PNHP

GOP Medicaid Cuts: Multifaceted, Severe, Deadly, Machiavellian

GOP Medicaid Cuts: Multifaceted, Severe, Deadly, Machiavellian

The GOP is well on its way to enacting major cuts to Medicaid. These have multiple components, with serious damage to care access, and thousands of added deaths. Surprisingly, the GOP has a strategy to minimize political blowback.

Tracking the Medicaid Provisions in the 2025 Reconciliation Bill, Kaiser Family Foundation (KFF), Updated: May 19, 2025

Requires states to impose cost sharing of up to $35 per service on expansion adults with incomes 100-138% FPL; maintains existing exemptions of certain services from cost sharing and limits cost sharing for prescription drugs to nominal amounts. Maintains the 5% of family income cap on out-of-pocket costs. Effective Date: October 1, 2028

Reduces the expansion match rate from 90% to 80% for states that use their own funds to provide or support health coverage … for individuals who are not lawfully residing in the US. Effective Date: October 1, 2027

Requires states to condition Medicaid eligibility for individuals ages 19-64 applying for coverage or enrolled through the ACA expansion group on working or participating in qualifying activities for at least 80 hours per month. Effective Date: January 1, 2029

Limits retroactive coverage to one month prior to application for coverage. Effective Date: October 1, 2026

Delays $8 billion annual reductions in subsidies for hospitals with high uninsured and Medicaid rates to September 30, 2028.

Blocks implementation of long term care nurse staffing requirements.

Blocks Medicaid participation for large not-for-profits providing primarily reproductive health care, i.e., Planned Parenthood.

House Republicans’ Medicaid Cuts and Associated Lives Lost, Center for American Progress, May 15, 2025

House Republicans’ radical new budget plan proposes requiring states to implement Medicaid work reporting requirements for adults enrolled through the Affordable Care Act’s (ACA) Medicaid expansion. Under this proposal, nonpregnant, nondisabled, noncaregiver adults ages 19 to 64 would be required to document at least 80 hours per month of work or qualifying activities (such as volunteering) in order to maintain their Medicaid coverage. Otherwise, they would need to seek approval for a qualifying exemption.

Evidence from prior state-level implementations show that bureaucratic paperwork requirements do not increase employment but do result in large-scale coverage losses—even among those who are working or should be exempt from the requirements.

The consequences of such coverage losses, however, are not just administrative: For thousands of Americans, they would be deadly. New estimates from the Center for American Progress show that 6.9 million people losing coverage by 2034 as a result of congressional Republicans’ proposed paperwork requirements would lead to more than 21,600 avoidable deaths nationally each year. [Provides table of avoidable deaths for selected Congressional districts.]

Comment:

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

Medicaid cuts in the House budget reconciliation bill just passed out of committee are a marvel of multidimensionality, severity, lethality, and politically adroitness. One by one:

Multifaceted: As inventoried by KFF, the changes are far-reaching in type, including enrollee cost-sharing, lower federal payments for states supporting undocumented immigrants, a work requirement, limited retroactivity, blocking minimum nursing staffing levels finalized under Biden, and proscribing participation by Planned Parenthood.

Severe: These are huge changes, with outsized increases in state costs; impaired affordability of care for enrollees with tenuous finances; millions of eligible individuals excluded from coverage by onerous (and ineffective) work requirements; dangerous nursing levels; and loss of a highly regarded provider organization. These shifts will massively impair access to care, with millions losing coverage and millions more facing new financial barriers. It will buffet state budgets, particularly in blue states that help the undocumented get coverage.

Deadly: As excerpted above, CAP estimates 21,600 added annual deaths, based on a 2017 study of Medicaid-associated reductions in mortality. Other research supports the substantial life-saving effects of Medicaid, including a comprehensive 2021 study using national surveys and datasets, and a just-published article in Lancet. There’s no question: cutting health insurance kills.

Machiavellian: The political chatter around these expected Medicaid cuts was that they would hurt the GOP in the 2026 midterms and 2028 presidential election. We underestimated the GOP political acumen / deviousness. Note that the most obviously hurtful provisions (e.g., cost-sharing and work requirements) go into effect only in late 2028 / early 2029 – thus minimizing pain to voters and electoral harm to the GOP in the interim. Guess who’ll be blamed by the voters for late 2028 and early 2029 Medicaid cuts? The Dems, if they win. Of course the Dems can cancel the cuts, but not in time to avoid significant political damage. And with GOP tax cuts (for the rich) and the Trump-tariffs-induced economic downturn, the federal budget won’t exactly be flush with funds to restore the program.

It’s truly astounding how complex Medicaid rules, funding, and politics have become. Take an apparently good idea – provide health insurance for the poor – and ultimately what you get is a major political distraction, with the immediate losers being the poor, and the long-term losers being the country. If only, if only … we could figure out a way to pay for health care simply, efficiently, generously … whereby we could remove our medical care from the dirty domain of party politics.

https://healthjusticemonitor.org…

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The U.S. Healthcare System in Conversation with Dr. Don McCanne

It leads the world in innovation and spending, yet leaves millions uninsured or in debt. We trace the history of how the US healthcare system became a profit-chasing industry, and speak with Dr. Don McCanne, a longtime physician and advocate, about what a more just and accessible future could look like.

By Chloe Crawford
Spero ~ Hope for the Future, May 13, 2025

The US healthcare system lives in two realities.

It is a system home to innovative treatments, leading research, and world-class hospitals, with the highest spending on health per person when compared to similar wealthy nations.1

However, simultaneously, it is a system where millions of Americans face barriers to healthcare. They must navigate complicated insurance rules, and a reality where an unexpected illness or accessing care without insurance can result in bankruptcy and crippling debt.

This leaves many to ask, “Why is access to healthcare in the United States so complicated and so expensive?”

