Illness is inevitable, and medical care can be expensive. The U.S. is the only developed nation without some form of universal health care. Instead, it relies on a for-profit system in which insurance companies often seek ways to reduce costs, sometimes by delaying or denying coverage for services. These delays can include requirements such as prior authorization or peer-to-peer reviews for standard, guideline-directed treatments. This process takes up health care providers’ time and diverts their attention from patient care. Meanwhile, many people (particularly those in low-income jobs without benefits) lack any health insurance coverage.
Former congressman and current Idaho attorney general Raul Labrador once said that “no one dies for lack of insurance.” In reality, access to guaranteed health care in the U.S. is largely limited to emergency treatment under EMTALA, which requires hospitals to provide emergency care but does not cover ongoing treatment for chronic illnesses. As a result, uninsured individuals often rely on the charity of hospitals and providers. Over time, this can lead to financial strain and even bankruptcy for those institutions, reducing access to local health care when facilities close. Shifting the costs of uninsured care to insured patients also contributes to rising health care expenses.
Insurance (whether health, home, or auto) works by pooling risk. Many policyholders who never file a claim help cover the costs for those who do. In health insurance, younger and healthier individuals help offset the expenses of those with greater medical needs. If only people who are already sick carry insurance, the system becomes unsustainable. The original intent of the Affordable Care Act (ACA) was to ensure that every American had coverage, including preventive care, while preventing insurers from denying coverage for pre-existing conditions. However, changes that reduced penalties for remaining uninsured weakened this risk-sharing principle. Even so, the ACA expanded coverage to about 20 million previously uninsured Americans and improved outcomes for chronic diseases such as cancer and diabetes.
Ultimately, reducing the profit motive in health care (or at least ensuring that every American has comprehensive health insurance) would help sustain hospitals and improve access to care nationwide.
Banu Symington is a hematology-oncology physician.
