PNHP

Medical funding should be a social good

Medical funding should be a social good

By Henry Kahn, M.D.
The Atlanta Journal-Constitution, Letters, July 28, 2025

As explained by Mike King in his AJC Opinion piece, “Why a beloved hospital failed – and why it doesn’t have to be this way,” July 20, the Atlanta Medical Center came to its end because it couldn’t survive in our country’s environment of profit-oriented medical care.

King is correct. The United States stands out among all wealthy societies as the only place where health and medical care are supposed to exist as businesses. In other wealthy countries, it’s presumed that health is – and should be – a social good, not a commercial product.

Those societies pay for their doctors, nurses, clinics, hospitals and public health services through progressive taxation plans that save money for the population. They don’t permit high overheads, lobbying or skimming profits off every collected dollar. Their medical coverage is essentially universal (everybody included in the same plan) because that’s the ethical and less expensive solution.

Medical funding in Georgia and the U.S. Is in a gloomy place right now. A bright spot can be found among the younger doctors, nurses and trainees who won’t accept the commercial distortion of their duty to deliver care where it’s needed. It’s time for our politicians and bean counters to follow the lead of the more Idealistic, coming leadership.

https://ajc.com…

When Doctors Suffer Too: The Hidden Crisis of Moral Injury in U.S. Healthcare

By Brenda Gazzar
Code Wack Podcast, July 28, 2025

Most of us know that our profit-driven healthcare system results in moral injury. How is moral harming physicians? And how is it harming patients? Dr. Diljeet Singh is an integrative gynecologic oncologist and the president of Physicians for a National Health Program. She’s leading a powerful new project with the Robert Wood Johnson Foundation to find out.

By gathering stories from doctors and patients across the country, her team is uncovering how corporate control and financial pressures are fueling moral injury in medicine—and what it will take to make things right. From physicians losing autonomy to entire communities losing access to care, the stakes are real—and deeply personal. This is the second episode in a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

The “Bright Side” of America’s Health Insurance System

By Jay Brock, M.D.
FXBG Advance, July 22, 2025

Not that long ago I happened to run into someone who was running as a candidate in a primary election for Congress. The conversation soon turned to the American health insurance system, including a number of points regarding the gaping insufficiencies of our current system.

We ended up discussing the most startling example of how our current health insurance system has failed the American people—each year, 70,000 Americans die prematurely because they cannot afford to pay for timely medical care.

The candidate’s response? In a nation of 350 million, having only 70,000 die each year as a direct result of a failed health insurance system seemed to be quite a low number.

I guess that’s one way to look at it.

(The candidate happened to be a veteran, and I still wonder what his reaction would have been if I stated that having only 70,000 American troops die in battle every year due to gross mismanagement—and indifference about their welfare—was also quite a low number. In any case, he didn’t get the nomination.)

But maybe he had a point. Let’s look at the bright side of our health insurance system.

We’re #1 in the world in healthcare spending per person. We may get worse results than all other advanced nations, and unaffordable healthcare may be the #1 kitchen table issue for most Americans for multiple election cycles, but no other nation can say they spend as much as we do. We’re still #1!

Only 25 million Americans don’t have health insurance—but 325 million do!

And of the 325 million with health insurance, if 60 million are by definition considered “underinsured” (they cannot afford to use their insurance due to onerous out-of-pocket costs) then 265 million Americans aren’t considered underinsured.

On the other hand, 3/4 Americans still worry that they won’t be able to afford to pay their medical bills if they get sick. The bright side, of course, means that one in four Americans don’t worry. Imagine: nearly 90 million Americans DON’T worry about being able to afford to pay their medical bills if they get sick! A remarkable success!

Only a half-million Americans endure a medical bankruptcy each year. That means 349,500,000 Americans don’t endure a medical bankruptcy in any given year. Of course, medical bankruptcy is not a usual occurrence in other advanced nations, but when it comes to medical bankruptcy we’re #1! And likely to stay there unless and until we get a different health insurance system. (Don’t hold your breath.)

That means that since 2000, some 12 million Americans (most with health insurance) have endured a medical bankruptcy. But who’s counting! (Certainly not Congress.)

Is the Big, Beautiful budget Bill recently passed by Republicans in Congress (not a single Democrat voted for it) another “bright side” of our health insurance system? Let’s see: the bill will cut about one trillion dollars from healthcare —especially Medicaid—over the next decade in order to provide huge tax breaks for the wealthiest Americans.

Though spending cuts will be directly affecting mostly the poor and disabled—the people on Medicaid—eventually even rich folk will be harmed by this bill when hundreds of local hospitals (that don’t serve just poor and disabled people on Medicaid) start closing their doors as a result of these dramatic cuts to healthcare spending.

But the bright side is that the wealthiest Americans will keep getting huge tax breaks!

Maybe they should have called this the “Big Beautiful Bright Side of Health Insurance Bill!”

