America’s health care debate has often been conceived as an ideological battle between government and so-called free enterprise. And, superficially at least, it’s easy to see why. Critics of the current model, for one thing, do tend to envision a larger role for the state in the provision of health care. The decades-long campaign against a universal and public model, meanwhile, has regularly framed the question as one of personal liberty: pitching the market as an institution better suited to protect patient choice and save taxpayers from having to fund more cumbersome government bureaucracy.

“Personal freedom vs. costly government bureaucracy”, it should be said, is a rhetorically effective framing — among the many reasons that America’s sprawling, private health insurance racket has been able to beat back so many attempts at reform. Spend any real time investigating what the landscape of American health care looks like, however, and you’ll quickly see that it’s bunk: the market model is in fact a complicated and at times totally inscrutable morass of profit-seeking, underwritten, no less, by the very public dollars its proponents claim to be saving.

It’s a point made forcefully by author and reform advocate Wendell Potter in a series of recent posts on his Substack detailing the profit breakdowns of insurance giants like UnitedHealth and Anthem. Potter, himself a former executive at Cigna turned whistleblower, notes that UnitedHealth boasted more profits last year than any health insurer has ever made for its shareholders — citing a chirpy company release that also boasted of 10.5 million new “members” using its health plans since 2011.

Beneath these profits and this growth, however, Potter reveals an altogether murkier and less sunny picture of how UnitedHealth’s business model actually works. The company, it turns out, is actually insuring over a million fewer people through its commercial risk division (through which it is itself the direct provider) than it did in 2011. The number of plans it now administers on behalf of employers and other groups, however, has surged over the past decade. As Potter explains:

United and its competitors do not insure people enrolled in these group plans. They make money by charging their employer (and in some cases union) customers (who are the actual insurers) a hefty fee to administer their workers’ health plan benefits.

The kicker is that 94 percent of the company’s total membership growth since 2011 has actually come through government programs. The upshot?

When you do just a little more math, you’ll discover that 72 percent of the $222.9 billion in revenue United’s health plan division took in last year came from you and me through the taxes we fork over to our Uncle Sam and the additional premiums many Medicare beneficiaries pay the company to cover their out-of-pocket expenses. Considering all of that, it’s neither accurate nor appropriate to refer to United and its peers as insurers, or, for that matter, as “payers” (except in the sense that they use our employers’ and our Uncle Sam’s money to pay doctors and hospitals for treating us).

In short, ordinary Americans are underwriting the health insurance industry’s growing profits, all while paying far more for their plans than they used to. It’s yet another reminder that what is generally called America’s “health care system” is in practice a series of elaborate mechanisms for transferring money upward to shareholders — and for ensuring that a basic human need remains subordinate to private profit.