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The Corporate Assault on Medicare

In our ongoing campaign against the corporate assault on America’s healthcare system, Ralph welcomes Kip Sullivan of “Healthcare for All Minnesota” to talk about what he terms “the creeping privatization of Medicare,” and tells us the story of how that ongoing corporatization is based on one particularly destructive yet durable myth.

Kip Sullivan is a Health Care Advisor with Health Care for All Minnesota, and has written several hundred articles on health policy. He is an active member of Physicians for a National Health Program, which advocates for universal, comprehensive single-payer national health insurance.

I’ve had numerous conversations with intelligent people with whom I agree on every political issue, except health policy.  Who tell me that we need Medicare Advantage, and we need programs like DCEs because there’s this “rampant overuse” in Medicare and in the country at large… Someone’s going to get a Pulitzer Prize to explain how that myth got such a grip on the brains of smart people… A whole lot of smart people that should be progressive on this issue are inebriated by it. And we need to get at the root cause of this apathy toward the takeover of Medicare by these companies by rebutting the myth that there’s something wrong with traditional Medicare.

Kip Sullivan


If you care about a sane and efficient healthcare system in this country, you have to care about retaining the traditional Medicare program. Because it’s an example of an imperfect, nevertheless highly efficient, single-payer program. We are using the phrase “Medicare for All” as a euphemism, or as a bumper sticker phrase for “single payer.” But the longer we wait and watch it get taken over– first by Medicare Advantage and by DCEs– the harder it is to hold Medicare up as a symbol.

Kip Sullivan


Complications are a controlling process by these corporations. Obamacare was over 1500 pages. 1500 pages. Medicare in Canada, when it passed in the 1960s, was 13 pages. 13 pages. So, all this complication is avoidable. And a much more just system is a much simpler system.

Ralph Nader

Ralph Nader Radio Hour Ep 410 Transcript (Right click to download)


  1. NooN says:

    WonderfuL Program as a follow up last
    Week’s Program with Marshall Allen also
    regarding 0ur Moat Necessary Health Care
    for All, oN all its levels.

    Since each request should be 18 months,
    so each Request includes an Election;
    Possibly each of us Congress Club Members
    Should choose a Specialty. What do U Think ?

  2. Don Harris says:

    While 20 million citizens investing 5 dollars a year to an organization advocating single payer healthcare sounds good at first, it does not hold much hope of real success any time soon.

    That’s 100 million per year against a lot more. And it will not make much difference to the politicians controlled by big money.

    In order for this strategy to work it would require those 20 million to give 5 dollars per year to many organizations to cover many different issues.

    That’s 10 dollars every two years to as many as ten or more organizations all trying to influence politicians controlled by big money. !00 dollars every two years.

    Wouldn’t it be more efficient to get those 20 million citizens to commit 100 dollars and our votes every two years to finance small donor candidates to replace the big money legislators?

    That would be 2 billion dollars in 2022 to finance small donor candidates in the 470 or so congressional and senate elections in 2022. And at least 20 million votes. There could also be citizens that do not contribute 100 dollars or any money but still use their votes to participate.

    The current “progressives” only propose legislation but do not achieve it because it is their job to appear to support these policies to prevent any real action while making citizens think they are making progress or the “progressives” just have been duped into believing they are making progress.

    With 2 billion dollars and 20 million plus voters participating in demanding small donor candidates in 2022 and enforcing that demand with our votes in 2022 it will change the narrative for 2024 inspiring millions more to participate in 2024.

    It is a little longer than 18 months to start and will need to continue, but it will yield results much faster than 18 years worth of 5 dollars per year to many organizations, though some citizens could actually do both.

    So what do you say, Ralph? Are ready to join and help lead this effort to tackle the one issue that is the major obstacle to available affordable solutions to most of issues such as healthcare, income inequality and the War on Habitat?

    If you believe this kind of organizing can work on healthcare or other issues, why can’t it work to get the big money out of politics?

    • Nancy G. says:

      Finding 20 million people willing to donate $100 will be difficult. See Pew Research – facts about US political donations. i appreciate your thinking about ways to achieve positive change. I do that sometimes. We do need an organizational structure that can achieve this objective and it is possible to achieve it. We just don’t know how yet. What do you think about collecting donations for an organization that is an umbrella for candidates who refuse PAC and corporate money and only take small donations from people? There would have be a vetting of such candidates so potential candidates who may try to later sell out their constituents once in office may at least be partially prevented from doing so. Any such candidate will agree to being a sponsor and support legislation to publicly finance all elections once in office. Office holders should not be able to betray the people that elected them. A pledge that should they do so will result in their immediate termination (accountability that we do not currently have). An alternative candidate will assume their position (will require legislation).

