The country club class and The Chamber of Commerce Class may own our country, but they don’t run our country. For almost 50 years they did. After World War II, an entire system of recapitalization of our economy grew from the model of what President Eisenhower called the MILITARY INDUSTRIAL COMPLEX. Instead of demand signaling exclusively how producers would allocate scarce resources, government programs utilizing a “command and control” model, where government agencies create programs out of thin air, many times designed by politicians to fund programs to organizations that would every two to four years provide campaign contributions to help them once again get reelected—over and over again have taken over at least 50% of the medical market place.
There certainly are times where “fail safe” command structures are needed—war and internal family governance (remembering that “the stuff of life happens in families”) come to mind, but almost all the time Adam Smith’s “invisible hand” is best for determining price signals in an open marketplace. In the 1970’s the education and medical communities saw an opportunity to take a bite out of the free apple paid for by taxpayers. I have not studied education up until now, but I know that colleges that traditionally taught Liberal Arts, Christian Education, are not being funded at the levels that more secularist universities are being funded. Colleges like Hillsdale College, Grand Canyon University, and College of the Ozarks where there is either no government funding or as little as possible are thriving and are, attracting the best teachers and the best students.
At the same time government transfer payments were making large hospital systems and medical schools dependent not only on their monetary resources, but also on the regulations that accompanied them, health care delivery, as opposed to the actual practices of medicine surgery and the allied health sciences, has failed miserably.
The liberal establishment is telling you that “people will die” because of cuts to Medicaid. The cuts are being made in the Obama care Medicaid Expansion group of young healthy adults. This group has taken away access and time in front of practitioners, from those living on the margins who through no fault of their own can’t take care of themselves. The promises of “access, quality, and cost” have been transferred from those truly in need, to those young healthy people who for the most part have no chronic or preexisting conditions themselves. Let me say again Medicaid advantage is hurting the very people that Medicaid was designed to help. So much for command-and-control economics.
Who benefits from these large “government industrial schemes? The large corporations who if there was an open market would be attending to their customers needs, instead of licking the boots of the politicians who provide for added revenue to their corporations. Most recently and predictably there has been an outcry from the large hospital systems and insurance carriers about cuts in Medicaid—again almost exclusively in Medicaid Expansion.
Where are the Expansion cuts coming from and why are the large corporations threatened by them? There are approximately 20 million people on Medicaid expansion programs. The savings will come from three groups, approximately 1/3 each. The first group is illegal migrants mostly in California. The second groups are from young and healthy able-bodied adults who aren’t working and who aren’t pursuing an education or work opportunities. The final third is from the medical community itself where it is estimated there are billions of dollars in all government programs being lost to fraudulent billings, fraudulent coding for services, and for up coding of services.
Another source of income from these large corporations is the so called “transfer taxes” they are paying that go to State Medicaid agencies to help the states pay their 10% to match the 90% Federal “contribution to the state-run programs. Talk about FRAUD. So, the large hospital systems pay 10% to the states and get 90% back in return! What the heads of these large corporations’ lack in virtue, they make up for in cunning and malfeasance.
Please review and enjoy the graphs below. Understand that almost 50% of the health care marketplace is controlled by our Federal Government. There is no marketplace in medicine today in our country. That is precisely why service, access and costs are all going in the wrong direction.
Finally ask, who are organizations like the IMA/ IHA/ IACI serving? Patients and citizens? I think not. Who are our politicians at all levels of government serving? Patients and citizens? I think not.
The answers to all those questions can be found by examining the graphs below.
Key Enrollment Numbers:
| Coverage Type | Number of People (Approx.) | % of U.S. Population | Notes |
| Private Insurance | 168 million | 51% | Includes employer, individual, and marketplace plans |
| Medicaid | 71.3 million | 21.6% | Traditional Medicaid only |
| Medicare | 65 million | 19.7% | Most are age 65+ or disabled |
| Medicaid Expansion | 20.9 million | 6.3% | Subset of Medicaid, adults covered via expansion |
Details
- Private Insurance:
About 168 million people in the U.S. have private health insurance, representing roughly 51% of the population. This includes employer-sponsored insurance, individual plans, and ACA marketplace coverage. * - Medicaid:
As of March 2025, about 71.3 million people are enrolled in Medicaid, the government program for low-income individuals and families. * * * - Medicare:
Approximately 65 million Americans are enrolled in Medicare, the federal health program primarily for people aged 65 and older, and some younger individuals with disabilities. * - Medicaid Expansion:
Medicaid expansion, which covers low-income adults in participating states, accounts for about 20.9 million enrollees as of mid-2024. *
Notes
- Some individuals may be counted in more than one category over the course of a year (e.g., switching from Medicaid to private insurance).
- Medicaid expansion enrollment is a subset of total Medicaid enrollment.
- These figures reflect the most recent data available as of mid-2025 and may fluctuate slightly due to ongoing eligibility redeterminations and policy changes.
Sources
- Medicaid & CHIP Enrollment: March 2025 * *
- Medicaid Expansion: June 2024 *
- Medicare: 2025 estimates *
- Private Insurance: Derived from current population and coverage rates *