Republicans are defending this trillion dollar cut to healthcare funding by claiming that they will save Medicaid for those who really need it. Their prime example: if you can work but aren’t, this program isn’t for you…unless you jump through numerous government-mandated hoops to prove that you really are deserving of health insurance.

It’s as if there are two groups of folks: those who deserve healthcare, and those who don’t. (In case you haven’t already noticed, this is remarkably representative of our current entire system, where rich Americans can afford great healthcare but non-rich Americans struggle.)

Republicans saying these huge funding cuts are actually saving Medicaid for those who really need it is reminiscent of American military spokesmen during the Vietnam War claiming that they needed to destroy a village in order to save it.

What Republicans aren’t saying is that mandating work requirements to be eligible for Medicaid doesn’t work. The overwhelming majority of those on Medicaid are in fact eligible, but the new bureaucratic paperwork requirements are so burdensome that many deserving enrollees will be thrown off the program, saving money to pay for those tax cuts for the wealthiest Americans.

Even worse, some states spend more on enforcing their eligibility requirements than they do on healthcare for these enrollees.

But who’s counting!

https://fxbgadvance.com…

Responding to Anti-Universal Care Social Media

Health insurance industry opponents of universal coverage have invested heavily in social media to sow doubt about the benefits of health policies and to undermine public trust in government and evidence. Effective response requires understanding the public’s values and a multi-pronged communication strategy.

Generating Opposition to universal healthcare policies the United States: An analysis of private health industry advertising on Meta platforms, PLOS Global Public Health, July 16, 2025, by Kendra Chow, et al.

Abstract

In 2019, the Partnership for America’s Health Care Future (PAHCF), a private health industry lobby group, launched a campaign across Meta platforms (Facebook, Instagram) to generate opposition to universal health care policies in the United States. This study investigates the content and the themes prevalent in PAHCF’s campaign and how these might shape public discourse and perceptions around universal health care policies. Using qualitative content analysis, 1675 advertisements were examined on Meta platforms within PAGCF’s campaign. Inductive methodology was applied to develop a coding framework. Details of campaign spend and number of impressions advertisements received were also collected. The qualitative coding strategies identified three overarching foci: policy targets, claims and themes, and targeted appeal groups. These elements were found to strategically and mutually reinforce one another to generate the narrative that proposed universal health care policies will be detrimental to public health, the economy, and society. Analysis identified that PAHCF engages in strategies common among unhealthy commodity industries. Social media in this instance powerfully perpetuated PAHCF messages that undermined universal health care efforts and contributed to the commercial determinants of health impacts of this industry. These findings indicate that the private health care industry is participating in wider commercial determinants of health activities, acting to protect their profits to the detriment of public health. Like other campaigns by unhealthy commodity industries, PAHCF’s campaign is designed to increase doubt in the benefits of health policies, undermine public trust in government and evidence, and promote public alignment with their own messaging and preferred solutions. To counter such tactics, public health professionals need to gain a better understanding of the strategies unhealthy commodity industries utilize to deflect attention from their underlying health-harming intentions, especially through more novel platforms like social media.

Comment:

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

This study shows that anti-insurance reform forces are aggressively exploiting the power of social media, our era’s central tool for disseminating ideas. The Partnership for America’s Health Care Future social media campaign cleverly crafts negative (and misleading) perceptions of a universal health care system.

Those of us advocating for universal, comprehensive, affordable health care have faced intense opposition, often from organizations like PAHCF. Such opposition has not relied solely on social media. Other avenues include political parties (both Republican and Democratic) and large media networks such as Fox News. These strategies have been all too successful at creating resistance and fear about an insurance approach that is functioning and appreciated around the world.

Support for universal health programs derives from a belief in social justice: everyone should have access to comprehensive health care that is kept affordable through progressive taxes. Opponents place a high value on each person being individually responsible for funding their own care, with a minimized role of government. The centrist consensus (GOP & Dem alike) is that free market dynamics and limited government programs like Medicaid will assure efficiency and (limited) generosity. However, anyone who has studied recent US health policy knows that the market model fails – neither efficient nor generous. The current system increases the wealth of investors by depriving lower-income individuals of needed care.

Could individuals across the political spectrum assemble to calmly devise a system that works of all of us? It appears not. Those supporting single payer, which requires funding based on the ability to pay, will never win the support of individuals who deem it unfair to require them to pay more, no matter how wealthy they are. In an age of billionaires, there seems to be rising inflexibility on this issue.

Ok, much education and persuasion is needed before we can gather to devise a functioning universal approach. Could we build this support through expanded social media? It certainly must be a central part of the strategy.

However, before we dive into persuasive techniques, let’s explore what substantive arguments might work. Both of us really like AI LLMs (large language models) for the ability to frame issues. Thus, to structure our thinking, we asked ChatGPT.

Let’s all ponder and critique this framework. In coming weeks we’ll refine these AI comments and build the persuasive arguments.

