Opinion | Big Medicine profits by denying care your doctor ordered. My father paid the price.

The American health care system is failing patients through a bureaucratic process known as prior authorization. This procedure requires insurance approval before a doctor can deliver specific care. In practice, large insurance companies now utilize this mechanism as a corporate veto over medical judgment. The profit motive is clear. Insurers frequently own the companies that adjudicate these requests. They face a financial incentive to deny care, even when physicians have prescribed it as medically necessary.

My family experienced this firsthand when UnitedHealthcare denied rehab for my father following his leg amputation. Despite having a team of hospital experts and my own background in health policy, we could not navigate the maze of paperwork. The system is designed to wear people down. My father eventually gave up the fight to preserve his remaining energy for cancer treatment. He passed away this February without ever receiving the prosthetic leg he needed. This is not an isolated incident. More than one in four physicians report that prior authorization has led to serious adverse events for their patients.

Publicly operated Medicare manages requests sparingly, whereas private Medicare Advantage plans adjudicate millions of determinations annually. Despite these barriers, Medicare Advantage plans cost taxpayers 22 percent more than traditional Medicare. The administrative burden is massive. Prior authorization consumes the time of nearly 100,000 full-time clinicians every year, worsening the national physician shortage. We are burning our medical workforce on paperwork intended to block access.

Washington must stop relying on voluntary pledges that do not address the core problem. The conflict of interest is structural. We need Congress to prohibit insurance conglomerates from owning the companies that adjudicate their authorization requests. Independent third parties should handle the rare cases where approval is actually necessary, and AI-based denials must be banned. No company should profit by blocking the care that doctors order for their patients.