OPINION:
Democrats have always been the party of health insurance over actual care, propping up giants such as UnitedHealthcare instead of prioritizing patients and doctors. This year, they are fully committing to this idea by shutting down Washington for the fifth time since 2000 to protect Obamacare subsidies.
If we’re to believe the Democrats’ track record, protecting these extended subsidies won’t help patient care because they will go straight to insurers. Between the Inflation Reduction Act and countless measures of “health policy reform” from liberal lawmakers, the Democrats continue to miss the mark on health care policy.
Republicans know that liberals are “negotiating” in bad faith; the American people should know as well.
Since the Affordable Care Act passed in 2010, liberal lawmakers have stopped at nothing to subsidize health insurance conglomerates with taxpayer dollars. More than 90% of Americans are now on at least one government-funded health care plan.
What do these “coverage” plans amount to for improvements in patient care or lower costs? Very little, it turns out. A Kaiser Family Foundation survey details that only 30% of those who like ACA plans believe these plans allowed them to get the health care they need, and only one-fifth say the plan helped with cutting costs. If you ask that entire population how they feel about Obamacare’s cost reduction promises, only 5% say it’s up to the task.
Yet momentum to enroll as many as possible continued through the pandemic emergency, as President Biden pumped ACA plans full of government subsidies to give relief to Americans out of work, even extending these benefits to Americans making incomes far above the federal poverty line.
Now, liberal lawmakers want to extend those subsidies past their expiration date, putting taxpayer dollars on the line to make little headway in actual health care policy change.
Sending money to insurance companies is not a winning solution for American health care policy. It’s not a solution for costs; total health care expenditures and out-of-pocket expenses have increased each year since 2010. It’s not a solution for care quality, either; mortality rates in health care settings have skyrocketed since 2020.
We need different solutions to the problems that ail us. Specifically, lawmakers need to start looking at free market solutions that level the playing field for providers and patients.
For costs, Congress ought to start by keeping another health care giant in check: large hospital systems. These hospital systems regularly overcharge Medicare patients by adding large “facility fees” to their bills. Hospitals say this is to compensate for higher-quality care and staff salaries, but the same fees exist at smaller doctors’ offices owned by large hospital systems. Meanwhile, these systems rake in record profits.
Lawmakers have gone after these larger hospital systems only in half-measures. The amount of overbilling is truly staggering: $150 billion in savings over the next decade. To materially implement site neutrality, paying the same price for the same service regardless of location, the Centers for Medicare & Medicaid Services and Congress need to work in tandem to implement it governmentwide.
Likewise, CMS needs to take more action to rein in insurers in another part of their ecosystem: Medicare Advantage.
In theory, Medicare Advantage is a great free market program that provides a private alternative to a government-run Medicare plan. Still, the incentives for Medicare Advantage plan administrators, usually large insurance companies, are warped. These insurers consistently overbill the federal government for routine procedures, often making up diagnoses that aren’t there or aggressively diagnosing common conditions as far worse to jack up the resulting bill.
Although a federal judge recently limited CMS’s ability to audit these plans for this kind of fraud, it’s just a warning sign for Congress and the agency to get creative to tackle this waste of taxpayer money. A Wall Street Journal analysis found that from 2018 to 2021, insurers pocketed $50 billion in fraudulent overpayments, a number that has increased in 2025. If liberals truly cared about helping patients get care, they would turn to the program’s fraud first.
Liberals should be losing in the court of public opinion on who is causing the shutdown, but they will lose the battle of whether their health care crusade is going to result in meaningful change. Extending subsidies that fund insurance companies instead of patient care misses that mark entirely.
• Marion Mass is a practicing pediatrician and board member of Free2Care, a coalition of 8 million patients and physician advocates.
Please read our comment policy before commenting.