Prompt:

What factors make a person decide that society should support an equitable, universal financing system for health care that enables everyone to receive the health care that they should have, as opposed to the view that each person should be individually responsible for providing the funds that are needed to pay for their own health care, whether by direct payment or payment through insurance?

ChatGPT said:

The decision to support an equitable, universal financing system for health care versus an individual responsibility model is shaped by a mix of moral, cultural, economic, and practical considerations. Here are the major factors that influence which viewpoint a person adopts:

1. Moral and Ethical Values

Belief in health care as a human right: People who see health care as a fundamental human right often favor universal systems, believing that access should not depend on wealth or employment.

Empathy and social solidarity: Those who place a high value on community welfare, fairness, and compassion tend to support systems that ensure no one is left behind.

Views on individualism vs. collectivism: In cultures or families that emphasize individual responsibility, people may lean toward self-financed health care. Conversely, collectivist values emphasize shared responsibility.

2. Economic Perspectives

Risk pooling and efficiency: Some recognize that universal systems spread risk across society, lowering overall costs and avoiding the inefficiencies of fragmented, for-profit insurance systems.

Concerns about personal cost: People who believe they can afford their own care (or have good insurance) may resist universal systems because they fear higher taxes or subsidizing others.

Awareness of market failures: Those who understand that health care markets don’t function like regular markets (due to emergencies, unequal information, and lack of consumer choice) may see universal financing as more rational.

3. Personal Experiences

Encounters with medical bills or gaps in coverage: A personal or family experience with medical bankruptcy, denial of care, or lack of insurance often shifts people toward supporting universal care.

Positive or negative experiences abroad: Exposure to universal health care systems in other countries can strongly influence perceptions.

Trust in existing insurance or employer coverage: People satisfied with their private insurance may feel less incentive to support systemic change.

4. Knowledge and Awareness

Understanding of how health care is financed: People who learn that even private care is heavily subsidized (through tax breaks, public programs, etc.) may be more open to universal financing.

Evidence of better outcomes elsewhere: Awareness that countries with universal health care often achieve better health outcomes at lower costs can sway opinions.

Misinformation or myths: Some oppose universal systems due to beliefs that such systems mean “rationing,” poor quality, or lack of choice, even when evidence suggests otherwise.

5. Political and Ideological Beliefs

Role of government: People who trust government and view it as a vehicle for public good are more likely to support universal systems. Those who distrust government often favor private solutions.

Perception of fairness: Some believe it’s unfair to require healthy or wealthy individuals to pay for others’ care, while others see universal care as a fair use of shared resources.

Influence of political parties and media: Political messaging significantly shapes opinions, with universal care often framed differently depending on ideological leanings.

6. Social and Cultural Factors

Sense of social safety nets: In societies where public education, roads, and policing are accepted as communal goods, people are more likely to see health care in the same way.

Cultural attitudes toward poverty and illness: Societies that view illness as a personal failing may favor individual responsibility, while those that see it as largely random and unavoidable lean toward shared financing.

7. Fear of Economic Insecurity

Job-based insurance concerns: People who fear losing health coverage due to unemployment or changing jobs may prefer universal financing for stability.

Desire for protection against catastrophic costs: Recognition that anyone can face unexpected illness can lead to support for collective risk-sharing.

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.

Betrayal, Burnout & Moral Injury: Doctors and the Financialization of Medicine

By Brenda Gazzar
Code Wack Podcast, July 21, 2025

What happens when doctors feel forced to act against their own moral compass? When financial barriers—not clinical judgment—determine the care a patient receives?

We’re talking about moral injury in medicine—how it’s affecting physicians, harming patients, and why it’s getting worse under our profit-driven healthcare system.

Joining us is Dr. Diljeet Singh, an integrative gynecologic oncologist and president of Physicians for a National Health Program. She shares powerful stories from her own practice—and from the front lines of American healthcare—that reveal a deeper crisis than just burnout. This is the first episode in a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

The Failure of Neoliberalism in Health Care

Two new articles by Hayden Rooke-Ley explain how neoliberal economics and the largely private insurance system it created have failed patients by maximizing profits at the expense of patient care. It’s time for a public-driven approach.

The Same Script: Value-Based Payment, Managed Care, and Neoliberalism, The Law and Political Economy Project, July 15, 2025, by Hayden Rooke-Ley

Ultimately, the private rationing of managed care and value-based payment is an abdication of governance – a failure of policymakers to wield the public authority required to equitably and efficiently administer a public health care program. A post-neoliberal health care agenda, by contrast, would contain costs through proper price administration and cutting private-sector administrative waste – the true drivers of overspending. It would directly reimburse physicians and other clinicians and nurture their professional autonomy, rather than empowering corporate executives and financiers to control them. It would use savings to make Medicare and other insurance programs more affordable for patients, and to properly pay overworked and underpaid caregivers. Now is the time to depart from the four-decade experiment with managed care and to structure financing policy to serve the interests of clinicians, patients, and their local communities.

