Member Resource

‘No real choice.’ How Medicare Advantage fails seniors of color

By Brenda Gazzar
Code Wack Podcast, Jan. 26, 2026

How does Medicare Advantage—also known as privatized Medicare—fail seniors … especially seniors of color? Why do many seniors find they actually have no other choice than an Advantage plan? What’s the consequence of that lack of choice? And how do Medicare Advantage insurance plans actually deepen racial and income disparities?

To find out, we spoke with Dr. Belinda McIntosh – an Atlanta-based psychiatrist with more than 20 years of experience, a board member of Physicians for a National Health Program, and co-author of a new PNHP report titled “No Real Choices: How Medicare Advantage Fails Seniors of Color.” This is the first episode in a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

A Campaign Endorsing Single Payer

Democratic candidate for US Senate in Michigan, Abdul El Sayed, discusses Medicare for All with podcaster Bryan Tyler Cohen.

Abdul El Sayed discusses Medicare for All with Brian Tyler Cohen (13 minutes), YouTube Podcast – Brian Tyler Cohen, January 17, 2026

Brian Tyler Cohen: And so, first and foremost, I understand that that when people think about Medicare for all, it still feels like it’s sorted into the very progressive camp, but from the folks that you’ve spoken with who are not necessarily super far-left, does it feel like this is a moment where there’s actually an embrace of something like Medicare for all?

Abdul El Sayed: You know, once you get past the left-right framing that all of us try to put our politics into and you actually go out into communities across the country, and I’ve been doing this up and down my state, you realize that most folks don’t really ask whether or not this is too progressive for me. They’re asking, “Does this actually solve a problem I really have?”

And even when you go back to the passing of the ACA … President Obama called it a starter home. And we have outgrown the starter home. And to me, the big failure, right, … is that it relied on a profit motivated health insurance industry to provide the bulk of the American public healthcare. And when you have profit motivated insurance and profit motivated healthcare providers, at some point all that profit comes from somewhere, which is your and my back pocket. And we’ve now come to a place where that has become unsustainable. …

We’ve just created a system where private health insurance can profit off of providing insurance to people when they’re their healthiest. And they don’t want to do it, you know, when they get sicker. They’ve created these advantage programs where they’ll take Medicare dollars, pocket them, and then use prior authorization to gatekeep seniors from their healthcare. They do that, but the whole thing’s a money grab, right? And so we don’t need private health insurance. If people want private health insurance, great. But you shouldn’t have to rely on it because it’s fundamentally unstable and it’s created this tiered system that creates challenges for people when they actually just want to get the care that they need.

BTC: Yeah. And by the way, I lived in France for a couple years after college and they have they have socialized health care, but then they also have a private offering. They call it a “mutuelle”, but it would be the same thing. I mean, you can buy extra health coverage if you want it, but otherwise, everybody’s covered. I remember I have two herniated discs in my spine. It’s a long time wrestling injury, and so I needed uh I did like electric stim and deep tissue massage and whatever just to like keep me in in one piece. But I remember finding a doctor in France who did that for sports medicine and whatnot. And I remember going and asking how much how much it would cost and everything gets reimbursed if you lay money out. And they said it would cost like would cost like €2.80. And I was like €2.80, and they were like but you’ll get it back. And she thought I was upset that I was going to have to lay out the money. She thought I was upset that I was going to have to like pay €2.80 and not that I was expecting her to say that it was going to cost like $275, you know.

AES: So we don’t have to live this way. Yeah. You know, that’s the funny thing about it, right, is that the idea that you would want to do something similar to somebody in a different country is somehow so terrible. …It’s crazy to me, right? Every country in the world has a military. Some militaries run better than other militaries. But nobody’s like, “Well, that country has a poor military, so our military is going to be trash, too.” You never hear that argument.

So my point is, look, we’re the United States of America. We have never settled for less than the best except for when it comes to healthcare. We’re okay with middling to complete shit infant mortality rates. … We don’t have to live like this. There is no reason why we cannot build the best health care system in the world.

[ Full transcript here. ]

Comment:

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

There is ongoing documentation in news media and reform newsletters on the failings of US health insurance – such as HealthCare un-Covered on ACA subsidy challenges and JustCare on Medicare Advantage gaming and rising drug prices. That’s essential, highlighting the futility of our chaotic approach.

