As health insurers have consolidated and tightened their grip on the U.S. health care system – and in particular on physician practices – doctors increasingly have to spend their days battling red tape, fighting with insurers, and watching their reimbursements shrink while their operating expenses increase every year. Doctors who are determined to resist being bought by an insurer or large hospital system are finding it harder and harder to do so without outside investment.
I frequently speak at physician conferences and I repeatedly hear doctors’ concern that private sources of capital are being blamed for the dysfunction in the health care system, deflecting attention away from the harm being done to their patients by the business structure and practices of health insurance conglomerates.
UnitedHealth, Cigna, CVS/Aetna, and Elevance have quietly built vertically integrated empires. They don’t just sell insurance. They own pharmacy benefit managers (PBMs), physician practices, urgent care chains, and data clearinghouses. UnitedHealth’s Optum unit controls one of the largest networks of doctors in the country. CVS Health has combined its insurance arm – Aetna – with retail pharmacies, PBMs, and growing numbers of clinics.
This is consolidation on a massive scale—far beyond what any physician group could achieve on its own. It is consolidation that directly reduces competition, drives up premiums, and limits patient choice.
Take what came to be called “surprise billing.” The real surprise for many patients isn’t that a doctor billed too much. Rather, their insurance company dropped that doctor from its provider network or narrowed its network so severely that patients had no meaningful choice. Insurers then used the passage of the No Surprises Act as leverage to slash reimbursements further. Doctors are being strong-armed into take-it-or-leave-it contracts that make it impossible to keep their doors open.
Insurers turned a reform meant to protect patients into a tool to expand their own market power.
These dynamics are also fueling a crisis in the health care workforce. Physicians are burning out, retiring early, or discouraging the next generation from entering medicine. The reason isn’t “outside investment,” but crushing administrative burdens imposed by insurers, including endless prior authorizations, repeated denials, and opaque appeals processes.
Doctors are being forced to work longer hours for less pay, more time spent on paperwork and less time spent with patients. It’s no wonder the U.S. faces growing shortages across specialties. Insurer-driven bureaucracy is draining the lifeblood from the profession.
When insurers delay or deny care, patients suffer. Examples abound: a cancer diagnosis that’s missed because a scan wasn’t approved, a child who can’t see a specialist because the network is too “narrow,” a parent who’s forced to switch doctors mid-treatment because the insurer suddenly dropped the practice.
Such anecdotes are the inevitable outcome of a system in which insurers make money by saying “no.” Every denial, every delay, every hoop they make a doctor jump through saves them money and shifts the cost onto families.
Critics of private capital in health care often fail to acknowledge that independent physician practices that have access to the financial resources they need to stay in business and independent are often the ones best positioned to provide high-quality, patient-centered care.
What matters most is whether physicians retain the autonomy to make decisions in the best interest of their patients. Private capital, when structured with physician leadership, can preserve that autonomy and serve as a counterweight to hospital monopolies and insurance takeovers.
Meanwhile, the largest insurance companies have been reporting record profits. They have perfected the art of blaming everyone else—doctors, hospitals, even patients—for high costs. But it is their business model built on consolidation and denial of care that is driving the crisis.
It’s time to stop pretending that doctors and patients are the biggest problem. The obstacle to affordability and access are the business practices and structure of big insurance conglomerates. If the U.S. wants to preserve physician independence, protect patient choice, and make health care more affordable, it needs to rein in insurer abuses.
That means enforcing antitrust laws against vertical monopolies, holding insurers accountable when they flout the No Surprises Act to line their pockets, and streamlining prior authorization so doctors can spend more time with patients and less time on hold with insurance clerks.
Doctors should be free to focus on healing, not haggling. Patients should trust that their care decisions are made by physicians, not accountants in the insurance industry’s executive suites.
Until the U.S. faces the truth about who is controlling the health care system, it will continue to chase the wrong villains and the crisis for both doctors and patients will only deepen.
Wendell Potter is president of Center for Health and Democracy.