To help answer this question, we spoke with Dr. Don McCanne, a retired physician, longtime health policy advocate, and Senior Health Policy Fellow with Physicians for a National Health Program (PNHP). Dr. McCanne has spent decades treating patients and fighting for reform. We explore how the U.S. got here – and with the help of Dr McCanne –  how it might set out a different path forward.

History of Healthcare in the US

While many similarly wealthy countries began to implement national health insurance plans throughout the 20th century, the US did not.

A brief timeline:

Early 20th Century – Independent physicians and low costs: In the early 1900s, most doctors in the United States worked independently, healthcare costs were relatively modest, and hospitals were often community-run or charitable institutions. There was a lack of country-wide healthcare initiatives or legislation. Most healthcare matters were left to states, who in turn left them to private and voluntary programs.

World War II – Birth of employer-based insurance: During World War II, wage controls prevented employers from raising salaries, so many began offering health insurance as a benefit to attract workers.3 This marked the beginning of America’s widely employer-based model of healthcare, where affordable access to healthcare became tied to one’s employment.

Post-War Era – Rise of for-profit insurance: Private health insurance was initially offered by nonprofit organisations like Blue Cross, which charged flat rates for hospital coverage.4 But after the war, they faced growing competition from for-profit insurers, who introduced risk-based pricing and charged more to groups with a history of higher health costs.5 For example, older or disabled workers faced higher rates. This laid the groundwork for systemic differences in access and affordability of healthcare.

Cold War Impact – National Health Insurance attempts blocked: While several presidents, including Truman and Kennedy, proposed national health insurance, these efforts met fierce resistance.6 Opponents, especially the American Medical Association and private insurers, framed such proposals as “a communist plot,” invoking Cold War fears of communism.7 As other wealthy nations built universal health systems after World War II, the U.S. doubled down on private-sector solutions.

1950s-60s – Tax policy and expansion of private plans: Private insurance continued to expand, partly because employer contributions to health coverage were not included in a worker’s taxable income.8 This tax advantage made it cheaper for employers to offer health benefits, cementing the dominance of private, job-based coverage. Meanwhile, those without employer coverage – especially retirees, the poor, and the unemployed – were often left behind.

1965 – A turning point! The creation of Medicare and Medicaid: President Lyndon B. Johnson signed the first nationwide public health insurance programs into law in 1965.9 Medicare provides federal health coverage for those over 65 and some with disabilities. Medicaid, a joint federal and state program, covers low-income individuals and families, but eligibility varies by state.

1980s-90s – Managed Care and Market Logic: Healthcare costs surged in the 1980s due to the introduction of new and expensive medical technologies, the use of a fee-for-service payment model (doctors and hospitals are paid for each test, procedure, or visit) which incentivised overuse, and minimal price regulation.10 In response, insurers introduced managed care models which restricted users to agreed-upon care providers and often required pre-approval to access certain services.11 While managed care briefly slowed cost growth, it also limited patient choice and created frustration and confusion among both patients and providers.

2010 – The Affordable Care Act: Introduced by President Obama and often referred to as Obamacare, it was aimed at reducing the number of uninsured Americans.12 It expanded Medicaid in many states and created online marketplaces where people could compare insurance plans. However, it preserved the central role of private insurers.

US healthcare is now a patchwork of private insurance plans and employer-sponsored coverage. While programmes like Medicare and Medicaid have helped millions, the system remains fragmented and dependent on private insurers. Dr McCanne and many like him believe these programmes need to go further. His career saw the impact of Medicare’s introduction on his elderly and retired patients, many of whom were living only on a social security check and were “suddenly able to have essentially unlimited healthcare.”

This is an approach he believes could work for everyone. However, over time, healthcare in the US has solidified itself as a for-profit industry, rather than a basic necessity for the benefit of everyone.

The Current US Healthcare System

Today, about half of Americans get insurance through work. Around 9% have no insurance at all, and many more are underinsured.13 The current system is costly, complex to navigate, and corporatised.

Insurance doesn’t always mean affordable – Most plans include:

  • Deductibles: What you pay before insurance kicks in
  • Copays: Fixed fees for services (like $40 to see a doctor)
  • Coinsurance: A percentage of costs you must cover (e.g. 20% of a hospital bill)

This means that many people who are technically insured still incur very high upfront or out-of-pocket costs.14

Insurance networks are restrictive – Most insurance plans use provider networks, approved doctors, and hospitals that have contracts with your insurer. If you go out-of-network, you’ll pay much more (or sometimes everything!) yourself.

Drugs and treatment are expensive! – Drug prices in the U.S. are much higher than in other countries.15 For example, insulin can cost almost 5x more in the US compared to just over the border in Canada.16 A key factor in this difference is that the US doesn’t regulate drug prices when products are launched or when substantial price increases are enacted after launch.17

Covid-19 exposed the underlying issues in the system – The pandemic laid bare some of the key systemic failures of US healthcare. Millions lost their jobs and, as a result, their health insurance. Hospitals were overwhelmed. Essential workers risked their lives with minimal reward.18 The crisis amplified calls for a more resilient, equitable system, not tied to employment nor distorted by profit.

Corporate Consolidation Has Taken Over Care – Healthcare is no longer local or community-based. Now, it’s big business. Through a process known as vertical integration, insurers, hospitals, and clinics have merged into giant corporate systems. For-profit companies now own the vast majority of healthcare facilities and practices, including hospices, nursing homes, and ambulance companies. For example, UnitedHealth, one of the largest insurers in the US, uses its offshoot company Optum to control more than 1500 clinics with 60,000 doctors. McCanne and his colleagues point to this example as evidence that “Increasingly, Americans’ insurer is also their doctor.”19

This corporate consolidation means less competition, fewer independent doctors, and decisions driven by profit for shareholders, no matter the cost to patients.