Delays and Denials in Medicare Advantage, JAMA, June 25, 2025, by Hayden Rooke-Ley et al.

The growth of privatized Medicare is increasing the rates of prior authorizations and claim denials creating barriers to care, increasing administrative waste, and demoralizing clinicians. At the core of this problem lies a conflict of interest: the Medicare Advantage (MA) insurance companies that profit from denials are entrusted to make neutral determinations of medical necessity as they apply Medicare’s coverage rules. They do not. Unsurprisingly, MA plans serve their financial interests first.

Privatized Medicare was not supposed to work this way. MA plans are mandated by law to cover the same benefits as Traditional Medicare (TM) and follow Medicare coverage rules. However, MA insurers often refuse to follow them.

For decades, observers have raised concerns about denials in managed care, researchers proposed various solutions, and regulators have promulgated rules to clamp down on certain conduct. However, these solutions stop short of addressing the core conflict of interest. Fortunately, a solution lies in plain sight. TM uses third-party contractors, known as Medicare administrative Contractors (MACs), to implement coverage rules, engage in targeted prior authorization, and process and adjudicate claims. Although MACs are not perfect, they do have one major advantage over MA insurers: they are not biased toward denying care. MACs are paid a simple administrative fee. They are not at risk for medical costs and have no financial interest in denying services or payments. This process is efficient: CMS spends less than 2% on administrative costs, compared to 13% in MA.

Comment:

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

Health care in the United States is far costlier than in all other countries, and the performance of our system falls near the bottom of industrialized nations. As often discussed in HJM, we understand the functional reasons for this underperformance – grossly inefficient processes and massive financial access gaps.

In these two publications, Hayden Rooke-Ley digs deeper to explore underlying causes. He cogently critiques our neoliberal economic approach, which places blind faith in private sector mechanisms to optimize system performance. The fundamental problem is: optimize for whom? The private sector-dominated insurance system prioritizes creating wealth for investors at the cost of depriving consumers of the medical care they should have. He finds a defective nexus of managed care, value-based payments, prior authorizations, and denial of care and/or care payments.

These highly detrimental dynamics could be resolved by applying a sound policy principle: return control of decisions that affect patients to individuals who have no financial stake in the decisions. These are public guardians and their agents, interacting directly with medical providers. Remove the profit-seeking intermediaries. This would also help us end other faulty policies such as narrow provider networks and excessive patient cost-sharing should.

Hayden Rooke-Ley has also written about how to transform the provider side – i.e., how the harm from private equity could be mollified by the revitalization of public provisioning of medical resources.

Both of these papers are well worth downloading to be fully consumed. And to be used to explain to others why our system is functioning so poorly considering its high costs. They can serve as a springboard to a system that would be affordable and work well for all of us: a single payer national health program.

https://healthjusticemonitor.org…

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

Sunlight Report on UnitedHealth Group

Center for Health & Democracy, July 16, 2025

Shining a light on a giant

The Sunlight Report on UnitedHealth Group is a first-of-its-kind look at the nearly 2,700 acquisitions and internally created subsidiaries that make up UnitedHealth Group, the largest health care conglomerate in the world.

Named for its mission to bring light to UnitedHealth’s vast and often opaque business structure, this project compiles and analyses publicly available data in an accessible way,  allowing the public to more clearly grasp the scope of the company’s reach.

Introduction

UnitedHealth Group has evolved from a small U.S. health insurer into a massive health care conglomerate through decades of strategic acquisitions and vertical integration. It provides health insurance and related services globally and is broadly divided into its insurance arm (UnitedHealthcare) and another major division (Optum), which provides other health care-related services. As of the fourth quarter of 2024, UnitedHealth operated in almost every country in the world, had more than 400,000 employees, and reported 2024 revenue of $400 billion. Through its vertical integration and acquisitions, it now employs or has close contractual ties with more than 90,000 doctors (nearly 10% of the entire U.S. physician workforce) and commands 15% of the U.S. health insurance market. As a result of this vertical integration strategy, almost 30% of total company revenue is now generated by internal business entities. 

(The relevant accounting term to further explain the significance of that percentage is “intercompany eliminations.” In its financial disclosures, UnitedHealth must report intercompany eliminations to avoid double counting. This is because the company is paying itself in many instances, i.e., UnitedHealthcare, the insurer, increasingly is paying health care providers (grouped under Optum) that it owns or otherwise controls. In 2010, before UnitedHealth had acquired most of its clinical assets and when the company’s revenues were $94.2 billion, eliminations totaled $18.3 billion, or approximately 16% of total revenue. In 2024, after hundreds of acquisitions of physician practices and other clinical assets and when the company’s revenues totaled $400.3 billion, eliminations had reached $150.9 billion, or 27.4% of total revenue. Here’s another way of looking at this: The eliminations in 2024 represented nearly 60% of Optum’s total revenues.)

