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.