In the 1965 movie “Ship of Fools,” there is an opening monologue by one of the passengers, Karl Glocken:
"My name is Karl Glocken, and this is a ship of fools. I'm a fool, and you'll meet more fools as we go along. This tub is packed with them... And who knows, if you look closely enough, you may even find yourself on board."
As the ship returns to Germany after no country will allow it entry, Glocken makes a prophetic statement.
"There are nearly a million Jews in Germany. What are they going to do? Kill all of us?"
If you are a Glocken, you can stop reading here. This article presents the facts about our current health caste system. This is not an article blaming any single political party for our current health caste system, but the facts about the inequity and poor quality of our for-profit health caste system.
In America, we do not have a healthcare system; we have an extremely expensive health caste system. Our healthcare system has been corporatized into a for-profit enterprise, where the corporations care more about their wealth than your health. This article will show the data that supports these assumptions. The article will also provide a solution that can return the system to one focused on healthcare while at the same time making our corporations more competitive in the world economy and reducing the cost of government.
“As of early 2026, over 28 million Americans are uninsured, a figure projected to rise significantly due to the expiration of enhanced Affordable Care Act (ACA) subsidies. Reports indicate that 4.8 million to nearly 5 million additional people could lose health insurance coverage in 2026 if these subsidies are not continued.”
While the Affordable Care Act was implemented with the good intention of giving the working poor a chance to have health insurance, it is government-subsidized private health insurance.
Our uninsured population utilizes hospital emergency rooms, federally qualified health centers, charity organizations, and public health sites for their care. The use of emergency rooms for routine care and the admission of critically ill uninsured patients increases the cost of uncompensated care for the hospitals. There is no free lunch in healthcare; the cost of the uncompensated care is passed on to insurance companies and the working private pay patients. The insurance companies in turn raise their rates to protect their profits. The number one cause of personal bankruptcy in the US is medical debt.
“As of early 2026, roughly 75 million people are enrolled in Medicaid/CHIP, with children comprising the largest group at approximately 47.6% (about 35.8 million) of enrollees. Adults aged 19-64 make up about 47.6%, and seniors (65+) represent roughly 8% to 10%. Children under 19 account for 31-36% of total enrollment, with the remainder composed of adults, disabled individuals, and dual-eligible seniors.’’
“Medicaid Enrollment by Age/Group (Approximate Data)
Key Trends and Usage Examples
“Federal Fiscal Year (FY) 2024, the federal government spent approximately $594 billion to $618 billion on Medicaid. This amount represents about 65%–69% of the total, with state governments covering the remainder. Total Medicaid expenditures, including federal and state funds, exceeded $900 billion in FY 2024. Medicare and Medicaid.”
Medicaid patients and persons with inadequate health insurance are underinsured and therefore find it very difficult to obtain specialty care. The underinsured face a secondary dilemma of having huge out-of-pocket costs if they have a major medical event.
“The average cost of an employer-sponsored family health insurance plan in the U.S. is $26,993 per year. Of this total, workers contribute an average of $6,850 annually (about $570
per month) out of pocket, while employers cover the remaining balance.”
Employer-sponsored healthcare began during World War II. The US government had a freeze on wages, and companies lobbied the government to let them provide health insurance for their workers. Over time, the employee percentage of the contribution to the health insurance plans, offered by their employers, increased. Today, if an employee does not elect to participate in the health insurance plan, they don’t pay what would have been their share of cost, but they also do not receive the savings on the employer's end in their paychecks.
“Medicare Advantage plans, with costs estimated to be roughly $83 billion higher in 2024 compared to traditional Medicare, largely driven by higher payments per enrollee. Total Medicare spending in 2024 is projected to be around $1.1 trillion, of which MA plans are a massive, fast-growing portion.”
Medicare Advantage plans are for-profit health insurance plans that cost the government more per capita than traditional Medicare and are restricted to lower-quality care. All insurance plans are shared risk enterprises. Actuaries work for insurance companies to calculate the cost risks and set the premium costs to maximize profits. Many seniors feel comfortable with these plans and their perks as long as they don’t have a major illness that results in denial or delay.