The result? Medical debt is one of the number 1 causes of bankruptcy in the U.S.20

Even insured patients can end up owing thousands for hospital stays, Emergency Room visits, or medications. Surprise bills, out-of-network charges, and denied claims leave many financially devastated.

Studies show:

  • 41% of US residents carry medical debt.21
  • 60% of uninsured adults delay care due to cost.22
  • Crowdfunding sites like GoFundMe host over 250,000 medical fundraisers every year.23

Another Path Forward

For decades, advocates like Dr. McCanne and organisations like Physicians for a National Health Program (PNHP) have championed Medicare for All – a single-payer national health insurance system that:24

  • Covers every American
  • Is funded publicly through taxes
  • Eliminates private insurance companies
  • Reduces wasteful bureaucracy
  • Gives doctors and patients freedom from insurance and profit-driven decisions

This doesn’t have to come at great cost to the American people. Dr McCane points to the many studies that show that comprehensive care can be provided to everyone at no greater cost than is currently being spent.25

But McCanne and others now recognise that even this bold reform must go further. They want you to ask not just how care is paid for care but who owns and provides it.

As corporate control over care delivery grows, reformers argue that the US needs a National Health Service model – publicly funded and publicly owned. In this model:26

  • Hospitals, clinics, and other vital facilities would be owned by the people, not shareholders.
  • Local communities, not corporate head offices, would control how care is delivered.
  • Federal oversight would ensure quality and equity.
  • The focus would shift from financial return to human well-being.

This approach would put public health back in the hands of the people, where it belongs.

Dr Don McCanne on how to fight for better

Dr. McCanne’s story is one of lifelong commitment. Inspired by his father, a teacher who became a physician later in life, he and his twin brother entered medicine not to get rich, but to serve. They set up and ran a community practice in San Juan Capistrano where they accepted all patients, no matter their citizenship or financial status.27

Now in his late 80s, despite health issues and retirement, he continues to write and advocate for change. He co-authored the long-running “Quote of the Day” column on health policy, now continued as Health Justice Monitor by his colleague, Dr. Jim Kahn. Even in today’s turbulent political climate, he still believes progress is possible:

“The injustice of our healthcare system is becoming harder to ignore. People are waking up.”

When asked what gives him hope, he points to the next generation. “At 87, I know that I won’t see it, but I still have hope for the future.”

Dr McCanne shows us the impact of showing up, dedicating time to your community and not losing hope. He still believes that the US has every potential to live up to its proclamations of being a great country for all those who live in it. Healthcare reform in the United States is not a pipe dream. It is within reach.

Dr McCanne serves as a reminder that change doesn’t start in government; it starts with people who care. Patients, doctors, nurses, and voters must stand together and demand a system that works for everyone. This sentiment rings even more true next to a backdrop of recent cuts to healthcare programmes and research.28

When reflecting on his lifelong fight for more equitable and accessible healthcare in the US Dr McCanne leaves us with this: “I realise that there is so much more work left to do, and it’s going to have to be done by you. I just hope that some of us can provide a modicum of inspiration to help move the process forward. We are so close.”

What You Can Do

Learn more about the solutions being proposed to US healthcare at: PNHP.org, Health Justice Monitor, DoctorsForAmerica.org

If you live in the US, talk to your representatives, share your own experiences and struggles with the system and vote at elections with healthcare in mind!

For those outside the US, take inspiration from Dr McCanne on how to persevere in pursuing a more just world for yourself and others.

Stay tuned at Spero to learn about other healthcare systems around the world!