  3. Nancy says:

    This is very interesting about the insidious corporate takeover of our health care system with an additional twist of these newer DCE programs. I did not quite follow what these DCEs are, but it is ominous that people in the affected areas who do not choose a DCE plan can be assigned to one without choice. I got the impression that this may be the case, even if those people have original Medicare and are happy with it. If this is truly happening, I protest!

    Your discussions of Medicare (dis)Advantage have been VERY informative, especially the one with Kay Tillow. I have this kind of health coverage. I did not know until I heard this that my Medicare Advantage plan is not government non-profit Medicare but is corporate for-profit Medicare. This was a shock. I don’t remember ever chosing not to get original Medicare, and I did not realize that Medicare has a corporate part.

    Do you know anything about Kaiser Permanente? I have been a patient of Kaiser much of my life. Kaiser is an HMO that has many patients in California. It offers the Medicare Advantage plan I have and other kinds of medical plans. It has its own doctors, staff, hospitals, equipment, and clinics. Kaiser is not an insurer like the ones you mentioned earlier that are middle-men between the patient and their medical care. Kaiser is different. It is both the insurer and the provider of medical care.

    Like the insurance corporations you mentioned, does Kaiser Permanente intentionally deny benefits to which people are entitled under their Medicare Advantage plan in order to increase their profits?

    I hope you will continue to keep us informed. I am now very confused about how to get Medicare health coverage that I can afford that will take good care of me when I need it. Original Medicare pays only 80 percent of covered services, excludes some services entirely from coverage, has copays and deductibles, and has no annual or lifetime ceiling on costs. That can be very expensive. It is important to me to get good health care when I need it, and it is important to me to be able to afford my health care and not have prohibitive health care costs. I am not sure what supplementary programs may exist to cover this need.

    I have never had original Medicare, and I don’t know how it works. I do not know how to compare original Medicare to my Medicare Advantage plan. If there is the built-in disadvantage of covered care being denied intentionally to increase corporate profits, I don’t know how to confirm that or cope with that. I do not know what Medi-Gap policies cover or cost, or how they improve Medicare, or where to learn about them. I don’t know how to get Medicare Part D, which is now covered for me, or how to learn about and arrange Medi-Gap coverage, or what else may be needed for my protection and what to watch out for.

    I don’t know how to find a doctor or hospital. I do not know how to file claims for my care, which I do not have to do under my plan now. If I do need care, I do not know where to go. There is not much located in my area. Would I need to take a bus when ill or injured and travel a long way? When are the open enrollment periods for each part I need of original Medicare, and do I qualify for them, and can I afford them? How can I sign up for all needed parts of Medicare at a time that does not leave parts of my coverage missing for awhile. There’s a lot to consider.

    It is overwhelming to try to work out alone the choice of a Medicare health plan. Ralph, could your program focus on this subject and provide resources and guidance, so that those interested can make an informed decision about whether or not, and when, to change from Medicare Advantage to original Medicare coverage?

    • Melinda Nichols says:

      Excellent questions, Nancy. Feel free to write to me and I can share my personal experience from 2015/2016 on behalf of my ailing father, who was on a Health Net (Dis) Advantage Medicare plan.

      I have heard “good comments” about Kaiser Permanente’s “(Dis) Advantage plan, but this is not from personal experience and I would hope Ralph and/or Kip can address the essential, heartfelt questions you ask about Kaiser’s plan and how it may be “better” or worse or the same as the other (Des) Advantage plans mentioned by Kip (Humana, United Healthcare, etc.).

  4. Dante Trembler says:

    Kaiser had a Medicare Advantage program. It is still Medicare Advantage. It take money from original Medicare. They are trying to destroy Medicare. KP is an in network system. You can be denied a procedure by KP. KP has a formulary list of drugs it covers. If your drug isn’t on it, you are out of luck. website will help you find a Medical and Part D program that covers your prescriptions. Medigap covers the 20 percent that Medicare doesn’t cover. As you get older and have more medical issues, Medicare Advantage will try to drop you or deny you procedures.

