The Problem with Our Healthcare System: Profit Over Patients
The U.S. healthcare system is facing a profound crisis, driven not by a lack of medical advancements or professional expertise, but by a profit-centered model that prioritizes financial gain over patient well-being. At the heart of this issue lies the intricate web of insurance companies and pharmacy benefit managers (PBMs), whose influence has reshaped the healthcare landscape into a system that perpetuates chronic illness rather than addressing its root causes.
A System Built for Profit
In the 1930s, health insurance began as a mechanism to provide consistent access to preventive care. By the 1980s, however, the rise of health maintenance organizations (HMOs) transformed it into a profit-driven industry. Today, insurance companies focus on maximizing revenue rather than ensuring quality care. They achieve this by delaying or denying treatments, reducing reimbursement rates for doctors, and creating convoluted pathways that prioritize profitability over timely medical intervention.
One key example is the role of PBMs. Originally designed to negotiate lower drug prices for consumers, these entities have evolved into profit centers for insurance companies. PBMs inflate drug prices through kickbacks and rebates, leaving patients to bear the financial burden. For instance, they receive substantial payments from pharmaceutical companies in exchange for placing high-cost drugs on preferred formularies, even if cheaper and equally effective alternatives exist. The result is a system where 30% of the cost of some medications, such as Ozempic, is attributed to PBM kickbacks.
Chronic Disease as a Revenue Stream
The U.S. spends more on healthcare than any other country, yet its outcomes rank among the worst in the developed world. This paradox is rooted in a system that monetizes chronic disease. Insurance companies profit from managing long-term conditions like diabetes, obesity, and hypertension through a continuous prescription of medications rather than preventive or curative measures.
For example, comprehensive bloodwork—which could identify chronic conditions in their early stages—is often not covered by insurance. Instead, patients are funneled into a cycle of medication and delayed care, ensuring that their illnesses progress to stages requiring expensive, ongoing treatment. This approach guarantees a steady stream of revenue for insurers while patients face deteriorating health and escalating medical bills.
The Impact on Physicians and Patients
The pressure to maximize profits extends to clinicians, who are increasingly forced into systems controlled by insurance companies. Independent practices are rare, with many primary care doctors now employed by hospital systems that adhere to insurer protocols. These physicians face reduced reimbursement rates and limited autonomy, often spending as little as six minutes per patient—an insufficient amount of time to address complex health issues.
Patients, meanwhile, are left navigating a labyrinthine system. Delays in approvals for essential procedures, inflated costs for drugs, and restrictions on accessing preferred providers all contribute to a sense of helplessness and frustration. These systemic barriers disproportionately affect vulnerable populations, leading to increased rates of medical bankruptcy and poorer health outcomes.
Toward a Solution
Reforming the U.S. healthcare system requires dismantling the financial incentives that prioritize illness over wellness. Eliminating PBMs would be a critical first step, reducing unnecessary costs and refocusing care on patient outcomes. Moreover, shifting toward proactive, preventive healthcare models—such as comprehensive bloodwork and lifestyle interventions—could significantly reduce the prevalence of chronic diseases.
The path forward also involves empowering patients to take control of their health through transparent pricing and direct care models. By removing unnecessary middlemen, patients can access care that prioritizes their well-being over corporate profits.
Conclusion
The current healthcare system in the U.S. has been captured by corporate interests, leaving patients and providers trapped in a cycle of inefficiency and exploitation. To restore trust and efficacy, we must reimagine healthcare as a system that values human lives over quarterly earnings. Only by addressing these structural flaws can we build a healthier, more equitable future for all Americans.