyrocketing health insurance premiums or of losing their health insurance altogether.

About 8 in 10 U.S. adults say the issue of health care is “extremely” or “very” important to them personally. That includes about 9 in 10 Democrats and three-quarters of Republicans, and it puts health care next to the economy among Americans’ top issue priorities.

President Donald Trump’s mega-bill that passed this summer cuts more than $1 trillion from federal health care and food assistance over a decade. Republicans say the cuts will prevent people who don’t need aid from gaming the system, but the cuts will ultimately result in millions of people losing health insurance coverage, according to projections from the nonpartisan Congressional Budget Office.

In interviews, some Americans said they doubted government leaders would take the necessary action to address their concerns on health care. But the poll reveals a deep ideological divide over what the government’s role should be, with Democrats far more likely than Republicans to say it’s the federal government’s job to make sure all Americans have health coverage. About 8 in 10 Democrats say this, compared with about one-third of Republicans.

About 4 in 10 U.S. adults say they trust Democrats to do a better job handling health care, compared with about one-quarter who trust the Republicans more. About one-quarter trust neither party, and about 1 in 10 trust both equally.

Comment:

By Don McCanne, M.D.

Let’s see if we can make sense of the attitudes of Americans toward health care costs.

First, probably the most important fact is that 80% of Americans believe that health care is ‘extremely” or “very” important to them personally. This has clear bipartisan support – 90% of Democrats and 75% of Republicans.

Second, 60% of all Americans are concerned about health care costs going up next year, and 40% believe that health care and insurance will be unaffordable or inaccessible.

Across the board, Americans believe that some changes need to be made to assure that health care will be affordable and accessible. But then comes the partisan divide: whether Democrats or Republicans would be more capable of taking the necessary actions to address Americans’ concerns on health care.

Let’s break down the numbers. Fifty percent believe that the Democrats would do a better or at least a competent job in handling health care (40% better, 10% equivalent to Republicans). Thirty-five percent believe that the Republicans would do a better or competent (25% better, 10% equivalent to Dems).

So what have we learned from this poll? People are clearly worried about affordability and accessibility of health care now, and even more for the future. Although a majority of Democrats and a minority of Republicans believe that the Democrats would do a better job in fixing the system, it appears that we should seek solutions that would receive bipartisan support.

We now have many studies that show that a well-designed single payer system could both provide affordable and comprehensive care for everyone, while bridging political differences in reform ideologies. Here’s how:

Single payer design features would automatically include everyone while reducing the profound excess expenditures caused by private insurers and private equity that diverts patient care funds to the entrepreneurial intermediaries that have driven up costs and driven down system performance. These funds would be re-directed to the delivery system for the benefit of patients (and thus reduce moral injury for providers). By eliminating administrative waste and profits for passive investors, we would have sufficient funds to provide care for everyone.

How about the political differences? With preferences for Democratic policies outweighing Republican policies, we could sit down and agree that the taxes used to pay for the system would be progressive, based on the ability to pay. The vast majority of taxpayers – Dem & GOP – would find that those taxes are reasonable. Billionaires might object to the numbers on their tax forms, even though they would see no impact on their lifestyles.

Isn’t it about time that the Republicans, Democrats, and Independents decide to cooperate on striving for a better society for all of us – by sitting down to craft a health care system that would solve our current problems and work well for all of us? Efficient cooperation seems like a much better approach than expensive and inefficient bickering. That’s the wealthy nation standard; let’s get with the program!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Dr. Diljeet Singh on NBC 4 Washington

PNHP president Dr. Diljeet Singh and immediate past president Dr. Phil Verhoef spoke to NBC 4 Washington for a news segment that was posted on November 3, 2025.

“Tens of thousands of people die every year because they do not have health insurance,” said Dr. Singh, who was leading a march and rally at the U.S. Capitol as part of PNHP’s first ever Advocacy Day in Washington, D.C.

Rachel Fox on CBS 9 Washington

SNaHP leader Rachel Fox spoke to CBS 9 Washington for a news segment that was posted on November 3, 2025.

“The corporate takeover of the health care system is unsustainable,” she said. “We’re here to fight for patient rights, and for our rights to practice.”

