The idea behind Medicare Advantage was simple: Pay private insurance companies to enroll elderly patients instead of forcing those over 65 to use traditional government-run Medicare. The competition between insurance companies would incentivize them to lower their premiums and offer more benefits to attract customers, saving taxpayers billions of dollars and allowing them more freedom to choose their own health insurance.

Instead, deceptive practices by the insurance industry have turned Medicare Advantage into a cash cow that costs taxpayers 22% more than traditional Medicare (an extra $83 billion per year).

Once insurance companies receive their federal subsidies, they use a tactic called “favorable selection” to seek out customers they know are unlikely to use up the entire subsidy. Then, large chunks of the expense come from “upcoding” — insurers’ tendency to exaggerate how sick their patients are to bill the government extra money.

The Committee for a Responsible Federal Budget has estimated taxpayers will spend $1 to $1.4 trillion on upcoding and favorable selection from 2024 to 2033. That’s up to $140 billion per year. There are only six federal agencies that spend that much in their entire annual budget.