Medicare Advantage now covers more than half of all Medicare beneficiaries, roughly 35 million seniors enrolled in privately managed plans that most people assume have always worked this way. They have not. This week I am walking through the full arc of Medicare Advantage: how it started, what it became, what is now structurally broken, and what Congress can do about it. Medicare Advantage began as Medicare+Choice under the Balanced Budget Act of 1997, then was rebranded and substantially reworked as Medicare Advantage under the Medicare Modernization Act of 2003. The original pitch was straightforward. Private plans competing for seniors would deliver care more efficiently than fee for service Medicare and pass the savings back to the program and to taxpayers. That promise has not held. The Congressional Budget Office now estimates Medicare Advantage overpayments will total roughly $1 trillion over the next decade. The Medicare Payment Advisory Commission puts 2026 overpayments at $76 billion, or 14 percent more than the same beneficiaries would have cost in traditional Medicare. Those numbers shape the budget neutrality fights that suppress the physician fee schedule every year, and they help finance the vertical integration that is squeezing independent practices out of local markets. This week: Tuesday covers the legislative origins and the design choices baked in from day one. Wednesday covers what the program actually became, from risk adjustment gaming to star rating bonuses to insurer owned physician networks. Thursday covers the full set of structural problems. Friday is Fix It Friday, with the legislative vehicles already in front of Congress that would address each of these problems directly. Independent practices fail because the underlying payment architecture rewards scale, consolidation, and coding intensity over clinical judgment. Medicare Advantage is one of the clearest examples of that dynamic.