But it’s also the perspective opponents of true reform want us to adopt – focused on nudges to our current dysfunctional system. Rather than highlighting system overhaul.

So … I was thrilled to hear the discussion between Abdul El Sayed (public health physician and candidate in the Democratic primary for US Senator from Michigan) and Brian Tyler Cohen (actor turned highly successful political podcaster). For half of their interview, they focused on Medicare for All. It’s worth a full listen (or a read … transcript link above).

I followed up with Abdul. He elaborated on his (and our) vision for Medicare for All: “Everyone in, nobody out. Medicare would be there for you regardless of your circumstances, whether you have additional private insurance or not. It’s guaranteed, always present, and any additional private insurance would be on top of Medicare. … And Medicare should cover every piece of healthcare folks could need.”

He elaborated: “I imagine that most folks would opt not to pursue additional private coverage for that reason. That said, if the idea of “choice” is what is keeping some folks from supporting M4A, I’m open to keeping their private option open as a matter of guaranteeing public insurance for everyone.”

This Medicare for All vision aligns with what dozens of other wealthy nations do. First, assure that everyone has the same comprehensive benefits, provided publicly or via not-for-profit private insurance. Then, permit supplemental insurance that adds specialized benefits or perks like private hospital rooms.

As Abdul said in the interview, “There is no reason why we cannot build the best health care system in the world.” 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.

Dr. Ed Weisbart on MeidasTouch

PNHP national board secretary Dr. Ed Weisbart spoke to the MediasTouch podcast on Jan. 23, 2026. He discussed the looming threats of Medicaid cuts and ACA premium increases—along with the urgent need for Medicare for All.

“It drives us crazy to know that the only reason people in this country can’t afford to get the lifesaving health care they need is because insurance corporations have put themselves in the middle,” said Dr. Weisbart.

“[They] have corrupted our democracy, and are finding every gain they can make to turn a profit.”

The Great Healthcare Plan Hoax

A page of vague and disproven ideas is not a serious health reform plan. The Trump strategy is nonsense, unworthy of serious consideration.

The Great Healthcare Plan, The White House, President Donald J. Trump, January 2026

Lower Drug Prices

Slash Prescription Drug Prices: Lower prescription drug prices for all Americans by codifying the Trump Administration’s Most-Favored-Nation deals to get Americans the same low prices for prescription drugs that people in other countries pay. This would build off President Trump’s landmark actions that made insulin more affordable in his first term and the successful voluntary negotiations following his recent executive order to lower drug prices. Voluntarily negotiated deals with HHS/CMS will be grandfathered in.

Allow More Over-the-Counter Medicines: Make more verified safe pharmaceutical drugs available for over-the-counter purchase. This will lower healthcare costs and increase consumer choice by strengthening price transparency, increasing competition, and reducing the need for costly and time-consuming doctor’s visits.

Lower Insurance Premiums

Send the Money Directly to the American People: Stop sending big insurance companies billions in extra taxpayer-funded subsidy payments and instead send that money directly to eligible Americans to allow them to buy the health insurance of their choice.

Fund Cost-Sharing Reduction Program: Fund a cost-sharing reduction program for healthcare plans which would save taxpayers at least $36 billion and reduce the most common Obamacare plan premiums by over 10%.

Cut Kickback Costs: End kickbacks from pharmacy benefit managers to the large brokerage middlemen that deceptively raise the cost of health insurance.

Hold Big Insurance Companies Accountable

Create the “Plain-English Insurance” Standard: Require health insurance companies to publish rate and coverage comparisons upfront on their websites in plain English—not industry jargon—so consumers can make better insurance purchasing decisions.

Publish Costs of Overhead vs. Claim Payments: Require health insurance companies to publish the percentage of their revenues that are paid out to claims versus overhead costs and profits on their websites.

Display Claim Denial Rates: Require health insurers to publish the percentage of insurance claims they reject and average wait times for routine care on their websites.

Maximize Price Transparency

Post Prices on the Wall: Require any healthcare provider or insurer who accepts either Medicare or Medicaid to publicly and prominently post their pricing and fees to avoid surprise medical bills.