The sheer size and complexity of the organization, coupled with its rapid pace of acquisitions, makes it difficult for consumers, regulators, policymakers, employers and other group purchasers of health insurance to understand the inner workings of the organization. This is compounded by often insufficient granularity in UnitedHealth’s financial and regulatory reporting. For example, current financial reporting aggregates data from multiple entities and regions, often without clear delineation of contributions by subsidiary or geography. This makes it difficult to analyze the performance (and significance) of its many individual components. Similarly, corporate filings and disclosures often do not include information about entity-specific operations and people.

We believe these factors leave the public without critical information needed to understand how UnitedHealth’s size and structure affects health care access, quality, and affordability. The details of many of its acquisitions are not publicly disclosed, which, coupled with its byzantine structure, deters most people from learning more or understanding what is at stake.

That is why we undertook the massive project of helping the public understand this corporation, which has grown to become the fourth largest on the Fortune 500 list of American companies.

full report: https://sunlightreportinsurance.com…

UnitedHealth Has 2,694 Subsidiaries and Affiliates. Is It Too Big to Manage?

This behemoth conglomerate might just be too monstrous for its own good.

By Jarod Facundo and Patrick Rucker
The American Prospect, July 16, 2025

UnitedHealth Group executives have long argued that buying rival health care companies was the key to earning long-term profits, and investors who endorsed that strategy were rewarded for years.

Since UnitedHealth announced disappointing earnings in April, though, Wall Street has erased roughly half of the company’s stock value, and its “buy everything” business model has come under scrutiny.

A new report tallies UnitedHealth’s vast holdings and chronicles how the company both spawned new enterprises and went on a prolonged buying spree to grow. In all, UnitedHealth has a whopping 2,694 subsidiaries and affiliates.

The report gives a deal-by-deal accounting of how UnitedHealth ballooned, but it also implicitly asks a key question: Has it become too big to manage?

“United is shaping our health care system, and few people know the company’s scope,” said Wendell Potter, president of the Center for Health & Democracy, which published the Sunlight Report on UnitedHealth Group with financial support from Arnold Ventures.

The report shows how a vast national health care system largely feeds the bottom line of one giant enterprise.

In a statement, UnitedHealth said the company sought to streamline a medical system that is fragmented and inefficient.

“We’re helping to accelerate the transition of the U.S. health care system,” said Dr. Wyatt Decker, a UnitedHealth executive who described the company’s “value-based” model for paying doctors more when their patients become healthy rather than for the number of treatments they give.

UnitedHealth, he said, seeks to move “beyond a transaction-based health system to a model that is designed to be proactive to help keep people healthy over the course of their lifetimes.”

Whatever UnitedHealth’s stated ambitions, the company has become so complex that it is difficult for regulators and enforcers who would rein it in, said Reed Showalter, a senior fellow for the Vanderbilt Policy Accelerator, a think tank within Vanderbilt University. He calls it “weaponized complexity.”

“You end up with this game of whack-a-mole because these companies are so big and they can hide unfairness and harms in so many different ways through their subsidiaries.”

The Prospect has previously detailed UnitedHealth’s relentless, single-minded, half-century search for profits. One industry analyst describes how the company has used its vast store of wealth to pull more and more rivals under its control.

“This is not a care delivery ‘system,’” said Jeff Goldsmith, who has followed the company closely for decades. “United is a profit-mining enterprise. They used profits to buy profitable companies.” But Goldsmith cautioned that this merger spree has stopped, with uncertain implications for UnitedHealth’s future.

Acquiring Profits

Established in 1974 to handle overhead and doctor salaries for then-popular health maintenance organizations (HMOs), UnitedHealth set its sights throughout the 1980s on rival insurers as part of a drive toward horizontal integration, Goldsmith said. More recently, UnitedHealth targeted health care providers and health data systems as a way to vertically integrate.

The company sought out profitable links in the health care delivery chain and avoided low-margin businesses like hospitals.

Roughly 1 in 10 physicians work for UnitedHealth; the company controls about 20 percent of the prescription drug market through pharmacy benefit manager (PBM) Optum Rx, and collected $300 billion last year providing insurance for patients.

Besides the eye-popping number of subsidiaries, UnitedHealth has a staggering 400,000 employees.

“Most patients do not realize their physician might also be employed by their insurer. It raises trust and ethical issues. How does United balance tensions between controlling costs and quality? They don’t say,” said Seth Glickman, a former insurance and health system executive. He now is a researcher and advocate for reform in the health care finance space who helped author the Sunlight Report.

“Can the CEO or the board really understand all that is happening?” asked Lawton R. Burns, a professor of health care management at the Wharton School of Business at the University of Pennsylvania. “When you get to this size, you run into issues of governance.”

In the light of some transactions, UnitedHealth resembles a financial services company more than an insurer. Its Optum Bank lends to independent physician practices and has nearly $15 billion in deposits. Optum Ventures, its venture capital arm, has more than $2 billion in assets.