  5. Melinda Nichols says:

    What this excellent presentation missed is that a good percentage of Medicare patients do not seem to be in favor of “Medicare for All” (Single Payer System). This a a vital constituency to approach in gaining their support, along with the AARP, which promotes at open enrollment periods “Medicare (Dis)Advantage plans” along with Original (Traditional) Medicare.

    I have been given reasons by some Medicare beneficiaries that they believe/are convinced their own medical care under Medicare would be severely curtailed and compromised if “everyone” could enroll in a Medicare for All (Single Payer System). They cite how in countries that have universal health care, the time it takes to receive treatment (e.g., surgeries, etc.) is unsafely delayed.

    Also, no mention was made in today’s presentation about Kaiser Permanente, Inc’s Medicare Advantage plan and how decent or indecent it is in actual coverage of vital medical care treatment as compared to other Advantage plans under, e.g., Health Net, Humana, United Healthcare, etc. One listener here, Nancy, has posted this question about her Kaiser Medicare Advantage plan is as one among several of her very crucial questions.

    Ralph, Kip, David,
    I love creating a people’s Congressional lobbying effort. Reach out to me and those if us who have written here. I have oodles of personal stories to take on the ‘Congressional lobbying road’ from my shocking but eye-opening experience in the last months of my ailing father’s life who had “chosen” a Medicare Advantage plan in lieu of Original Medicare. What a nightmare it turned out to be, at least for his $0 monthly premium (except for turning his Original Medicare monthly premium over to the Health Net Advantage plan (“subgroup Prospect” in his region), in the extreme limitations in hospital and skilled nursing facilities. They were all second- or third-tier quality under his $0 Advantage plan.

    Reach out to us here by replying to our comments and I will be on board to be a lobbyist!

  6. Kip Sullivan says:

    Nancy, the problem with Medicare Advantage is you don’t know what coverage you have till you need it. The insurance companies, including Kaiser, can and do delay and deny care when you need it.

    You are better off enrolling in traditional Medicare and buying a supplemental policy. But if you don’t enroll in traditional Medicare within six months of becoming eligible for Medicare, insurance companies that sell supplemental insurance (aka “Medigap” coverage) can take your health history into account and charge a high premium or refuse to sell to you at all. Before you leave Kaiser, make sure you are still within the six-month enrollment period for traditional Medicare. Congress should, along with eliminating the overpayments to Medicare Advantage plans, eliminate this trap that keeps beneficiaries in Medicare Advantage.

    • Melinda Nichols says:

      In 2015/2016, my father was 85 years of age. He had been in Medicare Advantage plans instead of Original Medicare for the last five to ten plus years. Yet, when in 2015 I saw that his Advantage plan was a terrible “middle man” that was brokering / choking his medical care and reducing his facility choices to much lower quality hospitals and skill nursing facilities, I immediately rolled up my sleeves and successfully applied for him to return to Original Medicare with a supplement plan ($337 supplement monthly premium). Note: This did not include a medication plan (Part D). I was working on making arrangements for that, but he died within a few weeks of this transition due to his illness.

      Unless the laws or regulations have changed, I am not aware that Medicare supplement plans can deny offering a plan or offer a plan at significantly higher monthly premiums based on age or health status. My father was in the hospital when we made the transition. I don’t think (or recall) seeing extensive questions on the Medicare supplement plan that asked about his health status.

  7. Sharon Schmidt says:

    I totally agree with Ralph Nader that we need to get lobbyist to cover Congress. Actually, I have been telling both HCAM and PNHP that they need to hire lobbyist to get the MN Health Plan passed in MN. That would be easier and cheaper and that is how Canada did it. One providence went single-payer and the other providences followed rather quickly.

    We need to put our heads together and think about who or what organization would be willing to front this idea. We should be able to get startup money from wealthy people that believe in Universal Health Care and hire people to organize this effort. Then the people hired could hire more people to start working the media and social platforms to procure more money and lobbyist.

    I have final got some DFL attention and they will be writing our Congressperson who supports reinsurance rather than Medicare for All (Universal Health Care).

    I also agree with Ralph that we should call it Universal Health Care. Medicare for All has been a confusing term and time is wasted explaining that it is an improved Medicare program where you would not have to buy a second insurance to cover the other 20%.