https://spero-hopeforthefuture.com…

Bibliography

  1. Turner, Ani, George Miller, and Elise Lowry. “High U.S. Health Care Spending: Where Is It All Going?” The Commonwealth Fund, October 4, 2023.
  2. Palmer, Karen S. “A Brief History: Universal Health Care Efforts in the US.” PNHP. Presented at the Spring, 1999 PNHP Meeting, 1999.
  3. Field, Marilyn J, and Harold T Shapiro. Origins and Evolution of Employment-Based Health Benefits. Nih.gov. Washington DC: National Academies Press (US), 1993.
  4. Field, Marilyn, and Shapiro. Origins and Evolution of Employment-Based Health Benefits.
  5. Field, Marilyn, and Shapiro. Origins and Evolution of Employment-Based Health Benefits.
  6. Moseley, George. “The U.S. Health Care Non-System, 1908-2008.” AMA Journal of Ethics 10, no. 5 (May 2008): 324–31.
  7. Moseley, “The U.S. Health Care Non-System, 1908-2008.”
  8. Palmer “A Brief History: Universal Health Care Efforts in the US.”
  9. Valaitis, Karen. “1.1 Historical Background.” In Exploring the U.S. Healthcare System. University of West Florida, Pressbooks, 2023.
  10. Freeland, Mark S, and Carol E Schendler. “Health Spending in the 1980’S: Integration of Clinical Practice Patterns with Management.” Health Care Financing Review 5, no. 3 (1984): 1–64.
  11. Heaton, Joseph, and Prasanna Tadi. Managed Care Organization. PubMed. Treasure Island (FL): StatPearls Publishing, 2023.
  12. Rosenbaum, Sara. “The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice.” Public Health Reports 126, no. 1 (January 2011): 130–35.
  13. Collins, Sara, Lauren Haynes, and Relebohile Masitha. “The State of U.S. Health Insurance in 2022.” Commonwealth Fund, September 29, 2022.
  14. Cohen, Joshua. “U.S. Healthcare System Leaves Far Too Many People Underinsured.” Forbes, January 1, 2024.
  15. Damberg, Cheryl L, Andrew W Mulcahy, and Erin Audrey Taylor. “The Expense of Health Care Explained: What Americans Need to Know.” Rand.org. RAND Corporation, October 8, 2024.
  16. Schneider, Tyler, Tara Gomes, Kaleen N. Hayes, Katie J. Suda, and Mina Tadrous. “Comparisons of Insulin Spending and Price between Canada and the United States.” Mayo Clinic Proceedings 97, no. 3 (February 2022).
  17. Raimond, Veronique C., William B. Feldman, Benjamin N. Rome, and Aaron s. Kesselheim. “Why France Spends Less than the United States on Drugs: A Comparative Study of Drug Pricing and Pricing Regulation.” The Milbank Quarterly 99, no. 1 (March 2021): 240–72.
  18. Gaffney, Adam. “Our Failing Healthcare System Costs Us Countless Lives. It’s Time to Adopt Medicare for All – PNHP.” PNHP, February 11, 2021.
  19. Himmelstein, David U., Steffie Woolhandler, Adam Gaffney, Don McCanne, and John Geyman. “Medicare for All Is Not Enough.” The Nation, March 31, 2022.
  20. Fay, Bill. “Bankruptcy Statistics.” Debt.org, April 24, 2024.
  21. Fay, “Bankruptcy Statistics.”
  22. Lopes Lunna, Alex Montero, Marley Presiado, and Liz Hamel. “Americans’ Challenges with Health Care Costs.” Kaiser Family Foundation, March 1, 2024.
  23. Martinez, Gina. “GoFundMe CEO: One-Third of Site’s Donations Are to Cover Medical Costs.” Time, January 30, 2019.
  24. PNHP. “About Single Payer – PNHP.” Physician for a National Health Program, 2010.
  25. PNHP, Preethiya Sekar, and Conor Nath. “Financing a Single-Payer National Health Program.” PNHP, n.d.
  26. Himmelstein, Woolhandler, Gaffney, McCanne, and Geyman. “Medicare for All Is Not Enough.”
  27. Cabrera, Yvette . “Putting Health First : Two South County Doctor Brothers Who Serve Mostly Latinos Aren’t Concerned about clients’ papers or pocketbooks.” Los Angeles Times, February 13, 1995.
  28. Pifer, Rebecca. “Trump Releases 2026 Budget Including Heavy Healthcare Cuts.” Healthcare Dive, May 5, 2025.

Health Insurance in South Korea

During a visit to South Korea (a nation with a robust democracy and economy), a quick ChatGPT inquiry highlighted the impressive success of national single payer insurance.

Query: Please tell me about health insurance in South Korea. What financing approach is used for the primary coverage — e.g., all private insurers (and of those, a role for profit)? all public? a mix? Is separate supplemental insurance? What % of the population is uninsured? Does everyone have the same coverage (benefits + cost-sharing obligations)? How high are deductibles? How common is medical bankruptcy / debt? How common are access to care problems for financial reasons? What is annual health care spending per capita? (Feel free to compare to the US)

ChatGPT 4o:

South Korea’s healthcare system is primarily a publicly financed, single-payer model known as the National Health Insurance Service (NHIS). It offers universal coverage with a standardized benefits package, supplemented by private insurance options. Here’s an overview comparing key aspects with the U.S. system:

1. Financing and Structure

  • Primary Coverage: Administered by the NHIS, a government-run entity under the Ministry of Health and Welfare.
  • Funding:
    • Payroll Contributions: Shared equally between employers and employees.
    • Government Subsidies: Support for low-income and self-employed.
    • Out-of-Pocket: Patients contribute through co-payments and services not covered by NHIS.
  • Private Insurer Role: supplemental benefits and services.

2. Universal Coverage and Enrollment

  • Coverage: ~97% of population enrolled in NHIS.
  • Medical Aid Program: Covers the remaining 3% (low-income unable to pay in).

3. Benefits and Cost-Sharing

  • Standardized Benefits: NHIS provides a uniform benefits package, ensuring equitable access to healthcare services.
  • Deductibles: No deductible system akin to the US.
  • Co-Payments:
    • Inpatient Care: Usually 20%.
    • Outpatient Care: 30-60%, depending on care level & facility type.
    • Exemptions: Low-income, age <6 and >65, cancer / rare diseases, disabled.

4. Supplemental Private Insurance

  • Purpose: To cover services not included in NHIS, such as certain advanced diagnostics, private hospital rooms, and alternative treatments.
  • Enrollment: Many individuals opt for PHI to reduce out-of-pocket expenses and access a broader range of services.

5. Financial Protection and Access

  • Medical Bankruptcy: Rare due to the comprehensive coverage provided by NHIS and Medical Aid Program.
  • Access Issues: While the system provides broad access, some individuals may experience financial strain due to services not covered by NHIS or high co-payments.

6. Health Expenditure

  • $4,570 per capita (2022).
  • US: $13,432 per capita (2023)

Comparative Snapshot

Comment:

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

My wife and I are in Seoul, the capital of South Korea, on holiday. Our first three days have been wonderful, in this vibrant, easy-to-navigate, safe, and friendly city. We’ve had terrific conversations with quite a few people, despite our nearly non-existent Korean. Many locals manage well in English, and love to discuss their country and ours. They seem pleased to discover that we know a bit about Korean history and culture, gleaned from reading and Korean TV dramas. As far as we can tell, the culture combines diligence about work and family obligations with a sense of calm. We see consistent evidence of high trust, with valuable items (even a vendor’s cash box) left unguarded.

Of course, I’m no sociologist, and our impressions are preliminary and tentative. Still, we like what we’ve seen so far. Of note, South Korea has a thriving, free-market economy. And a thriving democracy –a popular uprising suppressed an attempted military coup by the president in December 2024.

So, naturally, I had to inquire about how health insurance works here. I know some people are skeptical about ChatGPT and other AI large language models. However, the latest versions are, based on my scrutiny, reliable sources of nuanced information. A carefully phrased query yields a highly edifying response.

