When the CEOs of UnitedHealth, CVS, Cigna, and Elevance appeared before Congress, they weren’t just summoned to account for high premiums, hidden prices, and claim denials. They were expected to account for the entire system that perpetuates them.
The reality is that the system in place is a system designed and inherited by myriad stakeholders. It’s impossibly complex. But fixing it doesn’t have to be.
The truth is, America’s employer-based insurance model isn’t broken — it’s working exactly as it was designed to. Denials and delays aren’t glitches. In this model, they’re features. A byproduct of a system built to manage costs by putting up barriers.
But that foundation is cracking. And employers are starting to look for a better way.
The consequences of the broken system are visible everywhere. Physicians spend hours each week navigating insurer approval processes, while patients wait weeks for treatments that may ultimately be denied. This year, employers faced premium increases approaching 10%, the steepest in 15 years, with average family coverage already nearing $25,500. As more cost gets passed on to employees, they increasingly forego care. In fact, nearly 40% of insured adults report delaying treatment due to cost, and when care is skipped, conditions get worse. The pattern of rising costs continues, yet insurers operating within the bounds of the broken system have little choice but to respond with more of the same ineffective barriers rather than addressing the root problems.
When insurers dictate what constitutes “necessary” care, physicians lose autonomy and patients lose access. Prior authorization is a striking example: doctors order needed procedures, then confront administrative hurdles that delay or block care. Narrow networks further limit options, steering patients based on contracts rather than quality. These policies don’t reduce spending in the long run. They shift costs downstream. A colonoscopy postponed today can mean a stage-three cancer diagnosis tomorrow — far more costly to treat.
The deeper issue is structural: insurers have inserted themselves between doctors and patients while obscuring true prices. Real reform should focus on restoring that partnership, with decisions guided by transparent data on cost and quality rather than insurer dictates.
We know transparency can work. In every other sector, informed consumers drive value. Healthcare should be no different. Americans make their own decisions about their families, their finances, and their careers. They are not only capable of making their own healthcare decisions, they’re the best people to do so. A colonoscopy performed in a hospital can cost several times more than the identical procedure in an outpatient setting. When patients see and understand those differences — and are empowered and incentivized to act on them — they consistently choose higher-value options. Similar dynamics apply across services, from lab tests to prescription drugs.
Transparency must extend beyond pricing to include quality. Hospitals and physician groups should be able to showcase outcomes in cardiology, oncology, and other specialties, competing on cost and quality — just like virtually every other product or service sold. This approach would reward providers for excellence, help patients make informed choices, and allow employers to purchase coverage that produces measurable value.
The administrative burden on physicians also deserves urgent attention. Doctors spend, on average, 13 hours per week dealing with prior authorizations. Streamlining or eliminating these requirements would free that time for patient care, strengthen the physician-patient relationship, and reduce costly delays.
Employers are signaling their frustration: 60% say they expect to consider replacing their insurer or pharmacy-benefit manager in the coming years. Decades of cost-shifting have not solved the problem. What’s needed is not another patch, but a fundamental redesign that expands access, aligns incentives around value, and makes both cost and quality visible before care is delivered.
Legacy payers have had decades to readjust their approach. Costs continue to climb, patients still face denials, and physicians remain mired in bureaucracy. It’s time to replace a system built on restrictions with one built on trust — trust in clinicians to practice medicine and in patients to make informed choices.
Only by restoring that foundation can we create a healthcare market that drives better outcomes, rewards quality, reduces waste, and delivers sustainable value for employers and families alike.
Photo: zhaojiankang, Getty Images
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