Over 200 doctors, medical students, and activists were in Washington, D.C. for a march and rally at the U.S. Capitol, as part of our first ever federal Advocacy Day.

Universal Healthcare is a Winning Strategy for the Dems & All of Us

Current political battles over health insurance focus on premium ACA subsidies and protecting Medicaid funding. The president of PNHP reminds us that the real answer lies in a grander vision, which has wide popular support: universal health insurance.

Universal Healthcare Will Save Lives
 and Could Save the Democratic Party, Common Dreams, Oct. 22, 2025, by Diljeet K. Singh, MD, DrPH, president of Physicians for a National Health Program

As the only wealthy country without universal coverage, sticking to our current system is truly not “politically feasible.” Democratic leaders need to understand and embrace America’s desire for change.

The ongoing government shutdown, a standoff over health insurance premiums, is a missed opportunity to truly reform healthcare and revive the Democratic Party.

Democrats have been hyper focused on restoring Medicaid cuts and preserving Affordable Care Act (ACA) subsidies to blunt the harmful healthcare impact of the Republican budget. But this narrow strategy not only fails to address the core issues of the current system but ignores what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy. 


Americans want trustworthy, high-quality healthcare without conflicts of interest, co-pays, deductibles, or financial risk. A May 2025 Pew poll confirms this, with 68% of Americans, including 90% of Democrats and 45% of Republicans, believing the government should provide health insurance for all. A November 2024 Gallup poll shows 62% of Americans, including 90% of Democrats, 65% of Independents, and 32% of Republicans, think the federal government should guarantee health coverage for everyone. And a 2024 Marist Poll found 86% of Gen Z and 76% of Millennials also share the opinion that health insurance is the government’s responsibility. 


Meanwhile, Democrats are defending the status quo instead of fighting for the comprehensive health care reform that Americans need. Despite the unpopularity of much of what the Trump administration has done, support for the Democratic Party from its core members remains slim, with historically low voter registration and approval numbers. Championing universal healthcare gives Democrats a chance to move away from the status quo and win back frustrated voters, especially the youth.

Comment:

By Don McCanne, M.D.

Recently we pointed out that a health policy issue (ACA premium subsidies) is central to the federal budget battle and shutdown. Dems and voters favor retaining the subsidies.

In the above commentary, Dr. Singh – president of PNHP – emphasizes that maintaining a few subsidies isn’t going to cure our health insurance woes or help the Democrats. Instead, what’s needed is universal coverage – i.e., single payer, Medicare for All.

Dr. Singh states that “what most Americans want most: a system free from profit-driven conflicts of interest, prior authorizations, co-pays, deductibles, or the threat of bankruptcy.” And, “Americans from all parties agree that our political and economic systems need change.”

Yet neither major political party has it right in that the Republicans propose changes that would make our system worse, and the Democrats defend the status quo that has been so ineffective.

What both sides should agree on is that a comprehensive system progressively funded based on ability to pay, with billionaires contributing far more healthcare costs than they consume (but leaving them plenty for their extravagant lifestyles).

Bringing health insurance reform to the forefront now is timely with Dr. Singh leading the upcoming national meeting of PNHP, an organization that has long been a leader in the fight for comprehensive, accessible health care for everyone at a price that each of us can afford. She is correct that advocating for guaranteed, high quality, affordable health insurance that would boost the Democrats.

Yet, let’s look more broadly. Since we prefer that reform be based on sound policy rather than divisive politics, can we contemplate joining across parties in supporting health care justice for all, rather than battling ballrooms for billionaires vs. the unpopular status quo? There are plenty of Republicans, Independents, and Democrats who would unify on a government-financed health insurance approach that would guarantee all Americans “trustworthy, high quality health care without conflicts of interest, co-pays, deductibles, or financial risk.”

Let’s do it.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

“Last Week Tonight” on Medicare Advantage

“Last Week Tonight with John Oliver” aired a lengthy segment on the so-called “Medicare Advantage” program on October 26, 2025.

Oliver covered the many disadvantages of these corporate health plans masquerading as Medicare: limited provider networks, prior authorization requirements, surprise medical bills, and outright denials of care.

PNHP was one of the organizations briefing the show’s producers on the ins and outs of the “Advantage” program, including our comprehensive reports on overpayments, patient harms, and racial inequities.