Public research helps create medicines while private firms develop, market and price them. UnitedHealth’s growth adds urgency to the healthcare-financing debate.
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Summary
John Oliver’s takedown of UnitedHealth Group exposes more than one predatory corporation. It exposes the fatal arithmetic of for-profit healthcare. Every premium dollar diverted to executive compensation, consultants, advertising, sales commissions, redundant databases, corporate real estate, lobbying, profits, and shareholder returns is a dollar unavailable for medical care. Doctors and hospitals then spend still more money hiring armies of employees to navigate different formularies, networks, billing codes, prior-authorization rules, appeals, and denial systems. Private insurance does not eliminate administration; it duplicates it throughout the system and forces patients to finance every layer.
- The arithmetic indicts the model. A universal public insurer needs one enrollment system, one claims framework, and one risk pool. A multipayer system finances those functions repeatedly across competing companies while also paying executives, advertisers, consultants, lobbyists, and shareholders.
- Providers pay the duplication tax too. Medical practices must verify eligibility, determine network status, obtain prior authorization, submit insurer-specific claims, correct rejections, and contest denials. That labor raises the price of care without treating a single patient.
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Denials produce revenue. Premiums enter an insurer as income; medical claims leave as expenses. That accounting reality rewards delay, restriction, narrow networks, aggressive utilization review, and denial—even when corporate language disguises those practices as “care management.”
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Medicare Advantage disproves the privatization sales pitch. MedPAC projects that Medicare will pay private Medicare Advantage plans $76 billion more in 2026 than comparable coverage would cost in Traditional Medicare. The plans report that administration and profit consume 13% of their bids.
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Drug profiteering follows the same script. Taxpayers finance foundational science through the NIH and public universities, then pharmaceutical corporations acquire market power, impose monopoly prices, and return the proceeds to investors. A peer-reviewed study connected NIH-funded research to every new drug approved from 2010 through 2016.
This system does not fail because executives misunderstand healthcare. It functions according to capitalist incentives: maximize revenue, minimize payouts, consolidate power, and deliver returns to investors. Humane healthcare requires the opposite mandate—cover everyone, treat illness promptly, and direct healthcare dollars toward healthcare. Medicare for All would not create the need to finance care; Americans already finance it. It would stop forcing them to finance an extractive corporate apparatus on top of it.
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UnitedHealth Proves the Arithmetic: Capitalism Is Incompatible With Humane Healthcare
John Oliver’s investigation of UnitedHealth Group stripped away the euphemisms that protect the private health-insurance industry. The issue is not merely that one company grew too large, used one harmful algorithm, or denied one patient’s care. The issue is arithmetic. A healthcare system cannot spend money twice. Every dollar directed to corporate functions that do not deliver care is a dollar that cannot pay a nurse, fund a clinic, purchase medicine, or treat a patient.
The Center for Health & Democracy’s Sunlight Report identified 2,694 UnitedHealth subsidiaries and affiliates. Through UnitedHealthcare and Optum, the corporation reaches into insurance, physician practices, surgical centers, pharmacy benefits, prescription fulfillment, home health, hospice, data analytics, claims processing, and banking. UnitedHealth reported $447.6 billion in revenue in 2025. This is not a simple insurer coordinating care. It is a vertically integrated extraction machine positioned to collect money at nearly every point where illness meets payment.
The defenders of private insurance want the public to ignore basic addition. Multiple insurers require multiple executive suites, boards, consultants, sales forces, advertising budgets, provider networks, formularies, databases, claims systems, legal departments, office buildings, and shareholder distributions. Those are not hypothetical expenses. Patients finance every one of them through premiums, taxes, reduced wages, deductibles, and copayments.
Then the system adds a second administrative bureaucracy inside every hospital and medical practice. Providers must determine which insurer covers the patient, whether the clinician belongs to the network, which services require advance permission, which drug appears on which formulary, which billing code the insurer will accept, why a claim was rejected, and how to appeal a denial. A universal program would still need administration, fraud control, claims processing, and quality review. It would not need hundreds of competing rulebooks and duplicative corporate infrastructures.