Comment:

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

This is it! President Trump’s plan for reforming healthcare in America! In a single page. Specifics deemed irrelevant. But, as the wise saying goes, “the devil is in the details”.

Lower drug prices? By Executive Order? How much? How to enforce?

Lower insurance premiums? This would just shift costs elsewhere, eg deductibles and cost-sharing.

Hold insurance companies accountable? Sure, but it’s gloss. To really eliminate waste, eliminate this money-extractive industry

Price transparency? Sick people are terrible price shoppers. Market mechanisms don’t work in health care (Ken Arrow, Nobel Prize 1972). Recent price disclosure rules for hospitals failed miserably.

The problem, of course, is that Trump left out virtually all the reforms that we actually need to make the system perform as it should: universal (cover everyone), comprehensive (all appropriate health care), and affordable (for society and each of us). Let’s not be fooled by a 1-page list of unarticulated and untested (or disproven) ideas, and instead follow the successful real-world examples of scores of wealthy nations.

In a way, this nonsense “plan” is good news because Trump has left to us, the people, the task to demand from our legislators to enact a program that will work: a single payer, improved Medicare for All. Funding the system with progressive income and wealth taxes would ensure that those with low and modest incomes do not suffer from financial hardship, and for the billionaires it will be painless since they will not even know what they are paying without checking with their accounting firms.

At the midterms we must elect legislators who understand what real reform is, and should be able to enact it by the time we have in place a compassionate president who cares about the people instead of the billionaires.

(Just out – a thoughtful critique of Trump’s “plan” by Jonathan Cohn here.)

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.

With Medicaid & ACA Cuts, Counties Face Daunting Care Challenge

With huge reductions in federal funding for health insurance programs, leading to a surge In the uninsured, local jurisdictions in many states will be required to fill the gap. This poses massive, highly burdensome or infeasible, funding challenges.

On the Hook for Uninsured Residents, Counties Now Wonder How They’ll Pay, KFF Health News, by Christine Mai-Duc and Claudia Boyd-Barrett, January 6, 2026

Health Officials in California’s Placer County and across the country are bracing for an estimated 10 million newly uninsured patients over the next decade in the wake of Republicans’ One Big Beautiful Act. The act, which President Donald Trump signed into law this past summer, is also expected to reduce Medicaid spending by more than $900 billion over that period.

This is the moment where a lot of decisions have to be made about who gets care and who doesn’t,” said Nadereh Pourat, director of the Health Economics and Evaluation Research Program UCLA. “The number of people who are going to lose coverage is large, and a lot of the systems that were in place to provide care to those individuals have either gone away or diminished.”

It’s an especially thorny challenge for states like California and New Mexico where counties are legally required to help their poorest residents through what are known as indigent care programs. Under Obamacare, both states were able to expand to include more low-income residents, alleviating counties of patient loads and redirecting much of their funding for the patchwork of local programs that provided bare-bones services

“Most of the infrastructure that we had to meet those needs is gone,” said Rob Oldham, Placer County’s director of health and human services. “This is a much bigger problem than it was a decade ago and much more costly.”

“State leaders, if they choose to prioritize it, need to decide where they’re going to find the funding that would be needed to help those who are going to lose health care as a result of these federal funding and policy cuts,” said Scott Graves, a director at the independent California Budget & Policy Center.

Reviving county-based programs in the near term would require “considerable fiscal restructuring“ through the state budget, the Legislative Analyst’s Office said.

Health advocates fear that, absent major state investments, Californians could see a return to the previous patchwork of county-run programs with local governments choosing whom and what they cover and for how long.

Before the ACA, many uninsured people who needed care didn’t get it, which could lead to them winding up in ERs with untreated health conditions or even dying. Rachel Linn Gish, interim deputy director of Health Access California, a consumer advocacy group, said that “it created a very unequal, maldistributed program throughout the state.”

Comment:

By Don McCanne, M.D.

The United States is the only industrialized nation that does not guarantee accessible and affordable health care to essentially all of its residents. Because we have attempted to correct these deficiencies through fragmented, incremental programs, we ended up with the most expensive system on earth, with deficiencies that place us at the bottom of wealthy nations in the performance of our health care system.