    Thanks for the program. I will spread it around.

    • Thomas says:

      Wouldn’t it be easier for the corporations to attack a program on the state level. They would muster their entire apparatus and PR resources to lie and confuse the issues so much that nothing would be accomplished. That’s why Nader is always pointing to the 535 members of congress as the target for advocacy.
      I agree that it worked like that in Canada, but the US is a different beast.

  8. James Brown says:

    Please spread the word about Ralph Nader Radio Hour, The best info on the web.

  9. Mary K. Lund says:

    I believe the best chance would be to keep the Medicare name. Most people like Medicare and (incredibly) do not see it a “a government program” – which they DON’T like, because they know they pay into it during their working life.!

    Despite the “socialism” shouts thrown around during the 2020 Democratic primary, people would accept it if we eased people into it: by age groups, by making it an option for the uninsured, etc. Medicare already has been expanded to people in end-stage renal failure, ALS, and some other disabilities.

    The problem would be expanding Medicare eligibility without eliminating the corporate insurers. Their bean-counters will not stand by while the honeypot melts away. We need more cooperation from the medical community: doctors and hospitals.

  10. Daivd Hughes says:

    Ralph is naive how times have changed re moving against the power elite. It is not as simple as raising $100 million.

  11. John Puma says:

    So the “logic” of the start of corporate take-over of Medicare was “replace the greed of individual doctors with the cosmic greed of corporate giants”?

  12. Don Klepack says:

    Ralph Nader, thanks for this show that gives a platform for voices that you don’t hear on the Main Stream Media and Public Radio. My opinion, the assault on Medicare is enabled by the Government, specifically CDC, NIH and Unites States Congress. It also takes away power from independent Doctors that are forced to join medical groups because of the massive paper work and regulations. It would be nice if you have another show called the assault on Medicare by the partnership of Big Corporations and Government.

  13. Don Harris says:

    What happened to my comment about hiring new organizers. lobbyists and strategists with 10 billion dollars over ten years from billionaires Ralph wrote about in his blog compared to funding these organizers, lobbyists and strategists with 2 billion dollars every two years from Ralph’s 20 million citizens in my previous comment, which would also total 10 billion dollars over ten years?

    This comment posted for moderation but never appeared.

    What caused it to fail moderation?

    • Skro35 says:

      What do you mean? Is it the one from January 16th? Scroll up. It’s been there the whole time. Second from top.

  14. Don Harris says:

    It is not the one from Jan 16th. it was posted for moderation a day or two after that comment,

  15. Don Harris says:

    In a recent blog, “Think Big to Overcome Losing big to Corporatism” Ralph said that we need a plan that requires new organizers, lobbyist and strategists funded by enlightened billionaires contributing 10 billion dollars over ten years or it would lower expectations of progressive civic groups to a point of self-delusion.

    That is being self-delusional.

    The only reason a billionaire would contribute that kind of money is to control the opposition.

    The 2 billion dollars every two years in my previous comment also totals 10 billion dollars over ten years. The difference is that this source of funding would be the opposition controlling the opposition.

    2022 is an off year election so this is the optimum time to start this approach as there is no presidential election to take the focus off of Congress. It is not as good a time as 2018 was which could have changed the dynamics for 2020- but it is better than waiting for the next off year election in 2026 which would have no effect on 2024.

    Are you going to let the opportunity to test your theory that politicians want our votes more than big money to the test in 2022 slip by as you did in 2018 or are you going to stand behind your words with action on this critical issue?

  16. margaret walsh says:

    hi ..
    a lot comments ..
    too many too long for me to read ..

    i disagree ..
    i think we need a LABEL ..
    PNHP called it long ago ..

    a good call “Every BODY in .. No BODY out” ..
    Every ONE .. rich poor or in between ..
    pay according to your means ..
    Corporations too ..

    something like that ..

    Glen Anderson, activist, organizer, and teacher since the 1960’s.
    The speaker/guest at the January meeting of PNHPWASHINGTON ..
    Glen has offered to organize a movement ..

    i will send his contact info when i get it ..

    meanwhile consider this ..

    the documented waste, fraud and abuse of Medicare has raided the Medicare bank ..
    the “corporatization” has captured the label “Medicare” ..

    why not use a LABEL to build a NHP ..

    one big beauty is individual enrollment ..
    no matter who you or your folks work for ..

    now i am too long to read ..

    thank you for your consideration .. Margaret

    boy oh boy .. oh me oh mi ..
    one more ..

    i suggest there are just as many BODIES who would rather die than go to a doctor ..
    count the anti-vacers? spell that ..