That fragmentation costs are enormous. A peer-reviewed comparison published in Annals of Internal Medicine estimated that the United States spent $812 billion on healthcare administration in 2017—$2,497 per person and 34.2% of national health expenditures. Canada spent $551 per person and 17% of its health expenditures on administration. The researchers estimated that matching Canadian administrative levels would have saved more than $600 billion in that year alone. The numbers do not say that public administration costs nothing. They show that the American multipayer apparatus burns extraordinary sums sorting, billing, marketing, managing, and fighting over payment.
Prior authorization makes this waste visible inside the examination room. The American Medical Association’s 2025 physician survey found that doctors still reported high prior-authorization burdens across every major national insurer, even after the industry announced reforms. The physician and staff time those demands consume does not improve a diagnosis or deliver treatment. It exists because insurers erect payment barriers and providers must overcome them.
The economic incentive is clear. Premiums and government payments enter the insurer as revenue. Claims leave the insurer as expenses. Paying for more care reduces the money available for administration, acquisitions, executive rewards, and profit. Denying or delaying care moves the numbers in the opposite direction. Corporate executives may use soothing terms such as utilization management, efficiency, and value-based care, but accounting does not care about public relations. When a company keeps more of every dollar it does not spend on a patient, the conflict is embedded in the business model.
UnitedHealthcare’s post-acute-care record demonstrates the human cost. A Senate Permanent Subcommittee on Investigations report found that the company’s denial rate for post-acute services jumped from 8.7% in 2019 to 22.7% in 2022 as it expanded its use of predictive technology. These cases involved people recovering in skilled-nursing facilities and other post-acute settings—not consumers casually shopping for a luxury product. An algorithmically generated discharge target becomes dangerous when meeting it protects corporate margins more reliably than it protects a patient’s recovery.
Medicare Advantage supplies the decisive rebuttal to the claim that private insurers save taxpayers money. MedPAC projects that Medicare will pay private Medicare Advantage plans $615 billion in 2026—$76 billion, or 14%, more than it would spend if those beneficiaries received coverage through Traditional Medicare. MedPAC further reports that private plans allocate 13% of their bids to administrative costs and profit. Higher Medicare Advantage payments will raise Part B premiums by an estimated $11 billion in 2026, roughly $175 per beneficiary. Taxpayers and Traditional Medicare beneficiaries subsidize a private layer sold to the public as efficiency.
The pharmaceutical industry operates through the same upward transfer of wealth. Drug corporations insist that high prices compensate them for extraordinary research risks. Yet public institutions finance much of the scientific foundation those products depend on. A peer-reviewed study found NIH-funded research associated with every one of the 210 new medicines the FDA approved from 2010 through 2016. More than 90% of the identified funding supported research on biological targets—the long-term foundational work that makes later commercial development possible. Private companies perform trials, manufacturing, regulatory work, and distribution, but that does not justify pretending they created the underlying science alone or earned an unlimited right to price publicly enabled medicines beyond patients’ reach.
Pharmacy-benefit managers add yet another tollbooth. In 2025, the Federal Trade Commission reported that the three dominant PBMs marked up numerous specialty generic drugs by hundreds or thousands of percent. Their affiliated pharmacies generated more than $7.3 billion above estimated acquisition costs on the drugs studied. Optum Rx—part of UnitedHealth—was one of those three PBMs. UnitedHealth can therefore participate as insurer, pharmacy-benefit manager, pharmacy operator, provider owner, data processor, and lender. A payment leaving one corporate pocket can become revenue entering another.
Capitalism demands growth, market power, and returns on invested capital. Humane healthcare demands universal access, early treatment, continuity of care, and spending based on medical need. Those demands collide whenever denying care, raising prices, narrowing networks, or buying a competitor improves the corporation’s financial performance.
Medicare for All resolves the contradiction by creating one universal risk pool and removing the profit-seeking insurance middleman. It replaces premiums, deductibles, and copayments with public financing; replaces competing networks with portable national coverage; and replaces hundreds of billing regimes with one transparent system. It must protect displaced insurance and billing workers through income support, retraining, and job placement. It must also negotiate fair provider payments, control drug prices, prevent fraud, and operate under rigorous democratic oversight.
But the financing principle is irrefutable: Americans already pay enough to provide healthcare. They pay too much because the present system makes them finance healthcare and a vast extraction apparatus built on top of healthcare. The country does not need to make private insurance kinder. It needs to stop treating sickness as an investment opportunity and establish healthcare as a human right.
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