With recent Republican control of Congress and the White House, the situation has worsened. Low-income individuals will see a dramatic reduction of coverage from Medicaid. The government also failed to extend premium subsidies for the Affordable Care Act, which will leave millions of individuals and families unable to pay for insurance plans in the ACA exchanges. In addition, Medicare funding will likely suffer, due to budget deficits. These cuts will cause financial hardship or even bankruptcy for far too many, and, worse, inability to obtain care to prevent disabilities and even death. These problems are on top of the serious insurance deficiencies we already have.

Before programs were established to provide health insurance for much (if not all) of the population, medical care was often provided for the indigent through government facilities such as county hospitals and community health centers. As insurance coverage expanded, especially through the Affordable Care Act, these publicly-funded facilities were scaled back or even disappeared. But with the new austerity measures being put in place, there is a desperate need to replace such facilities and programs. That process will be quite complex, partly because funding will need to come from local, county, state and potentially federal sources. Also, regions controlled by conservatives will likely be stingier in providing the needed resources.

Republicans have indicated that they may change their mind and make ACA subsidies more available again. However, they have said that they will do this only if Health Savings Accounts are made part of our health care financing. The problem is that HSAs are designed to benefit wealthier, healthier individuals and families who can afford to fund them and can take advantage of the tax benefits designed for those with higher incomes. HSAs help purchase high-deductible health plans which will not adequately cover the health care costs of those with expensive illness and more modest incomes. Although the previous system offered poor performance at high cost, the most the Republicans offer now will set us further back in trying to bring a high performance health care system to everyone.

Conservatives tell us that a single payer system, such as Medicare for All, would cause prolonged waiting times for health care with inadequate resources to provide needed care. Unfortunately, that is true in some settings, where countries with universal health care systems have, in recent years, been controlled by conservative governments that deliberately under-resource their systems, partly to force a shift to private, market-driven systems. This shift drives more health care dollars to profits for middlemen (private insurers, private equity, etc.) by using funds that should go to patient care.

So what is the solution? A well-designed single payer insurance program that is comprehensive, equitably accessible, and funded based on ability to pay by using progressive income and wealth taxes. Ownership of the system should be by public provisioning – either government or nonprofit providers (eg community health centers and hospitals). Also the legislators and government administrators we put in place must believe in the moral and ethical concepts that would make affordable, comprehensive care accessible to everyone. Taxes should pay for legitimate costs (providing care!) while eliminating the middlemen who serve only to create personal wealth.

Simple. Elect legislators and a president who, deep down inside, truly believe that everyone should have high quality health care when needed. Design, enact, and implement a single payer, improved Medicare for All. Continue to keep in office government officials who sincerely believe that they are there for the people, rather than for the billionaires.

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.

How Physicians View Our Health Care System and What The Numbers Say

Interview with Dr. Diljeet Singh

By Rep. Pramila Jayapal
The Power You Have Podcast, Jan. 9, 2026

PNHP president Dr. Diljeet Singh spoke with Rep. Pramila Jayapal (lead sponsor of the Medicare for All Act) about why physicians are getting active in the fight for a single-payer national health program.

“For those of us who came into this work just to take care of people, it seems like we have no choice but to get engaged,” she said. “Otherwise we’re not going to be able to provide people with the health care they need and deserve.”

This episode concludes a three-part series on Medicare for All (part one HERE, part two HERE).

https://share.transistor.fm…

The Reality of Medicaid Cuts and Medical Debt

Threats to US Health: Vaccine Denialism + For-Profit Health Insurance

A recent New York Times Op-Ed critiques federal health agency abandonment of scientific evidence for vaccine benefit. Quote of the Day & HJM stalwart Don McCanne points out an even greater threat: private for-profit health insurance, generating ~900 reader endorsements.

We Don’t Seem to Be Making America Healthy Again, New York Times, Dec. 28, 2025, by Benjamin Mazer

As a physician and medical journalist, I have spent years watching, with both fascination and concern, as anti-vaccine groups honed their persuasive techniques. …

As secretary of health and human services, Robert F Kennedy Jr has spent the last year not only remaking federal immunization policy but shifting the national dialogue about this essential public health tool.