“Total revenue for major US private health insurers exceeded $1.5 trillion in 2024, with top companies experiencing a tripling of revenue over the past decade. Private health insurance expenditure, covering over 200 million people through employer-based and direct-purchase plans, was roughly $1.65 trillion in 2024, driven by high premiums and rising costs.”
“Net Earnings for Major Systems (Recent Data):
Key 2025 Health Insurer Earnings (First Half or Full Year projections):
“In 2024, the seven largest publicly traded U.S. health insurance companies recorded a combined $71.3 billion in profits, taking in over $1.5 trillion in total consolidated revenue. These companies generated massive gross earnings and revenues, though net incomes fluctuated due to rising medical claims and extraordinary costs.”
“Total Medicare spending in 2024 reached $1.118 trillion, representing a 7.8% increase from the previous year. Medicare accounted for roughly 21% of total national health expenditures and about 13% of the overall federal budget.”
“The total per-capita cost of healthcare in the United States is $15,474, with overall national health expenditures reaching $5.3 trillion. This accounts for nearly 17.6% of the country's Gross Domestic Product (GDP).
Key Spending Drivers
Global Comparison
The United States is one of the highest spenders on healthcare globally. On a per-capita basis, U.S. spending is roughly double the average of other wealthy, comparable countries, which average about $7,860 per person. “
“General Motors, the nation's largest buyer of health insurance, is sick of the high cost of health care. While saying that "national health care" should be an issue in this year's presidential campaign, Gary Cowger, president of General Motors Corp.'s North American operations, said government-funded national health care “is probably a bridge too far."The vehicle manufacturer spends $4.5 billion annually to cover its 1.2 million workers, retirees, and spouses, which is more than they spend on steel.”
“Pharmaceutical costs in the U.S. are significantly higher than in Europe, with U.S. brand-name drug prices averaging over 3 times higher than in other developed countries. While the U.S. offers faster access to new drugs and lower costs for unbranded generics, brand-name originator drugs in the U.S. are often priced over 400% higher than international counterparts.”
The United States generally has fewer practicing physicians per capita compared to many European nations. The U.S. has around 2.6 to 3.6 physicians per 1,000 people, while countries like Germany, Italy, and Spain often exceed 4.0. Europe has a higher density of doctors overall—roughly one for every 335 people compared to one for every 472 in the U.S.
“The biggest bottleneck in training new doctors is the federal government's limit on Graduate Medical Education (GME) funding, primarily through the Centers for Medicare and Medicaid Services (CMS). While the AMA heavily lobbies to expand these slots, historical legislation has effectively capped the number of Medicare-funded residency positions.”
Physicians in Europe are generally paid through a mix of public salaries for hospital doctors and fee-for-service or capitation models for general practitioners (GPs), often with significant pay variations by country. Salaries tend to be lower than in the US, with specialists earning significantly more than GPs, though Switzerland and Luxembourg are high-paying exceptions.
Medical coding affects physician payment and hospital reimbursement in Europe, though the system operates differently than in the United States. While many European countries have socialized or public healthcare systems, accurate coding of diagnoses and procedures is essential for hospital funding, resource allocation, and reimbursement.
Our health care system is rife with corporate greed. The for-profit and so-called not-for-profit hospitals and physician networks care more about their wealth than your health. There is no such thing as the family doctor anymore. All the doctors have been forced to become employees of hospitals and/or provider networks. Physicians cannot afford the administrative infrastructure needed to manage contracting and billing to survive economically with the multitude of insurance companies they have to deal with. The doctors, ARNPs, PAs, and other healthcare providers are salaried employees of Hospitals, provider networks, and other corporate entities. The corporate entities' goals are to decrease costs and maximize profits.
A battle between a local provider network and a mega insurance company is playing out in our community. Sarasota Memorial Hospital healthcare system, which includes First Physicians Group, a network of primary care and specialty doctors, has stopped accepting United Healthcare insurance plans. This means that anyone in the community who has UnitedHealthcare insurance will have to pay the exorbitant charges that the hospital and doctors charge if they continue to use the First Physician Group doctors and/or Sarasota Memorial Hospital. An acquaintance of mine who had booked a procedure at one of the hospital's surgery centers was informed that the center and the doctor no longer accept her insurance, and that she could still use their services by paying the exorbitant provider and hospital charges. Charges by healthcare providers don’t mean anything unless you are uninsured. Insurance companies have negotiated lower rates for services, and that is what the battle is about between Sarasota Memorial and its First Physician Group with UnitedHealthcare Insurance.
