Guest columnist: Predatory healthcare must end

There is much in the news lately about our health insurance premiums going up. Some states could see increases exceeding 60%. This is because government subsidies for insurance sold through the Affordable Care Act are going to expire soon, effectively removing all regulations on the cost of health insurance in the USA.

True, there's still Medicare for those 65 and over, tax funded and paying physicians and hospitals directly for services, but it is not comprehensive and requires additional supplemental coverage for prescriptions and long-term illnesses. Yet every other industrialized nation has some form of comprehensive, subsidized national healthcare which they are able to provide for all citizens at a fraction of our costs. This raises the question, in the wealthiest nation in the world, why can't we have this?

The answer points to motivation — is our focus on providing healthcare, or generating profits for shareholders? The fact is that the United States does not have a health care system, we have a health insurance system, run by corporations where the objective is profit. Profits translate to shareholder satisfaction and increased salaries for CEO's and board members. Healthcare in the USA has become just another industry, devoid of any humanity in its scramble for market share.

At the apex of this profit motivation are the companies that offer 'Medicare Advantage' (MA) plans. These plans offer an alternative to traditional Medicare, touting lower costs with perks like hearing, vision, and dental coverages that Medicare does not cover. Depending on your plan, you might only use doctors and facilities that are in-network and require referrals and pre-approvals, or you might go out of network and pay more. All MA plans must pay for emergency care, but if you leave the emergency room and are admitted to a non-network hospital, your insurance can decline to reimburse, leaving you with devastating costs.

MA plans are attractive until you become sick or disabled, whereupon the premiums can increase to unaffordable levels while your coverage diminishes, and your insurance can drop you at any time for any reason. If you get sick, your reimbursement costs will begin to exceed the premiums you pay, making you an expensive corporate liability, and eliminating liabilities is just good business. You could sue, but their lawyers will simply delay until you go broke or die. You could obtain traditional Medicare, but given your poor health, it's unlikely you would be able to secure a supplemental plan, making you responsible for costs when coverage runs out. Remember that medical debt accounts for over 40% of bankruptcies in this country (NIH).

Medicare is public insurance — Medicare Advantage is for-profit insurance, and fraud is rampant. These corporations are reimbursed by the government for the cost of your health care claims, using your tax money. This means that you are paying a monthly premium for the insurance, as well as income taxes to reimburse the corporations that reimburse you. What a deal!

Insurance firms classify your condition using a code that determines their amount of reimbursement. "Upcoding" is a fraudulent billing practice where a healthcare provider uses billing codes that are more severe or expensive than the services they actually provided in order to receive a higher reimbursement from the government, pocketing the difference. Collateral costs are also passed on to you, like your auto insurance going up due to the skyrocketing costs of paying for accident injuries.

It is estimated that MA firms are collecting $80 to $140 million per year through fraudulent practices, but the risk is well worth it. Our system pits the hospitals against the insurance companies. Hospitals spend $19.7 billion a year adjudicating denied claims with payers. In 2024, United Healthcare claimed $14.4 billion in profits, while Cigna Group posted profits of $3.4 billion, and both companies spend millions on lobbyists to ensure that politicians keep these profits flowing.

The imbalances are striking. MA plans spend about $3.9 billion annually on supplemental benefits (dental, vision, hearing) while their members paid $9.2 billion out of pocket for these same services. In other words, even with insurance, members were paying more than twice what their plans paid for their care. Legally, MA plans can only reduce your benefits by a certain amount each year, so to get around that, they suddenly drop everyone on their least profitable plans and introduce new plans with far fewer benefits.

It gets worse. In the past decade, private equity firms have been acquiring hospitals, physician practices, nursing homes, and air ambulances. Their focus on profit compromises patient care and results in higher costs. By 2024, nearly 7% of physicians reported their practice was owned by a private equity firm, and as of April 2025, approximately 488 hospitals were under private equity control, representing over 22% of for-profit hospitals. Such acquisitions are often financed with significant debt, which the healthcare provider must then repay, sometimes leading to cost-cutting measures to service this debt.

Withholding healthcare based on the ability to pay is immoral, as is profiting from the sick and injured, and no human being deserves to have their healthcare held hostage by the corporations. At some point, reason must prevail. Imagine if we take the billions of dollars spent yearly on MA reimbursements, combined it with the millions paid out in waste and fraud including the money spent investigating and prosecuting those cases, add to this the millions spent adjudicating denied claims, throw in our premium costs, co-pays, deductibles, facility fees, and out-of-network charges — and repurpose all of it into a comprehensive single-payer system. We could easily afford a simplified system of quality healthcare, likely for billions less.

As citizens, we could choose our physicians and hospitals, have access to affordable prescription medications, and never be dropped. We might study the French, Brazilian, German, South Korean, and Canadian models (Google them) towards developing an uncomplicated healthcare system that works best for us, motivated by humanity rather than by profit.

But that's socialism! Not exactly, but it is socialist inspired policy, and no different than those passed by FDR in the 1930s that created the middle class and ushered in decades of prosperity. We can have this. We deserve this.

Jeffrey Laird is a philosopher and retired cartographer. He grew up in Washington, D.C., and has lived in Frankfort since 1991. He can be emailed at [email protected]