Potter’s Sunlight Report uncovered UnitedHealth’s disparate holdings by drilling through required filings to state insurance regulators, known as Schedule Y.

Buying Spree

In 2010, the company controlled just 149 individual entities. By 2023, that number had ballooned nearly twentyfold. Nearly 80 percent of the acquisitions over that period were health care providers, according to the report. The remaining 20 percent consisted largely of international acquisitions and administrative enterprises that helped consolidate UnitedHealth’s vast health data system and PBM, and specialty insurance providers offering coverage for everything from workers’ compensation to dental plans.

As the company’s holdings grew, so did revenue, and it seemed like the business plan was working. Beginning in 2010, total revenue increased from $94 billion to $400 billion, while net income rose from $4.6 billion to $15 billion, according to securities filings. Meanwhile, investors saw share prices skyrocket from $30 per share to $530 a decade later.

While the overall growth numbers have been impressive, more and more UnitedHealth revenue has come from the company doing business with its own subsidiaries.

In 2010, roughly $18.3 billion of Optum revenue came from businesses it owns, according to SEC filings. Today, that number has increased nearly tenfold to $151 billion, according to an analysis of securities filings..

Unmanageable

With its vast and sprawling network of medical interests, it’s not just UnitedHealth’s size that worries Goldsmith, but its unmanageability.

“To create real synergies in this space, you have to make it easier for doctors to practice medicine and improve the patient’s experience. That hasn’t happened,” he said, noting that UnitedHealth has a net negative view among consumers.

“You have all these moving parts,” he said. “But the nerve endings are not reaching all the way to the fingers and toes.”

There is a fine line between a business that operates profitably at a large scale and one that struggles to manage its distinct parts, said Professor Burns at Wharton.

“The country has over 60 years of business history with conglomerates, and that history isn’t very glowing,” he said, noting that health care is particularly difficult to scale nationally.

“There is a reason that the largest hospital groups and provider networks are regional and not national,” he said. “It turns out, when it comes to health care, people prefer a local-based culture.”

Goldsmith put it more bluntly. “United does a terrible job providing services,” he said. “If you can’t meet my needs as a patient and if you can’t connect with all those talented docs that you acquired, you don’t have anything. You just have a bunch of assets that are depreciating in value. That is a recipe for a shrinking company.”

In response, UnitedHealth’s Dr. Wyatt Decker said, “Optum aligns with and employs physician practices to advance solutions to expand access to care, improve affordability, enhance the care experience and achieve better health outcomes.”

Medicare Profits

Regulators and investors are beginning to ask whether UnitedHealth’s vast provider network wrongly boosted its popular insurance program for seniors.

UnitedHealth controls roughly 30 percent of the Medicare Advantage market, and it enrolls more seniors than any other operator. Many of UnitedHealth’s acquisitions have solidified the company’s power to not only treat ailing seniors but also determine how sick they are for the purposes of reimbursement.

Roughly one-third of the acquisitions tallied in the Sunlight Report are related to a single deal: UnitedHealth’s $5.4 billion acquisition of home health provider LHC Group in 2022.

UnitedHealth has used home wellness visits and medical codes in health records to exaggerate the poor health of seniors, which boosts payout from the government, The Wall Street Journal reported last year. Medicare Advantage patient evaluations are known as “risk adjustments,” and UnitedHealth has defended the integrity of the practice and its Medicare Advantage program generally.

The company continues to do so. “[Medicare Advantage] plans are regularly audited for accuracy and compliance, and we consistently perform at the industry’s highest levels. We have advocated that CMS conduct audits for every plan, every year, and remain supportive of that proposal,” said UnitedHealth’s Dr. Decker.

The Journal followed up with a report in May of this year that the Justice Department is now investigating whether UnitedHealth engaged in criminal Medicare fraud. On July 9, the Journal reported that federal agents interviewed former UnitedHealth doctors and a nurse practitioner about the training and software used to capture lucrative medical conditions.

If UnitedHealth did use its vast provider network to boost its Medicare Advantage revenue, that business model could now be under threat. For now, UnitedHealth must try to squeeze efficiencies out of a disparate provider network and try to mollify doctors who might chafe under UnitedHealth’s control.

“You can try to get all these doctors on the same reporting system and have them help develop a business strategy,” Goldsmith said. “But United is still dealing with a pretty disaffected workforce.”

Bigger Is Better?

Some investors who are unfazed by UnitedHealth’s stock sell-off said they still believe in the company’s strategy, particularly the practice of acquiring health care providers.

“If you own providers, you have more touch points to keep the patient out of hospitals. That’s how you can control spend,” said one hedge fund manager whose portfolio is 20 percent health insurers, including UnitedHealth.

Insurers have traditionally paid doctors for the care they deliver, a model called fee-for-service. UnitedHealth has been a proponent of value-based care, which pays providers more when they can prove the patient got better after the treatment.