I never predicted that a fringe conspiracy theorist like Mr. Kennedy would one day become leader of the health care system, but it doesn’t surprise me. Anti-vaccine groups have developed into a potent force. They have learned to stoke suspicion of authority with masterful precision, they have become adept at applying a veneer of scientific legitimacy to their ideas, and they’ve prepared a superficially compelling response to seemingly every argument that doctors make to encourage immunization. These rhetorical tactics were first worked out at dinky conferences and obscure media outlets, but now the government itself has become a propaganda organ for the movement. This makes confronting vaccine skepticism much more challenging — and, amid growing measles outbreaks nationwide, far more urgent. …

Take the false idea that vaccines cause autism. The Centers for Disease Control and Prevention once plainly declared that they didn’t. Mr. Kennedy instructed the agency to take a different position: “The rise in autism prevalence since the 1980s correlates with the rise in the number of vaccines given to infants,” the C.D.C.’s website has been updated to read.

Most parents, for the time being, seem to trust their doctor’s advice. Childhood immunization rates remain relatively high in the United States. But it has taken only a slight decline in vaccine confidence to set off the disease outbreaks we are seeing. It is easier for anti-vaccine groups to chip away at public trust than it is for the medical community to rebuild it. …

Vaccines may be safe and effective, but just saying so is no longer enough. We’re only one year in, and how physicians and public health experts respond will shape what happens next.

Comment:

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

Jim: Dr. Mazer is absolutely correct to challenge the anti-scientific drift of US vaccine policy. Abuse of scientific methods in this realm is inexcusable, indeed deadly. But as Don highlighted with his online comment (below) and its highly enthusiastic reader response, the even bigger problem is the failure of our disjointed, heavily privatized and profit-ized health insurance. Each year, it wastes hundreds of billions of dollars and causes tens of thousands of excess deaths.

Don: My response to this NYT op-ed on vaccine denialism received the highest number of reader recommendations – 882 as of January 5th. This reflects the increasing popularity of Medicare for All.

Don McCanne
San Juan Capistrano, CA
Dec 28, 2025

As an 88 year old physician, I’ve had some exposure to our health care system. Watching some of our more serious diseases conquered by immunizations has been rewarding. On the other hand, watching our health care system evolve into one of the poorest performing systems of the industrialized world, while being the most expensive, has not been a matter of questionable judgement of the care we provide, rather it has been a matter of distributing our health care dollars to the very wealthy middlemen (insurers, private equity, etc.) when we really need to offer health care to everyone and pay for it through an equitable tax system based on ability to pay. Health care reform advocates will recognize that as a well-designed single payer system, or an improved Medicare for All. Let’s redirect our attention to where the real problem is.

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.

It shouldn’t take luck to stay healthy in Maine

By Grace Lee
Bangor Daily News, Jan. 3, 2026

I grew up helping my immigrant parents sort through insurance letters and medical bills long before I could understand the language printed on them. Now, as a medical student, I still hear the same fear in people’s voices: “I’m doing everything right. So why is health care still so expensive?”

Across communities throughout Maine — especially in rural towns — I hear the same worry. In a state with an aging population and long travel distances to care, those costs and gaps can quickly become barriers to staying healthy at all.

A recent AP-NORC poll found that Americans across political lines agree on one thing: health care is becoming harder to afford. Some describe it as a “privilege,” echoing a very human fear that resources are limited and someone else might take advantage of the system. That fear is understandable. Scarcity makes people defensive, not selfish.

But if withholding care truly solved our cost crisis, the United States would already have the least expensive health system in the world. Instead, we spend more per person than any other wealthy nation and still leave millions uninsured or underinsured. People are trying their best, yet the system is failing them.

Even those with “good insurance” run into barriers. One clear example is screening colonoscopies. Under federal law, these are supposed to be fully covered. But if a doctor finds and removes a polyp — something no patient can predict — the procedure may be reclassified as diagnostic, leaving people with unexpected bills. Patients who take preventive steps end up paying more for doing the right thing.

