The murder of UnitedHealthcare’s CEO has sent shockwaves through the health insurance industry. This tragedy raises many questions, especially since the suspect remains at large and the motive is unclear. However, the chilling words inscribed on the ammunition—“Delay, deny, defend”—suggest the possibility of deep dissatisfaction with the practices of the U.S. health insurance industry.
This dissatisfaction is not new. Many patients are unhappy with their health insurance, and they have good reason to be. Despite years of rising premiums, coverage and service quality have not improved proportionately. In fact, maintaining the same level of care often requires patients to pay higher co-pays and deductibles, while healthcare providers shoulder increasing administrative burdens to meet insurance requirements.
It’s common for patients to bring letters to their appointments informing providers that certain medications will no longer be covered. Providers then face the task of finding alternatives. Insurers argue that these alternatives are equivalent, but this is often not true—especially for medications like inhalers. I’ve seen many patients suffer from worsening breathing after switching to a new inhaler due to insurance changes.
When providers try to advocate for their patients and challenge insurance companies, they often encounter another hurdle: prior authorization. This process requires providers to submit additional documentation to justify the necessity of a specific medication or service. The irony is that the final decision isn’t made by the treating physician but by the insurance company, based on their internal guidelines.
These guidelines sometimes contradict well-established standard of care. For instance, I’ve had cases where an insurer denied a chest CT scan for my patient, insisting that a chest X-ray must be done first. Despite my clinical judgment that the X-ray would be useless, expose the patient to unnecessary radiation, and waste time and resources, the insurance wouldn’t approve the CT scan without it. This isn’t an isolated incident; such scenarios occur daily across the country.
The current health insurance model restricts access to necessary care, delays treatment, and imposes needless burdens on both patients and providers. It is time to reform the U.S. health insurance system.
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