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America’s health insurance system is rigged against patients and taxpayers. That’s because private insurance companies make money when they collect premiums but don't pay for health care. That in turn creates a dangerous financial incentive for insurers to overcharge buyers and deny treatment to sick people.

Consider this stunning example of how the system can go wrong: Between 2019 and 2021, private insurance companies billed Medicare for 66,000 cases of “diabetic cataracts” in patients who had already had cataract surgery, according to an investigation by The Wall Street Journal. Why was this a problem? Because when cataracts are surgically removed, they can't come back – it's medically impossible.

Yet patients under UnitedHealth's Medicare Advantage plan were 15 times more likely to be assigned a cataracts diagnosis by the insurance company than traditional Medicare patients. The Journal’s investigation found that over the three-year period analyzed, private insurers made hundreds of thousands of questionable diagnoses that allowed them to pocket $50 billion shelled out by taxpayer-supported Medicare for conditions that were never treated. UnitedHealth is currently facing federal criminal and civil investigations into its Medicare business.

In my new book “Insured to Death,” I argue that the same twisted incentives that allow companies to bill for imaginary diseases also drive them to deny care to real patients. The solution is to abolish private health insurance companies entirely and replace them with a system that puts patients – not corporate profits – in control of medical decisions.

Elizabeth MitchellJuly 2, 2025

Our current private health insurance system is a monument to misaligned incentives. Beyond overbilling for nonexistent conditions, roughly

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