Insurance companies have financially incentivized hospitals and physician networks to keep the cost of care down, not just denying needed services but actively compensating providers to ration care. Keeping people healthy and providing necessary care early is the best way to keep the cost of needed care down. Things don’t get better with time; early intervention is the key to solving any problem.
“Per Capita Cost by Country
Health consumption expenditures per person (adjusted for cost-of-living differences using Purchasing Power Parities) illustrate this disparity: [1]
What Drives the Cost Difference?
The gap between the US and Europe is not due to Americans using more medical services—in fact, the US has fewer physician visits and shorter average hospital stays per capita. Instead, the disparity is driven by structural differences:
Despite these much higher costs, the US consistently lags behind peer European countries in health outcomes, including metrics like overall life expectancy.”
The healthcare corporations have a strong lobbying presence in Washington. During the period when our Gross Domestic Product (GDP) was declining during the COVID era, healthcare GDP was actually rising. This means healthcare costs were escalating alongside profits.
There is a solution to this dilemma that will improve quality, reduce costs, and strengthen the economic position of every business in the US. It will take voters' action to elect politicians who will change the system. This isn’t a problem caused by either party; it is one caused by both the Republican and Democrat elected officials who have been bought by the Medical industrial complex.
The following are steps that can change our medical system from a focus on profit to one focused on care, while reducing costs for corporations and small businesses as well as their workers:
Eliminate Medicare Advantage plans. Medicare Advantage Plans are for-profit insurance plans that cost the government more than traditional Medicare. Medicare Advantage plans reduce the quality of medical care through denial, and delay of expensive services.
Eliminate all Medicare supplemental plans. Medicare supplemental plans are for-profit supplemental insurance plans. Combine all Medicare Supplemental plans A, B, C, D, etc. into one comprehensive healthcare plan.
As a first step to universal healthcare, move the Medicaid-eligible patients into Medicare. Medicare has the highest per capita cost of any age group, while Medicaid patients have the lowest per capita cost. Combining the programs would save the States billions while eliminating administrative costs for both the States and the Federal government associated with running the separate Medicaid program.
Make all patients in the new or existing program eligible for 340-B medication pricing. This is an existing program that the VA, critical access hospitals, and Federally Qualified Health Centers can use for their patients. The pricing is close to the costs that patients in other nations pay for the same medications we use.
Allow corporations, private businesses, and individuals to buy into the new Medicare for all at an actuarially calculated nonprofit rate. The rate would be based on the effect that the additional personnel would have on the program's cost. Most likely the cost would actually go down.
Require businesses that legally import temporary labor to purchase temporary Medicare for all coverage for each worker.
Use the J-1 visa system to recruit qualified critical-need healthcare workers (doctors, nurses, etc.).
Significantly increase the federal loans for medical education and provide loan forgiveness for graduates as long as they continue to practice medicine in the US.
Require that medications sold in the US can not exceed the average cost of the same medication sold in Europe.
Support the development of AI as a diagnostic tool for healthcare. “Artificial intelligence (AI) in healthcare is revolutionizing patient care, biomedical research, and clinical administration by increasing speed, lowering costs, and enhancing diagnostic accuracy. Rather than replacing doctors, AI augments human expertise, handling vast data processing and routine tasks so professionals can focus on direct patient care.
Key applications driving this transformation include:
Final comments: How does anyone achieve “Life, liberty, and the pursuit of happiness” if they don’t have good health? Why are we the only first-world nation where a citizen can go bankrupt because of medical debt?
Raymond Fusco RN, BS, MS, MBA
2 comments on this item
Only paid subscribers can comment
Please log in to comment by clicking here.
RRICH69176
I am retired after over 30 years in healthcare as a rehab professional. The abuse, greed and inequities of care due to the profit seeking U.S. medical care system is staggering at the patient care level. Great article-Thank you
Sunday, June 14 Report this
Lawdavid3265
Kudos to Ray Fusco for this well thought out and thoroughly referenced piece. The time has come for a gradual transition to universal health care. Tne question is do we have the political courage and leadership to accomplish this? There is no doubt our current system is a dumpster fire.
Tuesday, June 16 Report this