  17. Tom says:

    I cringe every time I see Joe Namath or Jimmy Walker on TV hawking these dis-Advantage plans.

    While I was aware how pernicious these plans/scams are, I appreciate your show providing additional detail.

    That said, for whatever it is worth, I emailed my representatives with the following and encourage everyone to do the same:

    (For the record, I borrowed much of the below from Kay Tillow’s post on the Counter Punch website)

    What is your position on the takeover of Medicare by private insurance companies with Medicare Advantage plans?

    This takeover is being led by Liz Fowler who President Biden appointed to head up the Center for Medicare and Medicaid Innovation (CMMI) within the Center for Medicare and Medicaid Services (CMS).

    Back in 2009, the insurance industry and anti-single payer policy experts promoted CMMI and wrote it into the Affordable Care Act to promote cost cutting in Medicare, Medicaid and CHIP through value-based payment models. But CMMI’s work is based on the wrong-headed theory that U. S. healthcare is too expensive because of overuse. Value-based payment advocates claim that too many doctors and hospitals are giving too much care. CMMI wants to reverse the payment scheme and pay doctors and hospitals more for doing less. They contend they will be paying for quality or value rather than quantity. Their attempts to force doctors to fill out endless forms are stressing physicians, but they have yet to find a way to accurately measure value. CMMI is working from a false premise: in the U.S., patients see their doctors an average of 4 times annually while in the U. K., France, Canada, Australia, Germany and Japan, patients see their physicians from 5 to over 12 times a year. In the U.S., Americans spend an average of .6 days per year in the hospital, whereas residents of other wealthy countries spend up to three times that number. So, if Americans are seeing their doctors less and spending fewer days in the hospital, why are we still spending more than wealthy countries on health care?

    There is a battle raging over what must be done to cover everyone and rein in costs. Single payer, improved Medicare for All, advocates assert that the key is to remove profit-making insurance companies and hospitals from the system, slashing administrative waste to the point where savings can improve care for those who are covered and expand it to those who are uninsured. Costs will be stabilized and even reduced because the profitmaking mechanisms are the source of the high costs, not the overutilization of services. Single payer advocates point to the fact that the U.S. spends on health care about double, per capita, what other wealthy countries spend. Yet the US has, on average, worse outcomes. A plan to remove profit-making from the system is the only plan that would rein in costs. The CMMI, meanwhile, is constructed around insurance company magical thinking of health care reform: cut costs while giving less but better care.

    Over the past decade, CMMI has experimented by setting up a number of alternate payment schemes designed to shift insurance risk onto hospitals and physicians. The results have not been good. Most of the CMMI experiments have been disappointing—either they don’t improve care, or they worsen care, or they don’t save money. Only 4 models of over 48 experiments have been adopted. The conclusion should be that if we are to expand care and reduce costs, we should adopt a well-designed national single payer plan. But the Biden Administration has rejected that logical conclusion. Instead, the President has brought back Liz Fowler to find a way to make their pro-insurance company plan work. The voluntary experiments of the CMMI have not proven the quality gains and cost saving that the insurance industry and its loyal experts predicted. Thus, Liz Fowler to the rescue. Fowler and others have hinted that they’re looking to move from voluntary to mandatory experiments that will force greater risks onto physicians, other caregivers, and hospitals.

    How much more of this nonsensical misery must the nation endure? A decade ago, Marcia Angell, MD, former editor of the New England Journal of Medicine, explained that in a for-profit insurance system, costs and care move in the same direction. To increase care, cover more people with better care, costs are increased as well. In a for-profit system, cutting costs also cuts care. To shift the dynamics and improve care while reining in costs, one must change to a single payer, not-for-profit system. She was right.
    When Senator Max Baucus refused to allow single payer advocates to participate in the hearings on the Affordable Care Act, nurses, doctors, and others stood to speak. Baucus called the police and had them arrested. But their courage to act sparked a debate and planted a banner for single payer. It’s time to lift up that banner once again.

    Will you advocate for the voters who elected you or the corporate insurance industry?

