The American health care system is facing mounting criticism from patients, providers, and experts alike, with many asserting that it fails to deliver the care that individuals deserve. As costs soar and accessibility issues persist, the public’s frustration is palpable. A recent survey reveals that nearly half of insured adults are concerned about affording their monthly health insurance premiums, highlighting a widespread crisis in affordability.
In a separate survey conducted by the Kaiser Family Foundation (KFF) in 2023, nearly one in five adults reported experiencing denied claims within the past year. This trend has raised significant alarm among advocates and patients who feel marginalized by a system that often prioritizes profit over care. The case of Michael Hinton exemplifies this struggle; he sought assistance from the Patient Advocate Foundation after his insurance denied coverage for critical surgery not once, but twice.
As the landscape continues to shift, companies like UnitedHealth Group find themselves in a precarious position. The organization has requested dismissal from a lawsuit, arguing that patients did not exhaust Medicare’s appeals process for denied claims. Meanwhile, they grapple with the fallout from a significant ransomware attack earlier this year that impacted Change Healthcare, a subsidiary that processes medical claims.
The disparity between spending and outcomes in the U.S. health care system is stark. Despite Americans spending more on health care than any other nation—yet achieving the lowest life expectancy among wealthy countries—the need for reform has never been clearer. Over the past five years, government data indicates a consistent increase in spending on insurance premiums, out-of-pocket co-payments, pharmaceuticals, and hospital services.
Many experts argue that transparency is essential to remedy the current discontent. The Trump administration previously issued rules requiring most employer-based health plans and individual issuers to disclose pricing and cost-sharing information. However, critics suggest that while transparency is necessary, blaming patients for the lack of clarity is not a viable solution.
“There might be fresh pressure for denial rates to be put out. I’d like for insurers and Medicare to be transparent about their denial rates,” – Parente.
The struggle for fairness and access in health care resonates strongly among patients. Caitlin Donovan, senior director of the Patient Advocate Foundation, emphasized the urgent need for a system that aligns with patient interests rather than corporate profits.
“People just want the system to be fair,” Donovan said. “They want to pay a reasonable amount and have their health care covered, and they want to be able to access what their trusted provider is prescribing them.”
However, opinions diverge regarding the role of insurers in managing claims. Some argue that if insurers were to approve every claim received, premiums would likely increase significantly.
“If you want to keep premiums reasonable, you do need the insurer to police some of the claims being filed,” Saltzman said.
The ongoing consolidation of health care providers into larger networks raises further concerns about accessibility and costs. Advocates argue that governmental scrutiny of this consolidation could help alleviate some of the barriers patients face when seeking care.
Moreover, public sentiment surrounding insurance practices continues to shift. Many individuals express disbelief over the treatment they receive from insurers. An anonymous Instagram user succinctly captured this frustration:
“Sorry but with the way they be denying coverage for everyday patients… no comment.”
As the conversations surrounding these issues grow more intense, it appears that many Americans feel a profound sense of injustice regarding how their health care is managed. They seek a transformation in the system—one where they are not just another number but valued as individuals deserving of fair treatment.
“I find it so disturbing and sad. It’s just unbelievable,” Hinton expressed, reflecting on his own experiences navigating the complexities of health insurance. “There are other methods of change—and that could look like trying to be your own advocate.”