As you see in the excerpt, South Korea relies on single payer. The result is high access, low costs, and impressive longevity. I can’t prove it, but I believe that universal public insurance also contributes to the high level of friendliness, calm, and trust that we’ve seen so far. Certainly, there are no significant downsides to providing universal insurance. When, oh when, will the US learn from the myriad exemplary insurance practices around the world?

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.

Private Equity Endangers Patients

An article in US Right to Know – motto “Pursuing truth and transparency for public health” – reviews the powerful evidence of harm inflicted by private equity ownership of medical care providers. We need community ownership along with single payer.

Private equity in health care puts patients’ lives in danger, studies show, U.S. RIGHT TO KNOW, April 28, 2025, by Pamela Ferdinand

Private equity firms claim their investments in U.S. health care modernize operations and improve efficiency, helping to rescue failing healthcare systems and support practitioners. But recent studies build on mounting evidence that suggest these for-profit deals lead to more patient deaths and complications, among other adverse health outcomes.

Recent studies show private equity (PE) ownership across a wide range of medical sectors leads to:

Poorer medical outcomes, including increased deaths, higher rates of complications, more hospital-acquired infections, and higher readmission rates.

Staffing problems, with frequent turnover and cuts to nursing staff or experienced physicians that can lead to shorter clinical visits and longer wait times, misdiagnoses, unnecessary care, and treatment delays.

Less access to care and higher prices, including the withdrawal of health care providers from rural and low-income areas, and the closure of unprofitable but essential services such as labor and delivery, psychiatric care, and trauma units.

Dr, Stephanie Woolhandler, a distinguished professor of public health at Hunter College and co-founder of Physicians for a National Health Program, isn’t surprised by the findings.

“Private equity’s track record in health care is so consistently bad that regulators should ban new private equity purchases in the health sector and impose stringent oversight on the health resources private equity already owns,” she says.

A landmark review in The BMJ analyzed 55 studies across eight countries, primarily in the U.S. It detailed how PE ownership in health care was most often associated with higher costs to patient or payers and “mixed to harmful” impacts on quality of care.

Now, new peer-reviewed research reinforces these findings and reveals a troubling pattern, especially in the absence of effective regulation and oversight: Patients treated at PE-owned facilities, whose numbers have skyrocketed, continue to experience worse or mixed outcomes – from higher mortality rates to lower satisfaction – compared to those treated elsewhere.

In fact, no study to date has found significant improvements to health care quality, efficiency, costs, or access as a result of private equity’s entrance into health care, according to a March 2024 report from Stanford Law Review.

“The drive for quick revenue generation threatens to increase costs, lower health care quality and contribute to physician burnout and moral distress,” they say.

Another study, published last year (July 2024) in JAMA, found hospital assets decreased by 24% in the two years after private equity purchases, leaving facilities less equipped to care for patients. The loss of land, buildings, major hospital equipment, and information technology – equivalent to $28 million in total assets per hospital – means fewer resources for effective patient care, experts say.

“It’s a very striking finding and should change the way people think about private equity in hospitals. The PE firms say, ‘We bring new capital into hospitals.’ It turns out that’s not quite true,” Woolhandler, a co-author of the study, told NBC News. “There are real dangers to the health care that people get if you deplete all of the capital from a hospital.”

Comment:

By Don McCanne, M.D.

To achieve affordable, high quality health care for everyone, the need for single payer has been recognized for decades. Our failure to act has resulted in an intolerable expansion of wasteful expenses without solving the problems of impaired access and individual financial hardship.

In recent years, the menace of private equity has crept into our health care system, greatly compounding its high costs and dysfunction. The “U.S. RIGHT TO KNOW” article convincingly demonstrates this.

Three years ago we wrote an article in The Nation explaining that mere enactment and implementation of a single payer Medicare for All program would no longer be satisfactory because entrepreneurial interests had gained too much control through provider ownership: insurance reform would no longer be enough to ensure that everyone would have access to affordable, comprehensive, high quality health care. We still need single payer, but we must also address ownership of the health care delivery system. We must agree that the system belongs to all of us — community-ownership of hospitals, clinics, and other health care resources.

What have we accomplished in the last three years? Incremental changes have had a negligible impact, allowing the status of our health care system to deteriorate even more. If we continue with our inertia, things can only get worse since private equity is a one-way street in the wrong direction.

You saw the images of the Medicare for All signs at the huge Sanders-AOC rallies. It’s time! Citizen action 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.

Medicare for All Act Reintroduced in Congress

Yesterday progressive Congressional leaders submitted the 2025 version of Medicare for All. In this time of oligarchic dominance, the symbolism remains powerful, even if there are no short-term prospects for passage. The fight for just and efficient health insurance continues.

Progressive Democrats Join Sen. Bernie Sanders’s Reintroduction of Medicare for All Act, Democracy Now!, Headline, Apr. 30, 2025

Democratic Congress members Pramila Jayapal and Debbie Dingell joined Vermont independent Senator Bernie Sanders on Tuesday in reintroducing the Medicare for All Act, which would provide universal single-payer healthcare based on patient needs, not industry profits.

Sen. Bernie Sanders: “Our legislation would provide comprehensive care to all Americans — rich, poor, young or old — with zero out-of-pocket expense. It would provide full freedom of choice regarding healthcare providers: You go to the doctor or the nurse that you want to. No more insurance premiums, no more deductibles, no more copayments, no more filling out endless forms!”

Sanders, Jayapal, And Dingell Press Conference About Reintroducing Medicare For All, Forbes Breaking News, Video (47 min), April 29, 2025

Comment:

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

Amidst the current oligarchic turn of national politics, with cynical performative gestures toward efficiency obscuring the billionaire pursuit of government largesse, it is critical to reassert our quest for Medicare for All — the powerfully synergistic combination of efficiency and generosity designed to help everyone.

