Health insurance functions primarily as a money-making system with intricate parts and conflicting interests. The confusion within the system often appears natural, yet it is deliberately manufactured. Each frustrating moment on hold and denied claim serves to disempower and keep you spending.
The worst part of this cycle is that your money flows back into a broken system that perpetuates poverty and illness. While it’s not a conspiracy with executives deciding fate, the issue is systemic, rooted in financial incentives overriding healthcare principles.
The Reality of Health Insurance
Health insurance is meant to act as a safety net. You contribute while healthy, hoping it supports you during illness. However, the reality experienced by many reveals the system’s business-like nature. Its main goals are risk management, expenditure control, and generating returns.
Your challenge as a patient is navigating this complex machinery amidst health crises. Misaligned incentives lead to undesirable outcomes, not bad people. Financial performance rewarded at the executive level, hospital margin protection, and physician pressure for high patient volumes prioritize profit over health.
The Economics at Play
The economics behind healthcare are significant. KFF notes the Affordable Care Act requires insurers in large-group markets to spend a minimum of 85 percent of premiums on medical care and quality improvement. Yet, the driving incentive is managing the massive healthcare spending pool.
Employer-sponsored family coverage nearly reached $27,000 in 2025 with workers contributing approximately $6,850. Meanwhile, about 100 million American adults hold medical or dental debt.
Healthcare costs are increasingly prohibitive, making you hesitate to utilize coverage due to financial fear. This leads to a healthcare environment with mounting bureaucracy, reduced doctor-patient interaction, and staff burnout. Prior authorizations cost an average of 13 hours weekly for physicians and staff.
The Wider Impact
The consequences of this system extend beyond healthcare facilities to workplaces, finances, productivity, and national competitiveness. Decisions made by parents and workers regarding medical treatment affect not just individual circumstances but society as a whole.
Continuing to support a healthcare economy driven by complexity profits will expand these issues. Instead, the focus should be on an efficient and health-boosting system where financial barriers do not prevent access to deserved help.
The Call for Transparency
Transparency is crucial in improving the healthcare system. It should involve insurers and providers making negotiated rates, reimbursement structures, and billing procedures accessible and understandable.
Employers need a clearer view of healthcare expenditures. Patients should question costs before facing the bill. While transparency alone won’t solve American healthcare’s complexities, it’s a vital first step toward enabling informed decisions and demanding better systems.
The future system should prioritize patient health and alleviate financial stress, setting a standard that provides deserved medical care.
Joshua Resnikoff is the founder of Sunstone Health, an AI-powered precision health platform aimed at reducing diagnostic time for genetic conditions. The views expressed in this article are his own.