Are We Headed Toward a Single-Payer System?

It’s hard to talk about health care today without talking about UnitedHealth Group. The company has ballooned into a $400 billion-a-year behemoth with 2,700 subsidiaries, 400,000 employees, and growing federal scrutiny over whether it gamed Medicare Advantage to boost profits. What began as an insurer is now a vertically integrated system that owns doctors, fills prescriptions, runs clinics, and sets prices.

A big part of UnitedHealth’s growth comes from doing business with itself. One of its many divisions, Optum, generates more than $150 billion in revenue from companies it already owns. That gives UnitedHealth enormous influence over what care looks like, how it’s paid for, and ultimately, how much profit flows back to Wall Street. With nearly one-third of the Medicare Advantage market under its control, the company doesn’t just provide coverage for seniors—it shapes how their health is documented, which determines how much taxpayer money comes in.

But….they are not the only ones.

The Consolidation Wave

UnitedHealth may be the most visible example, but this trend is industry-wide. Hospitals are buying medical clinics, pharmacy chains are merging, and private equity is rolling up everything from dermatology practices to dialysis centers. These deals are often marketed as “efficiency,” yet patients are more likely to see higher bills, narrower networks, and fewer independent options. When competition goes, markets lose the power to set prices. Patients lose out to shareholders.

Unfortunately, public policy might have just made the situation worse. President Trump recently revoked Executive Order 14036, a 2021 directive designed to curb consolidation and promote competition among large players in various industries, including healthcare. The DAY AFTER this revocation, UnitedHealth closed its $3.3 billion purchase of Amedisys, a home health and hospice provider with 500 care centers across 38 states. That timing underscores the reality: while regulators investigate, corporations expand their reach. Legislators and the executive branch have the power to slow this trend but have not taken the opportunity.

Regulators Playing Catch-Up

The DOJ is probing whether UnitedHealth trained clinicians to code diagnoses in ways that inflated Medicare payments. The FTC has raised alarms about mergers across the sector. But enforcement has struggled to keep pace with companies that can outspend, outmaneuver, and outlast government oversight. Each merger makes the market more consolidated and harder to unwind.

Time for Action!

A health care system dominated by a handful of corporations is not inevitable—but change requires clear policy choices and public pressure. Examples include:

·      Stronger antitrust enforcement that extends beyond headline-grabbing big acquisitions to addressing the steady roll-up of physician and specialty care practices.

·      Public programs like Medicare Advantage structured to reward quality outcomes rather than coding tactics that drive higher profits.

·      Greater transparency in pricing, ownership, and referral patterns to give patients and employers the information they need to hold companies accountable.

At the same time, consumers and taxpayers—the ones ultimately paying the bill—need to push for reforms that strengthen independent physician practices, expand real patient choice, and tricks that obscure the true cost of care. Without these changes, consolidation will keep advancing, costs will keep rising, and competition will continue to shrink.

Do we want a health system shaped primarily for corporate shareholders, or one that puts affordability, access, and patients first? If policymakers cannot act on their own, it’s up to us to demand they do.

References: Wall St Journal, Reuters, Prospect.org