M4A, aka single payer, is the magical yet real and practical strategy that would trim away hundreds of billions of dollars in profits and administrative burden, facilitating directing our massive spending on health care to … health care! (instead of executives and shareholders). Families will save money, and hundreds of thousands of deaths will be averted.

Many thanks to our progressive Congressional leaders, for again promoting this admirable vision in legislative form.

To learn more, and to urge your elected officials to co-sponsor the bills, consult the PNHP website.

And stay the course. We will, eventually, guide US policy to the commonsense solution used around the world: simple and comprehensive health insurance for everyone.

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.

Want to find the real waste in health care spending? Look at Medicare Advantage

By Rohit Prasad and Kaitlyn Castro
Austin American-Statesman, April 30, 2025

Elon Musk’s “Department of Government Efficiency” has made its way to health care and Congress has placed one critical program on the chopping block: Medicaid. This is the wrong approach. Medicaid is efficient and cheaper than private insurance.

The real waste in health care is in Medicare — namely Medicare Advantage.

Medicare Advantage plans cost us more without improving people’s health, all while private companies turn a profit on taxpayer money.

In traditional Medicare, the federal government operates as your insurance provider. In Medicare Advantage, the government instead sends that money to a private insurance company, such as Humana or UnitedHealthcare, to give people worse care.

Medicare Advantage costs the government 122% more per person than traditional Medicare. This amounted to $83 billion more in spending to the federal government last year alone.

This setup is sending our Medicare program on the path to financial failure. And all that spending isn’t even for our care. Approximately 14% of spending in Medicare Advantage goes toward things like television advertisements and executive salaries. On top of that, the private companies that deliver these plans pocket an average of $1,730 in profits per enrollee.

Despite this spending, there aren’t really any major differences in health between folks on Medicare Advantage and traditional Medicare. For example, blood sugar control among diabetic Medicare recipients was the same between patients on either coverage option.

As health care providers, we routinely see patients on Medicare who need, and deserve, a lot of care. In fact, more than 30% of Medicare patients see five different doctors each year. On top of managing chronic conditions such as diabetes or heart disease, many need cancer screenings like colonoscopies and CT scans. Not to mention the surgeries that come with growing older: knee surgery, hip replacements and cataract surgery.

We need our Medicare program to make sure this care happens efficiently, so folks can spend less time in doctor’s offices and more time doing what they love.

Unfortunately, compared to traditional Medicare, people in Medicare Advantage programs have:

  • More delays in care due to insurance approvals
  • Greater amounts of administrative paperwork to access services
  • Higher costs associated with copays and deductibles
  • Limited access to treatment options due to restrictive provider networks

Furthermore, some Medicare Advantage plans have landed in hot water for using artificial intelligence, not real qualified doctors, to authorize payments for care. Some Medicare Advantage plans have cut off care for patients recovering from cancer, strokes and amputations simply because a computer algorithm decided that care was no longer necessary. That’s why these companies are facing a class-action lawsuit and even congressional action demanding greater regulations.

The bottom line is Medicare Advantage is the least efficient part of our public health care. Medicare Advantage leads to delays in care, administrative hurdles, possible denials by computer algorithms and higher costs without actually improving people’s health. Not to mention that while patients deal with these barriers, the private Medicare Advantage companies rake in profits on the taxpayer’s dime. Unfortunately, though, this administration seems primed to double-down on the wasteful program.

If the federal government truly aims to improve the efficiency of healthcare spending, it is time to shift the focus to Medicare Advantage instead of forcing critical programs like Medicaid to pay the price.

Rohit Prasad and Kaitlyn Castro are medical students at the University of Texas Dell Medical School and members of the national advocacy organization Physicians for a National Health Program.

https://statesman.com…

Medicare Enrollment Proposals Would Speed Shift to Private Care

By Tony Pugh
Bloomberg Law, April 29, 2025

Medicare’s shift toward privatization could get a significant boost if the Centers for Medicare & Medicaid Services embraces either of two conservative proposals that could increase enrollment in the program’s bulging managed care option.

Project 2025, the Heritage Foundation’s national policy blueprint, calls for all new Medicare-eligible adults to “opt-in” to the program through a private Medicare Advantage plan rather than the traditional fee-for-service program, the historic landing spot for new enrollees since the program’s inception.

The Paragon Health Institute, a conservative think tank, wants to require newly eligible beneficiaries to “affirmatively choose” one or the other.

With strong Republican support of Medicare Advantage and GOP control of Congress and the White House, “I think the stars are properly aligned for something like this to take place,” said Robert Moffit, senior research fellow at the Heritage Foundation’s Center for Health and Welfare Policy. He said either proposal would be an improvement over the current system.

Fifty-four percent of eligible beneficiaries are already enrolled in Medicare Advantage plans, which are offered by private insurers like UnitedHealth Group, Humana, and CVS Health. The Congressional Budget Office expects that to reach 64% by 2034.

Both sign-up proposals would likely increase or hasten those MA growth projections, said Moffit and David Lipschutz, litigation director at the Center for Medicare Advocacy.

“The thumb is already firmly on the scales in favor of Medicare Advantage enrollment, and implementing either of these policies would just exacerbate that,” Lipschutz said.

But if either proposal is adopted without accompanying changes in the MA payment system, Moffit, Lipschutz, and others said the change could also weaken Medicare’s overall finances just as millions of aging baby boomers are swelling program ranks, and fewer working-age adults will be around to fund the program.

“You’re going to be stuck with a problem,” Moffit said, if the proposals become policy without addressing MA’s “flawed” risk adjustment system, and “broken” payment system, which can inflate plan reimbursements. “And they are going to fester as fiscal problems,” he added later.

