American healthcare has been under scrutiny for years, with patients and medical professionals criticizing the system for its inefficiency and overwhelming profit-driven motives. Recently, healthcare professionals have publicly spoken out about the extreme delays and denials caused by private health insurers, accusing companies like UnitedHealthcare of prioritizing their profits over the health and well-being of patients. As the system continues to evolve, many argue that this situation is not only frustrating but dangerous — potentially resulting in life-threatening consequences for individuals who fail to receive timely and necessary care.
The healthcare system in the United States is one of the most expensive in the world, with Americans spending a staggering $4.9 trillion on healthcare in 2023 alone. Despite this, the U.S. has the worst health outcomes in comparison to other industrialized countries, a stark paradox that has led to public outcry. Doctors are increasingly finding themselves stuck in a “vicious circle,” where rising healthcare costs, a lack of regulation, and insurance companies holding significant leverage over patients’ care, make delivering medical treatment increasingly difficult.
The Case Against United Healthcare
One of the most alarming stories to surface in recent weeks is that of a patient whose life was severely impacted by a delayed medical procedure. Dr. Cheryl Kunis, a nephrologist in New York City, described the ordeal of one of her patients who needed a PET scan to determine whether a tumor had spread. Kunis and the surgeon agreed that the scan was essential to decide the proper course of action for the patient’s treatment. However, despite their repeated attempts to secure approval from UnitedHealthcare, the scan was initially denied. Even after months of efforts, the scan was approved only after six months — by that time, it was too late. The patient had passed away.
“There’s no way of proving it, but there was a reasonable chance he would have been in better shape had there not been a six-month delay,” Kunis said, reflecting on the missed opportunity for earlier diagnosis and intervention. For her, this example serves as a clear demonstration of how the insurance system’s refusal to authorize care could lead to fatal consequences.
The Strain on Doctors
Many doctors are expressing similar frustrations with the insurance industry’s interference in their patients’ care. The system often forces doctors into the position of acting as “insurance experts” rather than focusing on the medical needs of their patients. Dr. Philip Verhoef, an ICU physician from Honolulu, Hawaii, shared his experience of dealing with insurance company representatives who challenge the medical decisions he makes regarding ICU admissions. According to Verhoef, the representatives are often not physicians and do not possess the necessary expertise to evaluate complex medical conditions.
In some cases, insurance companies may deny coverage for basic medications that could prevent life-threatening conditions. Verhoef cited examples of patients suffering due to the refusal of insurance companies to cover vital treatments, such as insulin for diabetes or inhalers for asthma. He also pointed out that insurance companies tend to reject coverage for preventative care, which results in individuals being admitted to intensive care units with preventable illnesses, further exacerbating the burden on the healthcare system.
Profit Motives Over Patient Care
Doctors, like Dr. Ed Weisbart, a former chief medical officer for Express Scripts, argue that these delays and denials are not merely unfortunate accidents, but are part of a deliberate strategy by insurance companies to maximize their profits. Weisbart points out that insurance companies thrive on reducing payouts for medical care, making decisions based on financial considerations rather than the health of their clients. In this system, insurers benefit from delays and denials, as they retain more money, leaving patients to suffer or face worse outcomes.
“There’s good evidence that these kinds of delays literally kill people,” Weisbart said. “For some people, this isn’t just an inconvenience and an annoyance and an aggravation. It’s a death sentence, and the only reason the insurance companies do that is to maximize their profits.”
Indeed, the practice of insurance companies delaying or denying care has become a widely acknowledged problem, with multiple reports indicating that the current system places profit over patient health. Weisbart believes that this culture of denial and delay is deeply ingrained in the business model of health insurance companies and is likely to continue unless radical changes are made.
A Call for Systemic Reform
Physicians agree that the current healthcare system in the United States is broken, and the only solution may be a complete overhaul of the way healthcare is structured. While private insurance companies continue to profit, patients, doctors, and healthcare providers struggle with increasing costs, bureaucracy, and the denial of essential care. Many doctors, including Weisbart and Verhoef, argue that the U.S. should move toward a single-payer, universal healthcare system, similar to those in other developed countries.
“The solution is effectively to overhaul the system entirely and then start from scratch with the national health insurance system,” Verhoef stated. “Solutions that depend on trying to regulate the private insurance industry are simply going to fail.”
Supporters of a single-payer system argue that it would reduce overall healthcare costs while providing comprehensive coverage to all citizens. Research shows that a single-payer system could cost the country less than its current private insurance-based system and would likely save thousands of lives each year. A shift to a single-payer system would eliminate the need for private insurers to focus on profits and allow doctors to focus more on providing necessary care without the interference of bureaucratic hurdles.
The Need for a Patient-Centered Approach
In a system where insurance companies hold the power to decide what care is covered and what is not, patients are at the mercy of the industry’s profit-driven motives. Doctors and medical professionals who are trying to provide the best possible care for their patients are frustrated by the constant battle with insurance companies to approve essential treatments. The system seems to be working more for the benefit of the insurance industry than for the patients they are meant to serve.
As Dr. Cheryl Kunis poignantly stated, “The healthcare system is just really stuck in this terrible, vicious circle, of prices constantly going up, lack of regulation, and the insurance companies unfortunately having leverage over the patients who are trying to receive the care.” This cycle shows no signs of letting up, and unless meaningful reforms are implemented, the American healthcare system will continue to fail the very people it is supposed to serve.
In conclusion, the failures of the U.S. healthcare system, especially regarding private insurance companies, are becoming increasingly apparent. Patients are dying because of delays in essential care, and doctors are left frustrated and powerless as they battle the bureaucracy of insurance companies. The healthcare system, as it stands, is failing both healthcare professionals and the patients they serve. A new approach is urgently needed, one that prioritizes patients’ health over corporate profits and ensures that everyone has access to the care they need when they need it.