Fixing Our Broken Healthcare System: Beyond Bipartisan Smoke and Mirrors

Healthcare in the United States is in crisis and requires immediate action. Compared to other wealthy countries, we are
an extreme outlier in terms of costs, outcomes, and service quality. We spend more than double the amount on
healthcare than other countries, five times more on administrative costs alone, and healthcare spending represents 18%
of our Gross Domestic Product (GDP), versus 10-12% in other wealthy countries. 

 We live in a country where millions are uninsured and many more are under insured. Compared to other wealthy
nations, we have the highest rate of preventable deaths, and our life expectancy is lower by more than four years.
While it is true that the United States’ quality of care is world-class, the current barriers to entry in our healthcare
system prevent many from receiving the care they deserve. We often hear stories in the media of people, especially
seniors, skipping medical care and medication because of its high cost. 

Two areas of healthcare that are most in trouble in terms of accessibility and cost are the Affordable Care Act (ACA)
and Medicare. The ACA plans are unaffordable, and Medicare is on the verge of insolvency beginning in 2033. While there
is intense debate between the two political parties over who should pay the ACA premiums — the individual member or
the taxpayer — neither party appears to be addressing the real problem that needs to be fixed. The ACA is in crisis
and dysfunctional. The services it offers are limited in terms of quality and accessibility, and its costs are out of control. 
For example, Access Health CT,  the Affordable Care exchange in our state, is neither affordable nor accessible. 
 
President Obama’s declaration, “If you like your doctors, you can continue seeing them,” turned out to be a false  promise. The ACA is not affordable, and its quality of care and provider network are limited. In our state, you cannot go to an
out-of-state hospital, and many of the top providers inside the state do not accept ACA insurance plans.  For example,
the highly recognized Connecticut-based Hospital for Special Care (HfSC) does not accept Access Health CT insurance. 
To understand the problem with the ACA, let’s dig a little deeper and examine our own state’s ACA exchange in more
detail. Picking an insurance plan on the Access Health CT website is like shopping for a mattress sold at different
stores under different names and model numbers, with slightly different bells and whistles. Wherever you shop, the
mattress is basically the same, and the minor feature tweaks at different locations are seemingly designed to make it 
difficult for customers to compare between stores.
 
While there are two managed care companies (MCOs) — Anthem and Connecticare — and 20 plans to choose from on the
exchange, the plans offered by each MCO are almost identical, and the different plan options, except for some
minor tweaks, are basically the same. If you analyze the various plans, it will quickly become apparent that, by its
very design, Access Health CT is basically nothing more than a broken single-payer system. The options on the exchange
are like 20 variations of the same lumpy mattress, with minor variations in pricing and covered services.On the
Access Health CT Exchange, you genuinely have only two options— you either pay more in premiums and have a
lower deductible, or pay less in premiums and have a higher deductible. Whichever plan you choose, the bare-
bones provider networks, the limited quality and accessibility of care, and the overinflated costs are practically
the same. While each plan might have different copayments and deductibles, whichever plan you ultimately choose,
they are basically the same in terms of their restricted in-state-only provider networks, limited quality and accessibility
of care, and unaffordable costs.  For the most part, it all boils down to a simple equation: the higher the premium, the
less the out-of-pocket expense; the lower the premium, the more the out-of-pocket cost. 

To illustrate my point, let’s look at the Connecticare plan options for a family of four residing in Fairfield, with parents ages
63 and 60 and kids ages 21 and 24.  The most affordable plan is the “Value Bronze HSA plan.”  The annual premium for
this plan is $54,272.52, the family deductible is $13,000, and the max out-of-pocket is $14,450.  In this scenario, the
member is responsible for a total out-of-pocket expense of $68,722.52 before reaching 100 percent reimbursement.
The other option is the “Value Gold Standard POS.” The annual premium for this plan is $83,272.92, the family deductible
is $2,400, and the max out-of-pocket is $14,750. In total, the member is responsible for an out-of-pocket expense
of $98,023.88 before the insurance provides 100 percent reimbursement. Looking at these numbers, it is quite confusing
as to which plan is better: the Bronze or the Gold. One would expect the Gold plan to provide superior coverage to
the Bronze plan. But if you have medical expenses that meet the out-of-pocket maximum, then you will do much
worse with the Gold plan. You’ll end up paying over $29,000 more for the exact same coverage provided by the
Bronze plan.  Perplexing, no? Tryingto calculate which plan is best is almost impossible. 