As a medical student, I’ve watched people ration medications, delay check-ups, or turn down tests because they fear the cost more than the diagnosis. I’ve seen families try to figure out which appointments they can afford. These are not failures of personal responsibility; they are failures of policy design.

There are steps states and communities can take right now:

Expand coverage and close remaining gaps. Ensuring more complete insurance coverage would prevent many avoidable medical and financial crises.

Strengthen protections around surprise billing. Closing loopholes that turn preventive care into unexpected expenses would protect people from being blindsided.

Invest in primary and preventive care. Every dollar spent upfront saves multiple dollars in emergency or hospital care later.

But conversations I’ve had with patients, community leaders, and clinicians point to a larger truth: small fixes can only go so far.

The most effective long-term solution, used by every other wealthy country, is universal health insurance. Countries that guarantee coverage through single-payer systems, hybrid models, or tightly regulated private insurers consistently achieve better outcomes at lower cost. More importantly, people don’t lie awake wondering whether a refill or a routine appointment will destabilize their finances.

No one should need luck to stay healthy — not the families I grew up around, not the patients I meet in a clinic, and not anyone in our Maine communities.

Health care shouldn’t depend on the right job, the right ZIP code, or the right timing. It should be a reliable foundation that helps people build stable, productive lives.

We have the knowledge and the tools. What we need now is the commitment to build a system that treats health care not as a gamble, but as a guarantee.

Grace Lee grew up in Maine and is now a medical student studying health equity and patient-centered reform.

https://bangordailynews.com…

There is a solution to healthcare in the United States

By Joshua Freeman, M.D.
Arizona Daily Star, Dec. 30, 2025

A headline in the Star on Dec. 27 is “Out-of-pocket pain means skimping on care.” The story is from KFF HealthNews, and you already know what it says. We all know. In the rare cases where we or our families or close friends haven’t experienced it ourselves, our newspapers and other media are full of such stories. Every day, we read about how people delay or forgo care, get sick, and even die because of costs: co-pays, deductibles, and other surprise charges, all in addition to the premiums they pay, which increase yearly. This is in addition to the other obstacles to care: prior authorization requirements and outright denials of care by insurance companies, and lack of access because of a shortage of healthcare clinicians.

Does it have to be this way? Is there no way out? Many politicians seem to take the same position as Representative Jeff Van Drew (R-NJ), who said, “Other than world peace, honest to God, health care is the toughest issue ever. It is really hard, but I think it behooves us to come up with something.” The last part is true, but not the first. There is a way, not only in theory but one that has been tested and retested all over the world. It is the system used by every wealthy country, and many with fewer resources: Universal health coverage. Really. It’s true. It is done in different ways, but they all cover everybody, for low, or no, out-of-pocket cost, funded by taxes. They are not all perfect, but the other thing that they have in common is that no country that has adopted universal health coverage has gone back. Ever.

Could it be done in the United States? Sure. The “Medicare for All Acts” (S. 1506 and HR. 3069) would do exactly that, expand the Medicare system to include us all. Everyone. Birth to death. No patchwork system, no falling through the cracks. Everybody in, nobody out. Medicare has served as a single-payer universal health care program for seniors and people with disabilities since 1965, so the structure is there. Just add the rest of us. These bills would also improve Medicare, by covering everything, including mental health, vision, hearing, long-term care, and the full cost of hospitalization (not 80% as now). It’s all good.

But how could we afford it? Wouldn’t taxes go up? They would, for some, but then all these other costs – premiums, co-pays, deductibles, etc. — would go away, and most people would see a net financial benefit, especially those who cost and pay the most — those who are sick. Most of the additional cost of providing healthcare to everyone would be made up for by eliminating insurance company administrative costs and profits. It is thus doubly good; not only does it save money, it creates a system whose goal is providing health care for the American people rather than making a profit for insurance and private equity companies. Imagine that! The current U.S. health “non-system” not only costs a lot more per capita than other comparable countries, but leads to worse health outcomes.

The Ultimate Gift We Owe Ourselves: End Private Health Insurance

An article in the LA Progressive succinctly summarizes the core problem plaguing our health insurance: the pervasive role of corporations. Support for a public solution – single payer – is robust among voters and progressive politicians. We deserve this ultimate gift.