“These guys are positioned for the adaptation of value-based care,” said the hedge fund manager, who declined to be named discussing investment strategy.

Value-based care has principally been limited to Medicare Advantage plans. “But it will increasingly be adopted on the commercial side,” the hedge fund manager said, referring to employer-funded health insurance.

Some analysts disagree and argue that UnitedHealth’s buying binge has only created a bloated, unmanageable company. Yet UnitedHealth’s strategic vision remains the same.

“Our strategy and structure are the right ones for this era,” Stephen Hemsley told investors on the day he took over for his second stint as CEO this May, after Andrew Witty stepped down. “We have made meaningful progress through value-based care approaches … I believe and expect we can also be in the forefront of modernization and innovation across the health system.” (Hemsley, while UnitedHealth’s chair, reportedly sold tens of millions of dollars in stock right after the Justice Department informed the company of an antitrust investigation in 2023, and right before it was disclosed in the media.)

Future Unclear

One reason for UnitedHealth’s earnings shock was a sudden uptick in medical expenditures among Medicare Advantage members. “The medical costs of many Medicare Advantage beneficiaries new to UnitedHealthcare remained higher than expected,” the company acknowledged in May.

“It’s unclear whether United simply mispriced their insurance book or made other correctable errors, or whether there are more structural issues from a business perspective,” said Hayden Rooke-Ley, a senior fellow at the Brown University School of Public Health and the American Economic Liberties Project. UnitedHealth’s drive to control more health care providers might not lower costs for consumers or improve health outcomes, but it can still be profitable, he said.

“Whether this playbook will continue to be successful will have a lot to do with whether policymakers and regulators continue to encourage this vertical consolidation—or start to question it.”

https://prospect.org…

Immigrants and Health Care

The Trump White House is emphatically pursuing a policy of massive immigrant detention and deportation that is both inhumane and unpopular. It is also profoundly harmful to our well-being: it threatens the backbone of our health care workforce.

Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis, The New England Journal of Medicine, July 5, 2025, by Patricia Mae G. Santos, et al.

As the federal government seeks to curb immigration of all forms, immigrant health care workers and their patients will inevitably find themselves caught in the dragnet, which will have serious consequences for the system at large. The United States already has been grappling with severe health care worker shortages, which are projected to worsen over the next few years. For aging populations the forecast is especially dire.

The physically demanding nature of direct care work (home health aides, personal care aides, and certified nursing assistants), combined with low pay and high susceptibility to exploitation, makes these roles unattractive to U.S.-born and highly skilled foreign-born workers. Indiscriminate mass-deportation policies not only infringe on basic civil liberties but may also exacerbate existing worker shortages.

Immigration policy must therefore protect the dignity of people who dedicate their lives to caring for others, The recent deportation of immigrant health care workers is our canary in the coal mine: policymakers must act swiftly, or risk endangering the health of us all.

What a $178 billion gift means for the immigration police state, The Washington Post, July 8, 2025, by Catherine Rampell

Trump’s new mega-law invests $178 billion in additional immigration enforcement over the next decade. To be clear, this is not merely about “border security.” It’s largely for more detention centers and boots on the ground within the U.S. interior. This means spending more dollars to round up gardeners, home health aides, grad students, nannies, construction workers, etc.

In other words, the administration is going after your family, neighbors and friends, regardless of how long they’ve been here, whether they present any “safety” threat or how much they’ve contributed to their communities.

With daily arrest quotas to meet, agents are filling detention centers not with criminals and gangbangers, but people with no criminal history whatsoever.

Trump is not merely siccing immigration forces upon those who had been undocumented (with or without criminal records), under the stewardship of Deputy Chief of Staff Stephen Miller, this administration has also been working to “de-document” hundreds of thousands of immigrants who are here legally.

The Justice Department recently announced plans to prioritize revoking citizenship from naturalized U.S. citizens. The administration is also still trying to strip birthright citizenship from babies born in the United States, including those born to both undocumented and many authorized immigrant parents.

Comment:

By Don McCanne, M.D.

Stephen Miller has been working with President Trump to advance immigration policies that are opposed by most of the American public. Perhaps foremost amongst these is his effort to dramatically reduce legitimate immigration into the United States, much of which is beneficial because most of these individuals improve our national productivity, not only in menial occupations but often in professional roles as well. Yet Miller distorts his pronouncements to provide a rhetorical basis for obstructing US residence of these qualified individuals.

Listening to his framing induces a “thought experiment” that places him as the object of similarly distorted thought processes:

“To repair a problem you must first define it. Stephen Miller defines immigration as a broad negative. This implies the need to expel foreigners whom he considers to be undesirable, even if they are upstanding, contributing to our health and economy. A prominent medical journal offers a more positive and honest view of immigration as implied in the title, “Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis.”