  18. Lucy McKenna-Currie says:

    For starters, ask Joe Rogan to invite Ralph Nader and Kip Sullivan on his program. Rogan has 11 millions viewers per episode, plus lately Rogan has gained even more mainstream attention as jealous cable news personalities throw barbs at him. Rogan could lend his support for a single-payer health care system. Nader and Sullivan could conduct a media blitz in getting out the word. Who better than them to explain what the health insurance racket is all about.

  19. Jason says:

    I copied the following excerpt from the transcript to send to my senators and rep.:

    Subject: Stop the overpayments to Medicare Advantage plans. Stop the direct contracting demonstration.

    KS: And so, what CMMI is proposing is that in ten cities, beneficiaries in the traditional Medicare program, who deliberately decided not to enroll with an insurance company like Humana, will now be–without their knowledge and possibly against their will–
    assigned to this direct contracting entity, which is going to operate very much like an HMO. It’s going to have utilization reviewers who will interfere in the doctor-patient relationship.
    RN: You’re a graduate of Harvard law school. You’re a lawyer. Isn’t that challengeable in court? How can they force people to do that?
    KS: We may be able to find a law firm that could do that and I’m working with several people who are thinking about a class action lawsuit. Here’s the kicker. This Direct Contracting Entities program pilot test in these ten cities would force every traditional Medicare
    beneficiary into a DCE. There might be four or five in the entire metro area and they would have no choice about it. And if they didn’t pick one, they would be assigned to one.
    Now, if that isn’t coercion, I don’t know what is. And to come back to your lawsuit question, yes, the theory I’m discussing with a few people that would lay the basis for a lawsuit would be that Liz Fowler and CMMI have abused the discretion that was given
    to them by the section in the Affordable Care Act that created the Center for Medicare and Medicaid Innovation.

    Also a suggestion for those sharing on Facebook – instead of sharing directly from the post on the RNRH page, copy it into a fresh post on your own news feed or group that you’re sharing it to, because then you can bold or underline key words in the excerpt, like “without their knowledge,” “against their will” and “force.”
    Everyone listening to this program who is on social media should be sharing it to as many outlets as possible. If we lose trad. Medicare to corporate insurance, we will probably never get it back.

  20. Jason says:

    P.S. If everyone listening to this could post a link to it on in the comment section of their posts, it would get more attention. Be sure to include some excerpt or explanatory content of your own, otherwise it might be flagged as spam.

  21. Karen Barry says:

    I chose a Medicare Advantage Provider because it included vision and Dental which traditional Medicare does not offer…I was forced into taking Medicare as i received a letter telling me i was enrolled and if I didnt choose a plan one would be chosen for me… but i could get “Extra Help” paying my premiums for part b and part d of my Medicare plan…i applied and was approved for both…received a letter stating my premiums would be paid by Medicaid under the low income beneficiary plan…i have yet to receive those benefits.. it has been almost a year…the letter stated that any premiums taken out of my social security checks would be reimbursed up to 3 months…if by then i hadnt received the benefits to contact them….im up to almost $2000 in out of pocket premiums. Plus medical bills that medicaid would have covered had i received the benefit. Before i was forced to take Medicare my medications were free and so was my healthcare through a low income clinic in my county.. and i was making more than what disability pays..once my premiums are paid im left with $700 a month to live off of….and Aetna only pays a small portion of my dr.bills and every procedure has to be pre… aporoved…i was better off without Medicare …when i enrolled the advocate who helped me quoted one thing and then once i spplied for this insurance it was totally different…my medications are on the formulary list but i pay $4 for each one except my inhalers i pay $10 for each one .my meds alone are around $100 a month. .i dont see where the advantage is…no one can seem to tell me why im not getting the extra help from medicaid .. so having medicare is costing me a fortune and leaves me nothing to survive off of…every month im deeper in debt.. ive called and asked for help explaining how Medicare works and why am i forced to take it…if you dont enroll when you are supposed to you are penalized for every year that you arent enrolled.. even if you sre covered by orivate insurance at the time of enrollment… so you are forced to take it . Even if you dont need it.. and have no choice in paying the premium because it comes directly out of your social security check. I could tell so much more but won’t. Would like to get in on that class action lawsuift though if it comes to fruition…some changes really need to be made…my brother had Medicare and Medicaid and always got healthcare when needed and his medications were a flat $4 a month…this was way before obamacare… .