Oz and Medicare Advantage

The proposals are receiving fresh attention because CMS Administrator Mehmet Oz is a longtime supporter of the MA program.

Earlier this month, the CMS boosted payments to MA plans by an average of 5% for 2026, even though MA coverage will cost 20% more per enrollee this year than fee-for-service Medicare, the Medicare Payment Advisory Commission estimates.

That’s $84 billion more to care for beneficiaries than if they were in traditional Medicare. The federal government is projected to pay MA plans $538 billion this year, up from $494 billion in 2024.

“Although he hasn’t spoken much, prior to his appointment, about his policy intentions and what he wants to do to improve health care in America, the one thing” Oz has “been very clear about is that the privatization of Medicare is high on his agenda,” said Donald Berwick, senior fellow at the Institute for Healthcare Improvement and a former CMS administrator.

Officials at the Department of Health and Human Services did not respond to questions about either proposal, but said HHS is committed to strengthening Medicare by promoting greater choice, competition, and affordability for American seniors. The agency’s focus remains on advancing reforms that align with President Donald Trump’s vision of improving health outcomes, empowering beneficiaries, and delivering better value across the Medicare program, according to the official.

Constraining Medicare Spending

An influx of aging baby boomers, greater use of medical services, and inflation are expected to drive 7% to 8% annual increases in Medicare spending over the next decade, as program costs nearly double from $1 trillion in 2023 to $1.9 trillion in 2032, the commission estimates.

That means 22% of personal and corporate income taxes will be needed to fund Medicare prescription drug and outpatient benefits in 2030 compared with 17% in 2023. Yet by 2029, only 2.5 workers per beneficiary will fund the program, down from 2.8 in 2023, the commission said. That reality makes constraining Medicare spending a high priority.

In a tradeoff for lower premiums and provider networks, Medicare Advantage provides a cap on catastrophic health-care costs, and offers supplemental benefits such as vision and hearing coverage that FFS doesn’t offer. Unlike traditional Medicare, which pays for each medical service provided, private MA plans receive monthly payments to cover each beneficiary’s cost of care.

The higher costs for MA care result mainly from “favorable selection,” when plan payments exceed predicted medical costs, and “coding intensity,” the inflated diagnosis of patient ailments.

‘Basically an Antique’

Lawmakers and policy makers “should ask themselves why traditional Medicare should be the default” enrollment “option when it’s based on a 1965 Blue Cross Blue Shield model,” said Moffit, a former HHS deputy assistant secretary.

“You’re talking about something that is basically an antique,” he said of traditional Medicare. “Who would buy today, with their eyes open, a health policy that doesn’t have any protection against the financial devastation of a catastrophic illness? We just keep doing it because we’re used to doing it.”

Since managed care has become the dominant form of job-based health coverage, “if you’re becoming eligible for Medicare and you already have a managed care plan from ‘company x,’ a lot of people just say ‘well, I’m not thrilled with it, but I’ll stick with what I know,” and go with Medicare Advantage, Lipschutz said.

But Berwick said “traditional Medicare is a better place for most patients,” because unlike MA, it has no provider network restrictions or pre-authorization requirements.

Both enrollment proposals are “bad policy,” he said. “And if we allow this continued slide into privatization to occur, which appears to be the intention of this administration, a lot of beneficiaries are going to be hurt.”

Any change in the enrollment of new beneficiaries would necessitate enrollee information so people with diverse needs and ailments could decide which MA plan to select, whether to opt out, or whether to go with fee-for service coverage instead, said Carrie Graham, director of the Medicare Policy Initiative at Georgetown University.

The debate offers an opportunity, Graham said, to weigh adding a catastrophic out-of-pocket spending cap to fee-for-service Medicare to help even the playing field with MA coverage.

https://news.bloomberglaw.com…

Doctors welcome the Medicare for All Act of 2025

We need a universal health care system that guarantees care for all—free of copays, deductibles, and job-based coverage restrictions

FOR IMMEDIATE RELEASE: April 29, 2025

Media Contact: Anika Thota, PNHP Policy & Communications Specialist, anika@pnhp.org

WASHINGTON, D.C. — Physicians for a National Health Program (PNHP), which represents more than 25,000 doctors nationwide, enthusiastically welcomes the launch of the Medicare for All Act. This bill, which is being introduced by Representatives Pramila Jayapal and Debbie Dingell in the House and Senator Bernie Sanders in the Senate, will finally establish a single-payer national health program in the United States. 

The Medicare for All Act arrives at a critical moment, as Medicaid cuts loom, public health infrastructure is being dismantled, and dangerous rhetoric from political leaders seeks to rewrite the meaning of “health care reform.” 

Under the false promise to “Make America Healthy Again,” politicians are threatening to gut safety net programs like Medicaid, and are already funneling billions of taxpayer dollars to corporate insurers through their privatized “Medicare Advantage” plans. 

So-called “Advantage” insurers are already overpaid by an estimated $140 billion annually, and impose widespread harm on patients, particularly those with cancer and other serious conditions, by delaying and denying care in the name of profit. This makes it especially galling that the Trump administration boosted MA payments by an additional $25 billion for 2026—money that could and should be used to fund patient care. 

“The Trump administration has somehow not heard the voices of Americans who are angry and frustrated with a healthcare system that is built to make profits for the few and to delay and deny care to the rest of us,” said Dr. Diljeet Singh, President of PNHP. “We need a universal health care system that guarantees care for all—free of copays, deductibles, and job-based coverage restrictions. With the passage of the Medicare for All Act, patients can get the care they need without fear of crushing medical bills and physicians can focus on healing patients, not battling insurers over denials and delays.” 

Across the country, physicians are also sounding the alarm on Trump administration policies, and making it clear that they want to practice in a system that puts patients before profits. 

