Only prescription is to remove insurers from the health care system

Re “How to provide Medicare for all” (Opinion, May 18): As Dr. Marcia Angell notes, the insurance industry profits by refusing to pay for needed care or else simply denying claims.

Insurers also have more insidious ways of turning a profit. One of these ways is to require time-consuming prior authorizations for certain services in apparent hopes that clinicians will be discouraged from trying to access those services.


In a study colleagues and I conducted, we found that emergency mental health care workers spent an average of one hour on the phone with insurers, obtaining permission to hospitalize suicidal youth. Given that authorization ultimately was granted in every single case, this is an administrative hassle whose sole purpose seems to be to dissuade clinicians from seeking care they deem necessary for their patients, even though every extra minute spent in an emergency room increases risk for both the patient and health care workers.

Another way insurers profit is by not maintaining accurate lists of providers who are in their network and accepting new patients. In a separate study, we used insurer databases of supposedly “in-network” providers and found that many practices were full and that the list was replete with wrong numbers. We were only able to secure appointments 26 percent of the time.

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Insurers have no incentive to ensure that people receive timely, needed care. As Angell so eloquently notes, they need to be removed from health care entirely and replaced by a not-for-profit system whose sole motivation is to get people the care they need.

Dr. J. Wesley Boyd


The writer is an associate professor of psychiatry at Harvard Medical School and a faculty member at the school’s Center for Bioethics.

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