Healthcare Beyond 2026, LA Progressive, Dec. 16, 2025, by Sharon Kyle

You first have to understand how healthcare policy making in the U.S. has been systematically bought by powerful corporate interests, especially the health industry lobby.

This isn’t just political influence. It’s institutional leverage over our health, our wallets, and our democracy. In every wealthy democracy besides the United States, healthcare is considered a public responsibility.

When the ACA was passed in 2010, it was sold as a corrective to the broken system. And it did expand coverage, but the ACA’s survival was only possible because it protected private insurers’ core business – mandating participation, subsidizing customers with public funds, and setting up exchanges that funneled taxpayers’ dollars directly into private plans.

Rather than displacing the industry, the ACA made insurers bigger and more dependent on federal policy. It created a system where billions in public money go straight to companies’ bottom lines.

Temporary “enhanced” ACA subsidies introduced during the COVID pandemic – which masked the true cost of premiums for millions – are expiring at the end of 2025. When those subsidies disappear, what people actually pay out of pocket is expected to increase dramatically.

Add to that insurers filing rate increases of 18-26% on average before subsidies – a projected hike that would be the largest in years – and you have a perfect storm of higher costs by design.

And because insurance remains a private commodity nearly unique among wealthy nations, millions could drop coverage, destabilizing risk pools and triggering yet more increases – a feedback loop predictably triggered by policy choices, not economic necessity.

Universal healthcare isn’t radical. It’s common sense in every other wealthy industrialized democracy. What’s radical in America is a democracy where an industry can veto fundamental reform indefinitely.

Why would a profit-driven industry tolerate the loss of millions of customers who will be priced out of coverage in January 2026? The answer is simple, if unsettling: insurers are not in the business of maximizing coverage – they are in the business of maximizing margins.

Many of the people expected to drop coverage when premiums rise are lower-income, higher-need enrollees who rely heavily on subsidies and use more care. From an insurer’s perspective, these customers are expensive to manage and often yield thin profits. When subsidies expire and premiums rise, insurers are not just reacting to costs – they are effectively pricing out the customers they least want.

Higher premiums act as a sorting mechanism. Healthier, wealthier, lower-utilization customers are more likely to stay. Sicker, poorer, higher-cost customers are more likely to leave. The Affordable Care Act prohibits denying coverage outright, but it does not prohibit pricing people out of the market. That distinction matters.

Insurers also know something the public rarely hears out loud: the individual ACA marketplace is not where they make their real money. The most lucrative growth areas are elsewhere: Medicare Advantage, Medicaid managed care, large employer plans, and vertically integrated healthcare empires that now include pharmacies, pharmacy benefit managers, and care delivery systems.

History has taught insurers that instability works in their favor. When premiums spike and coverage drops, public outrage grows. Congress comes under pressure. And insurers re-enter the conversation not as villains, but as “partners” asking for renewed subsidies, reinsurance payments, regulatory relief, or other forms of public stabilization. In short: they expect the government to blink – because it always has.

Universal healthcare is not radical. It is normal. What is radical – and uniquely American – is allowing a profit-driven industry to decide who gets care, at what price, and for how long.

Comment:

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

The Affordable Care Act was supposed to fix our health care system by placing uninsured individuals into exchanges of private insurance plans so that everyone would be covered. Well, it didn’t work. Many remained uninsured, and more than ever insurance plans expose them to unaffordable out-of-pocket costs. High prices and profits still permeate the system. Thus, the US still has by leaps and bounds the costliest system in the world, and despite that sits near the bottom in performance (access and longevity).

The crisis we face as 2025 ends is that COVID-era government subsidies for the Affordable Care Act plans are expiring. Skyrocketing premiums and cost-sharing will leave millions more with inadequate coverage. Despite considerable political pressure to extend the subsidies to avoid financial hardship for patients, the party in control has refused to do so.

Still, this issue is a distraction. Renewing the subsidies would help, to be sure. Yet our insurance would remain the world’s most expensive while perversely, pervasively under-performing.

Other proposals, such as health savings accounts, are much worse because they would make health care even more unaffordable, further impairing access to care and increasing exposure to financial hardship when care is mandatory due to medical urgency.

