By Rohit Prasad and Kaitlyn Castro
Austin American-Statesman, April 30, 2025
Elon Muskās āDepartment of Government Efficiencyā hasĀ made its way to health careĀ and Congress has placed one critical program on the chopping block:Ā Medicaid. This is the wrong approach. Medicaid is efficient andĀ cheaper than private insurance.
The real waste in health care is in Medicare ā namely Medicare Advantage.
Medicare Advantage plans cost us more without improving peopleās 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 insteadĀ sends that money to a private insurance company, such as Humana or UnitedHealthcare, to give people worse care.
Medicare Advantage costs the governmentĀ 122% more per personĀ than traditional Medicare. This amounted toĀ $83 billion moreĀ 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 isnāt even for our care.Ā Approximately 14% of spendingĀ 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 ofĀ $1,730 in profits per enrollee.
Despite this spending, thereĀ arenāt really any major differencesĀ in health between folks on Medicare Advantage and traditional Medicare. For example, blood sugar control among diabetic Medicare recipientsĀ was the sameĀ 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 patientsĀ 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 doctorās offices and more time doing what they love.
Unfortunately, compared to traditional Medicare,Ā 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 toĀ restrictive provider networks
Furthermore, some Medicare Advantage plans have landed in hot water forĀ using artificial intelligence, not real qualified doctors, to authorize payments for care. Some Medicare Advantage plans haveĀ cut off careĀ for patients recovering from cancer, strokes and amputations simply because a computer algorithm decided that care was no longer necessary. Thatās why these companies are facing a class-action lawsuit andĀ even congressional actionĀ 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 peopleās health. Not to mention that while patients deal with these barriers, the private Medicare Advantage companiesĀ rake in profitsĀ on the taxpayerās dime. Unfortunately, though, this administration seemsĀ primed to double-downĀ 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 organizationĀ Physicians for a National Health Program.