The Ultimate Gift We Owe Ourselves: End Private Health Insurance

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

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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.

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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.

https://healthjusticemonitor.org…

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