By Allen Cooper, MD, Professor of Medicine, Emeritus

Medicare, created in 1965, revolutionized health care for the elderly and those with disabilities.    There has always been Republican opposition because it is “socialism.”  In 1997 what is now called Medicare Advantage paid private insurers per enrollee (capitation) for seniors who opted out of traditional Medicare, thus beginning privatization.

The Affordable Care Act established the Innovation center to new payment and service delivery models. Using this, the Trump administration created Direct Contracting Entities (DCEs). These provide capitation payments to groups of physicians and allow up to 40% for profit and administration compared to traditional Medicare’s 2-4% for administration!!! 

Private equity and insurers recruited medical groups to form DCE’s. The Biden administration rebranded the plans as Accountable Care Organizations Realizing Equity Access and Community Health (ACOREACH). Elizabeth Fowler who worked on the ACA and in the pharmaceutical industry was appointed to run this program. Her explicit goal is to privatize all of Medicare by 2030. 

When a patient’s physician becomes part of an ACOREACH capitation plan they must find a new primary care doctor who is not a member of the ACOREACH medical group if they want the flexibility of traditional Medicare. To increase profits the plans attempt to keep patient referrals in their network and minimize expense on medical care. 

ACOREACH groups in the Bay Area include all of Sutter Health’s 1,200 clinicians. San Francisco based One Medical now operates nationally. They went public under the name ILife. After becoming a DCE they were purchased by AMAZON! Privatization clearly puts profit over patient care.

Opposition to privatization has been led by Physicians for a National Health Program. Numerous political and union organizations have passed resolutions demanding an end to ACOREACH, including the San Francisco Democratic Central Coordinating Committee that unanimously passed such a resolution. Our group, the Movement to End Medicare Privatization is urging progressive leaders including Elizabeth Warren and Pramila Jayapal to speak out against this. To learn more about this see https://pnhp.org/direct-contracting-entities-handing-traditional-medicare-to-wall-street/.  My email is This email address is being protected from spambots. You need JavaScript enabled to view it. .