More than half of all Medicare beneficiaries are now enrolled in Medicare Advantage.

That’s a significant shift—up from just 32% in 2015 to 54% in 2025.

And it didn’t happen by accident.

As I wrote two years ago in this piece on the “golden goose” of Medicare Advantage:

So how did we end up with over half of America’s seniors in Medicare Advantage plans—and what does that mean for the future of Medicare?

In this article, I’ll walk through how MA became the behemoth it is today, why it’s been such a financial windfall for insurers, and what needs to change to make the system more sustainable—for patients, providers, and taxpayers alike.

Medicare was born in 1965 when President Lyndon B. Johnson signed it into law, offering health insurance to seniors and people with disabilities. It was a beautiful law—older adults no longer had to drain their retirement savings just to afford hospital stays or doctor visits.

But the original Medicare program, built on a fee-for-service (FFS) model, came with its own set of problems:

When the federal government can’t run things efficiently, we call on the private sector.

In the 1980s, the federal government began looking for ways to improve Medicare’s efficiency and financial sustainability. The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 opened the door for private insurers to contract with Medicare and offer managed care plans—planting the seeds of what would become Medicare Advantage.

That experiment evolved through the decades. The Balanced Budget Act of 1997 formally created the “Medicare+Choice” program, which was later rebranded as Medicare Advantage under the Medicare Modernization Act of 2003.

The idea? Let private insurers offer Medicare coverage with added perks and coordinated care—ideally at a lower cost to the government. If done right, it was a win-win-win (triple win?):

Medicare Advantage now covers 54% of all Medicare beneficiaries—that’s 34 million people. Back in 2007, it was just 19%.

But in 2025, that growth is starting to slow down. Enrollment only increased by 1.3 million this year—a 4% bump. That’s still big, but it’s down from 7% the year before. The MA train is still moving, I’d say—but it’s not accelerating like it used to.

👉 Upgrade to Huddle+ to access the full Huddle #Trends article.

Hospitals don’t handle most of their supply negotiations. That job goes to Group Purchasing Organizations (GPOs)—middlemen that promise savings by pooling hospitals’ buying power. Sounds efficient, right?

What’s interesting is that GPOs aren’t paid by hospitals. They’re paid by the suppliers. In other words, the more money hospitals spend, the more GPOs make. And thanks to a little-known safe harbor in federal law, that setup is perfectly legal.

It’s a model that’s widely accepted—but rarely questioned. And it raises concerns that feel a lot like what we’ve seen with pharmacy benefit managers: vendor-funded entities shaping what gets used in patient care.

So are GPOs actually saving hospitals money—or are they quietly driving up costs behind the scenes?

👉 Read more details here.

We were trained to take care of patients. But no one ever taught us how the system actually works:

That’s why I built this course: How Healthcare Really Works.

It’s short, visual, and built for people like us — physicians trying to make sense of the business and policy forces shaping our day-to-day work.

👉 Enroll in the course here.

We keep saying AI will solve documentation burnout. But what if it’s just shifting the burden instead of lifting it?

AI-generated notes—especially ambient AI—are supposed to free us from hours of clicking, typing, and templating. And while the technology is getting better, most of it still needs us to proofread and clean up the mess. It’s like supervising a really fast, slightly unreliable med student. You still need to double-check everything.

Unless AI can hit Six Sigma levels of accuracy (3.4 errors per million), we may be introducing more liability, more inefficiency, and more burnout than we started with.

👉 Full breakdown in my latest Insights article here.