From 2013 to 2023, Medicare spending in the United States nearly doubled. During that same decade, UnitedHealth Group’s earnings per share rose almost fivefold. As a for-profit company, it is understandable that its goal is to maximize revenue. But to achieve this, much of the health insurance industry has followed a familiar playbook—one that too often comes at the expense of patients and providers. Under the banner of “protecting patients from unnecessary treatment,” insurers have restricted access to medications, created layers of administrative barriers, and denied essential services based on internal policies that few outside the company truly understand.
One of the most common tactics is the push toward generic medications. Insurance companies often emphasize that generics are FDA-approved and equivalent to brand-name drugs. On paper, that’s true—but in real life, it doesn’t always work out that way. Many patients who were switched from one blood pressure medication to another because of coverage changes notice their blood pressure becomes unstable afterward. They end up scheduling additional doctor visits and lab tests just to regain control.
A similar issue arises with inhalers for asthma and COPD. Insurers frequently assume that inhalers in the same drug class are interchangeable, overlooking the fact that inhaler devices differ widely in design and ease of use. For many patients, switching inhalers isn’t just a minor adjustment—it directly affects how well the medication reaches their lungs and how consistently they use it. When an inhaler is not on the “preferred” list, the out-of-pocket cost can reach several hundred dollars a month, which is unaffordable for most people. Without access to the right inhaler, patients simply can’t breathe well. Many eventually end up in the emergency room, an outcome that is both more dangerous and far more expensive.
Then there’s prior authorization. On paper, it sounds reasonable—a safeguard to ensure treatments are appropriate before approval. In practice, though, it has become an obstacle course for both doctors and patients. Over the years, prior authorization has expanded from high-cost drugs and procedures to include even basic tests and inexpensive medications. It wastes time, delays care, and frustrates everyone involved. Physicians are often required to justify their decisions to insurance “medical directors” who may not even work in the same specialty—a urologist denying a chest CT, for instance. The denial letters that follow are filled with vague, robotic language that feels detached from real patient care.
When these decisions are questioned, insurers often claim that providers can appeal. In reality, clinicians are already overwhelmed with full schedules and cannot spend hours on hold or arguing with automated systems. While insurers tout “efficiency,” patients are the ones who pay the price—literally and figuratively.
Healthcare isn’t supposed to work like this. It’s not a business transaction—it’s about people trying to get well and the professionals trying to help them. Yet the widening gap between insurance company profits and patient access shows how far we’ve drifted from that basic principle. The system desperately needs reform—not just to control costs, but to restore compassion, trust, and common sense to healthcare. Until that happens, patients and providers will keep navigating the same red tape, hoping for a future where care once again comes before profit.
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