Part of a series called Crossroads: Policy and Politics written by Michael Lighty, President of Healthy California Now

What are we to think about policymakers who cannot avoid seeing the signs of a failing healthcare system and yet do nothing to address the failure?

Evidence is piling up that commercial insurance harms patients. If “do no harm” is the first principle of medicine, what legitimate role do these insurance companies have?

Some findings of harm include:

  • Commercial plans save money by denying patient claims (KFF, 1/20/21)
  • Medicare Advantage (private) plans find ways to dump dying patients (US GAO 6/28/21)
  • High cost-sharing has potentially deadly consequences (Circulation, June 2021)
  • Those with commercial insurance face worse access, higher costs than those in public plans (JAMA, 6/1/21).

Supposedly concerned with high costs, deficits and “fiscal responsibility,” elected officials ignore the hugely determinantal impacts of out of control profit-making, waste, and unregulated prices on family and government budgets.

Some insights on the actual fiscal reality:

  • Both the insured and uninsured struggle with medical costs (Commonwealth Fund, 7/16/21)
  • Americans’ medical debt reaches record levels (JAMA, 7/20/21)
  • Proving medications for free leads to greater adherence and cost-savings (PLOS Medicine, 5/21/21)
  • Direct advertising leads to increases in Medicare spending on expensive drugs (US GAO Report, May 2021)

What can we say about a country whose policymakers take millions from the healthcare industry in the form of political contributions, and enable those corporations to profit from human suffering? The commercial insurers made massive profits during the pandemic: UnitedHealth Q2/2021 of $4.3 billion; CVS Health/AETNA, $2.8 billion; Anthem $1.8 billion; Cigna, $1.5billion, (Axios, 8/30/21).

Yes, there is a clear alternative that works. For example, Medicare reduces racial disparities in coverage (JAMA Internal Medicine, 7/26/21). As life expectancy drops most for people of color (BMJ, 5/24/21), and US health spending goes disproportionately to white people (JAMA Network, 8/17/21), we need a universal national program that guarantees a single standard of safe, therapeutic culturally competent care for all. Only through an improved and expanded Medicare for All can we create a humane healthcare system. California is a great place to create the model for that system.

NB: Thanks to PNHP Newsletter Fall 2021 for these sources. Join at or email