“As a future physician, I want a health care system in which I can base my patient care and clinical decision-making on my patient’s needs, not on their insurance,” said Rachel Fox, a student leader with Students for a National Health Program (SNaHP). “Our current system benefits no one but the shareholders of private health insurance companies, and a universal, single-payer system like Medicare for All is the only sustainable option for long-term reform of our broken health care system.”

The Medicare for All Act of 2025 would provide health coverage to every U.S. resident—including comprehensive medical, dental, vision, mental health, and reproductive care—with no out-of-pocket costs, copays, or deductibles. By eliminating waste and corporate profiteering in health care, the bill would save hundreds of billions annually that could be invested in actual health care, resulting in better, more equitable health outcomes. 

“Physicians are calling for Medicare for All because we see, every day, the harm that our profit-driven system inflicts on our patients,” said Dr. Singh. “We need a system where health care is guaranteed, not denied and delayed for corporate profits.”

Physicians for a National Health Program is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.

US Mortality High & Strongly Linked to Wealth

A new cross-national study highlights two stark facts: Mortality is substantially higher in the US than in counterpart European nations, and it is more closely associated with wealth stratum (inversely, of course). Health insurance and wealth inequality play central roles.

Association between Wealth and Mortality in the United States and Europe, New England Journal of Medicine, April 2, 2025, by Sara Machado, et al

In the United States, there has been a massive transfer of wealth from the middle class to the wealthy in the past 60 years, which has increased wealth inequality. Other high-income countries have seen concurrent growth in wealth inequality, but these have been less pronounced than in the United States. Life expectancy in the United States is also lower than in other high-income countries, and it is decreasing. These are of key concern, particularly because increases in mortality are most pronounced among the poorest people.

Interpretation: Survival over time among adults 50-85 years old is lower in the US than in Northern / Western Europe, with more spread by wealth level.

From the Discussion:

We found that wealth was associated with mortality across the United States and Europe and that the difference in mortality between the top and bottom quartiles of wealth appeared to be larger in the United States than in Europe. Mortality in the United States was higher than in Europe, even at higher wealth levels.

Comment:

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

We have reported often that the US can greatly increase the access and affordability of health care by enacting and implementing a well-designed, single payer, improved version of Medicare that is provided to all.

However, as this study indicates, our health is also broadly linked with economic disparities. The well recognized problem of wealth inequality in the US is associated with reduced life expectancy, especially afflicting lower-wealth individuals, far more than in European nations. At the same time, when compared to those nations – with comprehensive universal health care systems – all US wealth levels have higher mortality, even at the top tier. So the wealthy should understand that they will gain life expectancy if the system is fixed overall. Single payer is not about trade-offs, it’s about improvements for everyone.

What does this tell us? Clearly, as we have said for decades, our nation’s overall health would improve with an improved system of Medicare for All. But it also demonstrates that we need a more equitable distribution of wealth which would be more likely if we also had an equitable system of income distribution. The study showed that life expectancy was related to wealth. However, it is very difficult to see how wealth could be made more equitable without ensuring adequate income for everyone. We also really need a progressive wealth tax if we are going to correct the profound inequities created by today’s preoccupation with the accumulation of mega-wealth.

This is not the same as calling for equal income and wealth. Instead, it is a plea for fairness and justice in income and wealth distribution instead of the creation of centi-billionaires made possible by denying middle- and lower-income workers their fair share of society’s productivity. This, of course, requires effective government oversight, unlike the inhumane, slash-and-burn administration we have today.

What can we do? In just 100 days, extensive damage has been initiated to our socioeconomic and legal systems, and much more is threatened. So reversing the current politics and policy is an emergency. Once we have control of the situation, we can move forward with changes that will let us function like our European friends, perhaps even better. Solving our major challenges would enhance our nation’s well-being and return us to a place of leadership and admiration in the world. Our progress will increase global well-being! But it’s up to the people to act.

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.

Stand-Up for Simple Health Insurance

In just 90 seconds, this highly entertaining comic conveys the absurd complexity of health insurance out-of-pocket costs. It’s a potent tragi-comic case for affordable, simple health insurance. Finally, the difference between HSAs and FSAs is clear!

“Oh my God, like what is going on with the healthcare system?” or on YouTube, 1.5 minute video, April 15, 2025, by Darlene Bereznicki

Comment:

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

Ms. Bereznicki starts her riff with “When the Luigi Mangione thing went down, my Canadian friends asked … OMG what is going on with the healthcare system?” That’s the question we’re all asking ourselves, all the time. Leave it to a professional comedian to answer to that question so well and amusingly, in just a minute and a half. Maybe she should delivery my health policy talks!

Deductibles, copays, out of pocket maximums, etc – she quickly covers the gamut. This routine even alerted me to the fundamental difference between HSAs (health savings accounts, which roll over tax-free to retirement*) and FSAs (flexible spending accounts, use them or lose them).

Note the massive attention to the Instagram video in just five days, and all the supportive comments. (The YouTube video was just uploaded by Ms. Bereznicki, as a favor to HJM readers.)

Why did this resonate so widely? Because we’re all fed up with a laughably convoluted and inefficient – plus unfair and harmful – set of clunky mechanisms to pay for health care. Ms. Bereznicki and her Canadian friends would agree I’m sure: the US needs a single public payer, with minimal or no cost sharing.

* HSAs are a major gift to the healthy and wealthy, and undercut insurance markets…

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 More Perfect Union

PNHP president Dr. Diljeet Singh spoke to More Perfect Union for a video segment that was posted on April 15, 2025.

She talked about the blatant conflicts of interest that should have been a red flag for senators voting on the nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services—especially his enthusiasm for the so-called “Medicare Advantage” program, and his investments in firms like UnitedHealthcare.

“Every single health care dollar should go to health care,” said Dr. Singh, “not profit and not shareholder dividends.”