COMMENTARY: Health Costs Are about to Rise Sharply ...
... and more than a million people are watching their Medicare Advantage providers bow out of the market.
By Jay Brock
COLUMNIST
Several articles in the news regarding healthcare caught my eye recently.
The first concerns Medicare Advantage plans. While these may be for seniors and certain people with disabilities, they are largely run by, and ultimately for the benefit of, the private for-profit American health insurance industry. So there’s a lesson here for every American who might at some point have an interaction with our healthcare system.
It turns out that some of these plans are not as profitable as the companies that run them (and the investors who own them) would like. As a result, the companies are either cutting back on certain benefits; no longer offering certain “product lines”; or are simply leaving markets that aren't profitable. This will affect more than a million members now being covered by the two biggest Advantage insurers, United HealthCare and Humana.
As UHC’s CEO said last month, “We have made the difficult decision to exit plans that currently serve over 600,000 members…We will be watching the market closely… so we can better assess our market positioning and respond quickly.”
Lesson learned? In the race between profit and your healthcare, in our health insurance system profit is the winner: if more than a million people will lose their current coverage and must now scramble to find a different plan to cover them, well, that’s just how our system works—and not just for seniors.
Another article concerned the hike in premiums for millions more Americans covered by the so-called Affordable Care Act, which, it turns out, is not that affordable—and is about to get even more unaffordable: Premium costs might rise close to 20% on average in 2026. Additionally, it’s possible that government subsidies that help 9/10 ACA enrollees pay for these premiums will disappear at the end of this year. As a result, premium costs will become unaffordable for too many Americans, and many will simply drop their coverage. It’s not just sick people who will drop out (that’s bad enough): so will those who are healthy, leaving them at risk for medical bankruptcy or worse if they get sick without health insurance. Also, with relatively fewer healthy and more sick people in the risk pool, costs for all will increase further, worsening the fiscal health of the program.
One reason cited by insurance companies for skyrocketing healthcare costs for the ACA and other plans—costs that must be passed on to their customers—is the use of increasingly popular and increasingly utilized GLP-1 weight loss drugs. Some of these medications can cost $1,000/month for a patient to use, so insurers are hesitant about using them. The rub: the cost to manufacture this type of medication can be less than $5/month.
This is yet another stark example of how our system allows such huge profits for private industry while healthcare, which should be a “public good”, takes a back seat to profit.
The main reason our healthcare costs are so high—especially compared to the rest of the world’s other advanced nations—is how we structure our health insurance system to benefit private industry and its need for ever-increasing profit, a private good, rather than benefiting patient needs, a public good. One need look no further than how we spend our healthcare dollars: In 2024, of the $5 trillion we threw at our healthcare system, about $1 trillion was wasted on costs that had nothing to do with healthcare and everything to do with accommodating the needs of the for-profit health insurance and pharmaceutical industries—about $700 billion went to administrative costs over and above what a public-financed system would cost (billing for services rendered can be extraordinarily expensive in our system); as much as another $200 billion went to overcharges for medications (medications can be extraordinarily expensive in our system); and estimates of overcharges by Medicare Advantage companies might add another $100 billion. A trillion wasted here, a trillion wasted there, and pretty soon, as the late Republican Senator Everett Dirksen would say, you’re talking about real money. Spending less on waste and more on patients is something politicians talk about, but they largely refuse to fix it. (It would take a new health insurance system.)
Our health insurance system, aided and abetted by the Washington politicians who are supposed to look after the best interests of the American people, suffers from what could be called “Malignant Profit Syndrome.”
It’s not going to be fixed any time soon.
Finally, there’s an article in the New York Times last month about healthcare giant UnitedHealth Group: It doesn't like to be criticized, and responds with legal threats regarding what it calls defamation and libel. The Times chronicled the insurance behemoth’s attempts to silence critics ranging from journalists to physicians and activists who make videos critical of the company. One targeted journalist said “The aim was to use scare tactics to intimidate”; a physician “perceived it as retaliation” when a surgery center she owned was excluded from the UnitedHealth network. UHG claimed that, among other things, “Negative publicity may adversely affect our stock price.”
Indeed.
For Additional Reading
“Insurers pull Medicare Advantage plans as profit pressures mount,” Becker’s Payer, August 5, 2025, by Jakob Emerson
“How much and why ACA Marketplace premiums are going up in 2026,” Petersen-KFF, August 6, 2025, by Jared Ortiliza, Matt McGough, Kaitlyn Vu, Imani Telesford, Shameet Rakshit, Emma Wager, Lynn Cotter, and Cynthia Cox
“Novo Nordisk’s $1,000 diabetes drug Ozempic can be made for less than $5 a month, study suggests,” CNBC, March 27, 2024, by Annika Kim Constantino
“United Health’s Campaign to Quiet Critics,” New York Times, July 14, 2025, by David Enrich
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Thank you, Dr. Brock