Private Equity Looting of U.S. Health Care: An Under-Recognized and Uncontrolled Scourge.

Private equity investments in U.S. health care have become very common across more parts of our health care system than most physicians and other health professionals realize.

Disparities and Inequities in US Health Care: Alive and Sick.

Disparities and inequities based on ethnic and racial differences have been a part of health care in America from the time of its founding. These disparities have persisted through recurrent efforts to reform our health care system. This article brings historical perspective to what has become a systemic part of US health care; examines the extent of disparities today as they impact access, quality, and outcomes of care; and considers what can be done within our polarized political environment to eliminate them.

Privatized Medicare Advantage for All: The Latest Assault on U.S. Health Care.

Privatized Medicare Advantage has grown rapidly among seniors in the United States in recent years. It is now being promoted actively by corporate stakeholders and even by the Centers for Medicare and Medicaid Services itself as a new proposal to extend this approach to cover all Americans. There is little public awareness, however, of the current costs and adverse impacts of Medicare Advantage on enrollees' access, costs, and outcomes of care while deceptive marketing and disinformation prevails.

The Future of Work in America: Demise of Employer-Sponsored Insurance and What Should Replace it.

The COVID-19 pandemic has wrought fundamental changes in the US workplace, placing employer-sponsored health insurance (ESI) in disarray. Before the pandemic, ESI was the single largest share of private health insurance in the country, including some 150 million Americans. Even before the pandemic, however, ESI had become increasingly volatile and more unaffordable for both employers and employees.

Investor-owned Health Care: The Hidden Blight on America's "System".

Investor ownership of US health care has grown exponentially in the past 50 years through ever closer ties with Wall Street corporate interests. More recently, private equity firms have accelerated this process, invariably with harmful impacts on access to affordable care, its quality, and profiteering, with little accountability. These impacts are fueled by several concurrent trends: (1) increasing privatization, (2) consolidation and mergers, (3) increasing bureaucracy and waste, and (4) profiteering that may bleed into outright fraud.

Beyond the COVID-19 Pandemic: The Urgent Need to Expand Primary Care and Family Medicine.

The COVID-19 pandemic, together with its resultant economic downturn, has unmasked serious problems of access, costs, quality of care, inequities, and disparities of US health care. It has exposed a serious primary care shortage, the unreliability of employer-sponsored health insurance, systemic racism, and other dysfunctions of a system turned on its head without a primary care base. Fundamental reform is urgently needed to bring affordable health care that is accessible to all Americans.

COVID-19 Has Revealed America's Broken Health Care System: What Can We Learn?

The COVID-19 pandemic has exposed long-standing system problems of US health care ranging from access barriers, uncontrolled prices and costs, unacceptable quality, widespread disparities and inequities, and marginalization of public health. All of these have been well documented by international comparisons. Our largely privatized market-based system and medical-industrial complex have been ill equipped to respond effectively to the pandemic.

Crisis in U.S. Health Care: Corporate Power Still Blocks Reform.

The corporate, largely privatized market-based U.S. health care system is deteriorating in terms of increasing costs, decreasing access, unacceptable quality of care, inequities, and disparities.

Beyond the Affordable Care Act: Alternate Futures for Family Medicine and Primary Care.

Changes in the landscape of medical practice in recent years, accelerated since the passage of the Affordable Care Act (ACA) in 2010, have led to further fragmentation of primary care and disruption of the doctor-patient relationship for many millions of Americans. Patients face escalating costs of care and restricted choice of physician and hospital in a largely corporatized health care system. The goals of family medicine are compromised by these system trends.

A five-year assessment of the affordable care act: market forces still trump the common good in U.S. Health care.

The Affordable Care Act (ACA) was enacted in 2010 as the signature domestic achievement of the Obama presidency. It was intended to contain costs and achieve near-universal access to affordable health care of improved quality. Now, five years later, it is time to assess its track record.

Cost-sharing under consumer-driven health care will not reform U.S. health care.

Various kinds of consumer-driven reforms have been attempted over the last 20 years in an effort to rein in soaring costs of health care in the United States. Most are based on a theory of moral hazard, which holds that patients will over-utilize health care services unless they pay enough for them. Although this theory is a basic premise of conventional health insurance, it has been discredited by actual experience over the years.

The generalist disciplines in American medicine one hundred years following the Flexner Report: a case study of unintended consequences and some proposals for post-Flexnerian reform.

Abraham Flexner's analysis of U.S. medical education at the turn of the 20th century transformed the processes of student selection and instruction, the roles and responsibilities of faculty members, and the provision of resources to support medical education.

Moral hazard and consumer-driven health care: a fundamentally flawed concept.

For more than 30 years, most health care economists in the United States have accepted a conventional theory of health insurance based on the concept of moral hazard: an assumption is made that insured people overuse health care services because they have insurance. The recent trend toward "consumer-driven health care" (CDHC) is advocated by its supporters based on this same premise, assuming that imprudent choices by patients can be avoided if they are held more financially responsible for their health care choices through larger co-payments and deductibles and other restrictions. This article examines how moral hazard-based CDHC plays out in both private plans and public programs.

Disease management: panacea, another false hope, or something in between?

Disease management is being promulgated by many policy makers, legislators, and a burgeoning new disease management industry as the next major hope, together with information technology and consumer-directed health care, to bring cost containment to runaway costs of health care. Many expect quality improvement as well. The concept is being aggressively marketed to employers, health plans, and government in the wake of managed care's failure to contain costs.

Myths and memes about single-payer health insurance in the United States: a rebuttal to conservative claims.

Recent years have seen the rapid growth of private think tanks within the neoconservative movement that conduct "policy research" biased to their own agenda. This article provides an evidence-based rebuttal to a 2002 report by one such think tank, the Dallas-based National Center for Policy Analysis (NCPA), which was intended to discredit 20 alleged myths about single-payer national health insurance as a policy option for the United States. Eleven "myths" are rebutted under eight categories: access, cost containment, quality, efficiency, single-payer as solution, control of drug prices, ability to compete abroad (the "business case"), and public support for a single-payer system.

Privatization of Medicare: toward disentitlement and betrayal of a social contract.

An intense political battle is being waged over the future of U.S. Medicare.