It is not a secret why the ACA is broken — these plans are run by large for-profit corporations that are more concerned
with their stock price than with accessibility and the quality of care.  For years, MCOs have squeezed providers
on reimbursement rates and restricted care under the guise of “Medical Necessity” to increase their own profits. What
has made matters worse is the rise of large Integrated Delivery Networks (IDN). These are hospitals and providers that
have formed large provider companies to combat the financial pressures of the managed care industry. In
Connecticut, there are also only two large Integrated Delivery Networks (IDNs) — Yale New Haven Health System
and Hartford Healthcare. These two systems, over the past several years, have aggressively expanded, buying up
hospitals and medical practices to gain negotiating leverage over the MCOs. With the IDNs’ newfound negotiation clout,
the MCOs' only remaining means to increase revenue is to raise member premiums substantially. This year, the state
of Connecticut approved a 25% premium rate increase for Connecticare. Since the start of Access Health CT in 2014,
the average premium cost has increased by almost 300 percent. Yet the Consumer Price Index (CPI), which tracks
overall inflation in Connecticut, has increased by only 35–45% since 2014, a fraction of the rise of ACA premiums.

 Unlike ACA enrollees, Medicare beneficiaries do not have problems with premium costs, accessibility, or the quality of
care. Eighty-six percent of Medicare participants say they are happy with their plans. In my practice, I often hear
seniors’ joke: “The only benefit of getting old is my Medicare.”  The problem with Medicare is that its fiscal foundation is
on the verge of collapse. According to the Congressional Budget Office (CBO) and the Medicare trustees’ data, if
Congress does not figure out how to increase funding, Medicare will become insolvent by 2036.

While many people believe that a nonprofit single-payer system is the way we need to go, how we get there is
rarely discussed by politicians on either side of the aisle. The debate between who should pay these outrageous
ransom-like fees —we the individual or we the taxpayer — is nothing more than bipartisan smoke and mirrors spun
by politicians who are in bed with insurance lobbyists.There are clear steps our government can take to begin to heal
our sick healthcare system.

What I propose in this article is a plan that would significantly reduce healthcare costs and keep Medicare solvent
for another 20 years. What I am suggesting is the addition of a new tax bracket for married couples earning more than
$1 million per year.  If the top 0.5 percent of the population (approximately 65,000 households) were to pay a tax rate
of 47.7 percent, rather than the current marginal rate of 37 percent, on earnings above $1 million, not only would Medicare
be solvent for another 20 years, but we could lower the age of Medicare eligibility to 50. 

Lowering the Medicare eligibility age to 50 would be financially beneficial for almost everyone—the
government, corporations, healthcare providers, and individuals of all ages. It would also improve the quality of care
and accessibility for the entire United States population.  The only ones who would lose in this scenario would be
the managed care industry and the politicians who accept lobbyist funding. 

ACA premiums would decrease significantly because members aged 50-64 are the highest cost enrollees in these plans
If the Medicare eligibility age were lowered to 50, it is estimated that over 25 million would exit the ACA. The ACA risk
pool would become younger and healthier, and claim volatility and costs would decrease significantly, becoming
more stable and predictable.Since members ages 50-64 have the highest premiums and out-of-pocket costs under
the ACA, adopting this program would eliminate the financial catastrophic risk for millions. The government would 
save billions in subsidies,since approximately 25 percent of subsidy recipients are in this older age group. Hospitals
would see modest increases in volume from newly eligible adults. They would also benefit from more predictable
Medicare rates and from reduced burden of absorbing the cost of treating patients without insurance coverage.
Most importantly, rural hospitals, which are currently facing financial ruin, will be able to stay open because of the
stability and increased percentage of insured patients. 

Such a change in our healthcare system does not have to be done all at once; it can be done gradually. For example, if
the Medicare eligibility age were lowered at first to 60 rather than 50, the required surtax for married couples earning
more than $1 million could drop from 47.7% to 45.6%.  This would significantly reduce overall healthcare costs and
allow Medicare to remain solvent for another 20 years.

The problems in our healthcare system didn’t happen by accident—they’re the result of policies that put
insurance companies and corporate profits ahead of patients. The ACA has become expensive, restrictive, and
unreliable, and Medicare—one of the few programs people actually trust—is heading toward insolvency if nothing
changes. But there is a realistic way forward. By slightly increasing taxes on households making over a million dollars
and lowering the Medicare eligibility age, we could stabilize Medicare for decades, dramatically lower ACA
premiums, improve access to care, and reduce financial strain on families, hospitals, and the government.This isn’t a
partisan solution; it’s a practical one. We can either stay with the current broken system—sky-high premiums,
limited networks, and growing instability—or we can make targeted, sensible changes that strengthen Medicare and
make healthcare more accessible and affordable for everyone.
The path is obvious. What we need now is the will to take it.

This blog was originally published in The CT Mirror on December 10. 2026. To see the article click on the button below.

CT Mirror