The great irony is that we already know how to provide comprehensive care for everyone at a price that is affordable to each of us. That, of course, is a well-designed single payer system that would be a refined version of Medicare; that is, improved Medicare for All. We can’t enact and implement it in January 2026. But, as we’ve written, the public is informed on this insurance model and a majority of voters support it. Even a significant plurality of the party that has been opposed now wants to see Medicare for All.

Watching the politicians squabble over grossly inadequate solutions to tweak our health care system is intensely frustrating when we know how to really fix it. There are paths forward: two federal single payer bills, and several meaningful state initiatives. Progressive politicians are gaining in popularity and visibility.

Is 2026 the year when (finally!) the US does the right thing in health care, after the oh-so-many false starts? THAT is the holiday gift we all deserve.

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Excise middle-men from Hawaii Medicaid

By Stephen Kemble, M.D.
Honolulu Star-Advertiser, Dec. 21, 2025

Thanks for the excellent articles in the Star-Advertiser’s Dec. 14 Insight section, on proposals to save primary care practices in Hawaii, especially on the neighbor islands. I agree with the three doctors who co-authored the Island Voices piece, “Support Hawaii’s primary care providers,” that we need to direct a much higher percentage of health care spending to primary care.

We also need to reduce unnecessary administrative burdens that now result in practice overhead costs that are squeezing primary care take-home pay well below what it costs to live in Hawaii, especially on the neighbor islands. Those unnecessary burdens include abusive prior authorization polices, especially by Medicaid managed care plans, and also detailed data reporting required by HMSA’s “value-based” payment policies imposed on primary care over the past decade. Administratively costly payment systems also raise the cost of Medicaid and HMSA premiums for taxpayers and purchasers of insurance.

Hawaii turned Medicaid over to private insurance plans in 1994 and 2009, and the managed care plans added ever-increasing prior authorizations and formulary restrictions, with the result that doctors began to refuse new Medicaid patients. Financing Medicaid through capitated private plans also adds administrative costs of around 13% of total Medicaid spending — and the real figures are likely higher because poor oversight by MedQUEST, incomplete data reporting from the plans, and use of multiple subcontractor costs reported as “health care” enable plans to disguise substantial administrative costs as “health care.”

Removing the middle-men from Medicaid could relieve administrative burdens imposed on primary care practices due to abusive prior authorization policies and also free up money from the state budget to improve payment and support for primary care.

Like Hawaii, Connecticut privatized Medicaid in the 1990s, but in 2012 that state fired the managed care middle-men and started paying primary care doctors extra to manage care instead of expecting insurance companies to do that. Connecticut’s Medicaid spending promptly fell by about 13% due to administrative savings. Connecticut used 3% of the budget to improve primary care pay and add community-based support for high-risk patients. Improved pay and relief from burdensome managed care restrictions resulted in 33% improvement in physician participation in Medicaid from the first year. Increased access to primary care led to decreasing emergency room and hospital spending, and by five years out, Connecticut was spending 15% less per Medicaid beneficiary than in 2012.

Hawaii’s current Medicaid managed care system is quite similar to that of Connecticut in 2012, and a detailed study on Medicaid managed care by Physicians for a National Health Program in September estimates savings for Hawaii from similar reforms would be in the range of $85 million to $145 million per year.

Further reduction in both practice overhead for primary care and in the administrative cost of health insurance could be achieved if HMSA were to abandon primary care capitation and “value-based” payment with its high administrative overhead, and return to a simpler and less costly form of fee-for-service that includes payment for time required for documentation and care coordination.

The Democratic Party of Hawaii Health Committee has drafted a bill to remove the middle-men from Hawaii’s Medicaid program, following the policies that have proven so successful for Connecticut. Passing the bill in the 2026 legislative session would go a long way toward helping save primary care in Hawaii. Large administrative savings would also enable the state of Hawaii to weather impending cuts in federal support for Medicaid a year from now that will otherwise have devastating effects on our entire health care system.

Dr. Stephen Kemble, a retired psychiatrist, served on the now-inactive Hawaii Health Authority, charged with designing a universal health care system for Hawaii residents. He is a national board member of Physicians for a National Health Program.

https://staradvertiser.com…

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