Title: Reevaluating U.S. Health Care: Advocating for Systemic Change
By M. Bennet Broner, Medical Ethicist
In 2024, more than 80 percent of Americans reported dissatisfaction with their health insurance, irrespective of whether it came from private insurers, employers, or government initiatives like Medicare Advantage (MA). The major complaints arose from soaring premiums, increasing out-of-pocket expenses, and restrictions or rejections of vital coverage. These issues directly affect citizens, who are faced with higher co-payments, deductibles, and premiums. Ironically, the public frequently attributes the rising costs to heightened patient expectations, while underlying factors are primarily responsible for this increase.
The Actual Contributors to Cost Increases
Contrary to widespread belief, the individual demands for particular treatments or tests do not primarily drive the escalating health care costs. Rather, the profit-driven framework of U.S. health care entities and insurers is a significant factor. Initiatives like Medicare Advantage, which aimed to reduce expenses, have notably exacerbated the financial strain. For example, various hospitals were found to engage in upcoding—deliberately overstating the severity of patient conditions to secure larger reimbursements. A study across five states in 2019 revealed over $14.6 billion in such erroneous payments, translating to an estimated $169 billion nationwide by 2024.
Similarly, MA insurance providers frequently filed exaggerated claims to the federal government, citing additional or fictitious diagnoses to boost their revenues. Such tactics impose direct costs on taxpayers and working individuals, who finance Medicare through taxes. These misleading practices shed light on why premiums keep escalating even as confidence in the system wanes.
The Unfulfilled Promises of Medicare Advantage
Initially designed to enhance the efficiency and cost-effectiveness of care, Medicare Advantage has instead resulted in a 22 percent increase in health care costs per patient by 2024. However, the benefits mainly accrue to a small group: five major insurance firms amassed roughly $185 billion in annual profits between 2014 and 2024. Additionally, an astonishing $450 billion is squandered annually due to administrative inefficiencies—ranging from redundant paperwork to inconsistent coverage criteria and eligibility determinations. This bureaucracy costs the average American around $4,850 each year.
The Legacy of Corporate Power
The merger of health care and capitalism has deep historical roots in America’s longstanding acceptance of capitalism, where minimally regulated market forces are celebrated. The influence of business, often disguised as the public good, extends from local governing bodies to federal policies. While some early American thinkers raised concerns about the appropriateness of corporate power, their voices were historically sidelined—and remain so today.
Even Adam Smith, regarded as the father of modern capitalism, would likely be critical of the current commercialized state of health care. In his renowned work, The Wealth of Nations, Smith advocated for the moral duty of businesses: to uplift the workforce, maintain safe working environments, and provide fair compensation. He would probably view today’s profit-motivated insurance sector—and its collusion with the government—with disapproval.
Health Care as a Fundamental Right
In a democratic framework, access to essential health care should be regarded as a basic right, not a benefit linked to employment or financial status. Nevertheless, in the United States, the provision of health care is predominantly left to profit-oriented organizations operating under limited regulation. Alarmingly, even some religious hospital networks have pivoted away from their charitable missions, accumulating billions in undisclosed profits overseas. One such network was reported to have hidden $41 billion abroad, with no clear rationale for such actions.
In contrast to the United States, most other developed—and even some developing—nations have recognized the crucial role of government in safeguarding public health. This perspective is not about opposing capitalism; it’s about recognizing that medical care is too vital to be entirely left to market-driven forces.
A Call for Comprehensive Reform
Policy advocates like Donald Berwick and Stephen Woolf have long asserted that piecemeal reform is inadequate. Only a “systemic transformation” can rectify the foundational flaws within the existing structure. The most promising model for the United States might be a hybrid National Health System (NHS)—which combines government-administered services with strictly regulated for-profit elements to ensure fairness, accessibility, and equity.
While a nationalized health care system presents its own challenges—including funding obstacles, workforce shortages, and sometimes slower innovation—these issues are not exclusive to government-managed health care. In fact, they already afflict America’s current fragmented commercial plans. What sets nationalized systems apart is their consistent delivery of superior health outcomes, provision of universal coverage, and attainment of longer life expectancies at considerably lower costs.
The Evidence Is Clear
For the past 50 years, extensive comparisons of international health care systems have demonstrated that the United States significantly trails behind. Recent data ranks the U.S. 16th among developed nations in terms of overall health care quality and a dismal 96th globally in healthy life expectancy. Alarmingly, inhabitants of nations like Cuba and Lebanon—countries often characterized