“The growing dislike of Miller for his disruption of the valuable contributions made by immigrants to US prosperity creates a new proposition: How can we neutralize Miller’s harmful actions? Removing him from his current White House role seems the logical path. Some say his own immigrant origins should be investigated, to scrutinize the legitimacy of his claim to be in the US. That seems fair. However, we reject drastic measures, as suggested by some, because we value humanity, which we’re unsure Stephen Miller does.”

The ”oust Stephen Miller” path should have far greater appeal to the public than the despicable ideas and actions he is foisting off on us. In removing him, our society would achieve a trifecta: more humane, healthier, and wealthier.

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.

Trump-GOP Budget: 17 Million Americans Lose Health Insurance; 51,000 Preventable Deaths Expected Annually

Interview with Dr. Phil Brewer

Counterpoint, July 7, 2025

PNHP past president Dr. Adam Gaffney discusses the expected overall health care impact of the Trump-GOP federal budget bill just passed by Congress that cuts $1 trillion from Medicaid and Medicare, will take away millions of poor families’ access to food and nutrition programs, and will close hundreds of community and rural hospitals.

Dr. Gaffney also addresses viable alternatives to America’s current failed for-profit health care system—notably a single-payer national health program aka improved Medicare for All.

https://btlonline.org…

July 4 protesters in Midtown sound the alarm against Trump’s ‘Big Beautiful Bill,’ now the law of the land

By Gabriele Holtermann
AMNY, July 5, 2025

As President Donald Trump signed his “Big Beautiful Bill” into law at a White House military family picnic on July 4, around 75 demonstrators gathered across from Trump Tower in Midtown Manhattan sounding the alarm that the new legislation would harm the most vulnerable Americans.

Physicians for a National Health Program NY Metro, Indivisible, and Rise and Resist organized the Independence Day protest. Julie DeLaurier, a member of the political action group Rise and Resist, said the protesters were gut-punched and horrified at what she described as Republicans’ “gleeful” cruelty.

She joined the protest, which also included a die-in outside of Trump Tower, on the Fourth of July because it was “better than sitting at home and crying.”

“We’re going to fight this,” DeLaurier vowed. “We’re only six months into [the Trump administration]. We’ve got a long way to go, and we are here for the duration. We are never, ever going to sit down and take this. Other countries made the mistake. Other generations made that mistake. We will not make that mistake.”

Feeling ‘run over’ by Trump

DeLaurier also expressed her frustration with the Democratic leadership, like Senate Minority Leader Chuck Schumer, for believing that they did not explore and use every possible avenue to stop the bill and Trump’s agenda. Republicans hold razor-thin majorities in both the House and Senate.

“They have unanimous consent. They have the filibuster. They used nothing to stop or stall these appointments [and] these bills,” DeLaurier said. “They’ve let Trump and the MAGAs run over them like Panzer tanks.”

The massive tax and spending bill cleared its final hurdle in the House on July 2 and calls for $4.5 trillion in tax cuts, mostly benefiting the top 1% earners, as well as $350 billion for national security, including $30 billion for Immigration and Customs Enforcement (ICE) and $45 billion for 100,000 migrant detention facility beds.

The legislation also raises the national debt limit by $5 trillion, according to the nonpartisan Congressional Budget Office, which also projected it will add another $3 trillion to the national deficit — already at over $37 trillion and counting — over the next decade.

Losses to Medicaid and SNAP

Meanwhile, the new law cuts funding to programs such as the Supplemental Nutrition Assistance Program (SNAP) by nearly $300 billion, as well as to Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program, by approximately $930 billion. The law imposes work requirements of at least 80 hours per month to be eligible for Medicaid coverage, and states offering Medicaid to undocumented immigrants would also lose federal funding.

Dr. Steve Auerbach, a retired pediatrician and public health doctor, told amNewYork that the United States is the only capitalist democratic country without universal healthcare, and cutting Medicaid would add more stress to an already fragile healthcare system, putting the lives of Americans at further risk.

Auerbach, who also serves on the board of directors of Physicians for the National Health Program New York Metro chapter, said every physician had stories about patients who didn’t have the money to fill prescriptions or tried to make a dose spread out that it didn’ take care of their health condition, people who were afraid to call the ambulance because of the bills and died because of a heart attack, or couldn’t afford to check out the lump in their breast and died of cancer.

“And now it’s going to get worse for the first time in American history, we’re actually going backwards on our already dysfunctional, limited health care,” Auerbach said. “As a patriot, why can’t the United States do this as well as every other rich capitalist democracy around the world? [Universal healthcare] is not a lefty fringe socialist commie thing.”

In a statement, Gov. Kathy Hochul said the big “ugly” bill would make life harder for working families and worked closely with the NY legislature to “brace for the impact and protect as many New Yorkers as possible.”

“There’s nothing beautiful about this bill,” Hochul said. “It’s a big, ugly betrayal — stripping health care, hiking costs, and slashing food assistance for millions. And it was made possible by New York’s seven Republican members of Congress. They wrote it. They endorsed it. Now they’re cheering it on, selling out the very people they were sent to Washington to represent.”

https://amny.com…