NEJM August 21, 2024
Medicare is at a crossroads. Enrollment in the Medicare Advantage program among eligible beneficiaries surpassed 54% in January 2024, up from 43% just 4 years earlier.1,2 The meteoric rise of this program, fueled by subsidies, has ignited debate about the influence of private insurers on one of the most cherished and enduring social programs in U.S. history. Some tout gains from market forces and innovation, while others decry profiteering and regulatory capture by corporate interests. As is often the case in the United States, the controversy has been cast in polarizing terms such as “privatization.”
Less debatable are the fiscal and structural challenges presented by Medicare Advantage. Because this program costs substantially more per beneficiary than traditional Medicare,3 an expansive...
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