Rethinking Accountability in Health Insurance
Insurers Were Accountable – Picture this: You’re in a courtroom, and the defendant is a major insurance company. The charge? Denying a life-saving claim, leading to devastating health consequences. The prosecutor turns to the jury and declares, “They prioritized profits over lives.” It’s a striking thought, isn’t it?
It may sound extreme, but consider this: What if insurance companies were legally responsible for the outcomes of their decisions? When we visit a doctor, we expect accountability, expertise, and a commitment to our well-being. Shouldn’t insurers—who make critical choices about coverage—be held to the same standard?
When Physicians Lead the Decision-Making
Insurers Were Accountable: Now, let’s imagine an alternative system where claim decisions are made by experienced doctors—not by administrators focused on cost-cutting. A board of physicians, with firsthand patient-care experience, could ensure decisions prioritize health over profit. This shift could prevent situations where a patient is forced to fight for coverage for essential treatments, such as cancer therapy or a necessary surgical procedure.
Doctors already make life-or-death decisions daily. If they were also responsible for coverage determinations, patients might avoid unnecessary denials that jeopardize their health.
Incentivizing Healthier Choices
What if insurance plans rewarded individuals for proactive health choices? Imagine a system where maintaining preventive care—like annual check-ups or screenings—lowered your premiums. Meeting personal health goals, such as quitting smoking or improving fitness, could translate into reduced deductibles. Proactive care lowers costs in the long run, and insurance companies should recognize and support that.
Chronic conditions such as diabetes, heart disease, and cancer account for 90% of the $4.5 trillion the U.S. spends annually on health care. Early interventions could dramatically reduce these costs. What if your insurance statement celebrated your healthy choices by saying, “Your preventive care saved the system $12,430 this year”?
Breaking the Employer-Dependent Model
In the U.S., approximately 60% of people rely on employer-sponsored insurance. Losing a job often means losing health coverage, leaving many individuals vulnerable. This structure ties health security to employment, creating instability for countless families.
Many countries with universal health systems, such as Canada and the U.K., ensure access to health care regardless of employment status. While these systems have challenges, they remove financial barriers that prevent people from seeking timely care. It’s worth rethinking whether health care access should be contingent on a person’s job.
A Look at the Bigger Picture
Insurers Were Accountable: The health insurance system didn’t start this way. Employer-sponsored insurance became widespread during World War II, when companies used health benefits to attract workers amid wage freezes. Over time, a temporary fix turned into a deeply entrenched system. Today, despite efforts like the Affordable Care Act (ACA) to reform coverage, we still see insurance companies reporting billions in profits while medical debt remains the leading cause of bankruptcy in the U.S.
In 2023, health insurance companies made $88 billion in profits. Meanwhile, countless patients faced financial ruin due to medical expenses. This contradiction raises an essential question: Should a system designed to support health care be so heavily profit-driven?
Advocating for Change
Health care reform isn’t just an abstract policy debate—it’s a moral imperative. A system that prioritizes patient well-being over corporate profits is within reach, but it requires collective action. Advocacy efforts must push for greater insurer accountability, physician-led decision-making, and patient-centered incentives.
As the late Senator John Lewis once said, “Never, ever be afraid to make some noise and get in good trouble, necessary trouble.” It’s time to challenge the status quo and demand a system that works for patients, not just for insurance companies.
Join the Movement
Stanford Physician Advocate is committed to reshaping health care policy and championing patient-centered reforms. Visit StanfordPhysicianAdvocate.org to learn how you can contribute to the conversation, support advocacy efforts, and stay informed on the latest in health policy.
For further reading on health care advocacy and reform, check out these resources:
Change starts with awareness and action—let’s work together toward a more just health care system.