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By Joshua Resnikoff
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Health insurance is a system designed to make money.
The system, they’ll tell us, is full of moving parts and competing interests, and confusion is just the natural residue of a system that size.
They’re not entirely wrong. But the underlying mechanism is that the confusion we see is manufactured. Every hour we spend on hold, every denied claim we have to appeal, it all serves a purpose.
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Confusion keeps us powerless and unable to act. That frustration wears us down and keeps us paying.
The worst part? Our money goes back into the broken system that's keeping us poor and sick.
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I know it sounds cynical, and I’m not saying there is a room full of executives deciding which patients live or die. The problem is more ordinary, and therefore more difficult to fix.
We built a system around financial incentives, gave those incentives enormous power, and then acted surprised when they began dictating how healthcare works.
We like to imagine health insurance as a safety net. We pay into it while we are healthy, expecting it to catch us when we are sick.
But unfortunately, far too many of us have experienced the truth.
The Model
The American healthcare and insurance system we have today is, at its core, a business.
Its responsibility is to manage risk, control expenditure and generate returns.
Our responsibility, as the patient, is somehow to navigate the machinery while we’re sick, frightened, exhausted, or sitting beside a sick child.
That distinction changes everything.
The system does not need bad people to produce bad outcomes. It only needs misaligned incentives.
An executive is rewarded for financial performance. A hospital has to protect its margins. A physician is pushed to increase patient volume.
Each decision can appear rational on its own while collectively creating a system that rewards financial outcomes more reliably than it rewards health.
The Economics
Consider the economics. KFF cites that the Affordable Care Act requires insurers in the large-group market to spend at least 85 percent of premium dollars on medical care and quality improvement.
Yet the fundamental incentive remains to manage the enormous pool of healthcare spending flowing through the system.
If the pie grows, the dollars attached to that percentage grow with it.
And Americans are paying plenty. Reuters reported that employer-sponsored family coverage reached nearly $27,000 a year in 2025, with workers contributing an average of $6,850 toward premiums.
Meanwhile, 100 million American adults report current medical or dental debt, according to Forbes. The cost of staying insured is rising alongside the cost of actually using the insurance.
In essence, we’ve created a strange proposition. Pay thousands of dollars for access to healthcare, then hesitate to use it because we’re afraid of the bill.
This is what happens when healthcare becomes a conveyor belt of medical red tape. Doctors are pushed to see more patients, staff burn out, and patients receive less time and more bureaucracy.
Prior authorization alone consumes an average of 13 hours of physician and staff time each week, while 95 percent of physicians surveyed by the American Medical Association said it delays necessary care.
The Consequences
The consequences do not stop at hospitals. They reach workplaces, household finances, productivity, and national competitiveness.
A parent deciding whether an injured child is worth another medical bill is not merely making a healthcare decision. A worker delaying treatment is not merely making a personal decision.
Multiply those choices across millions of families, and healthcare becomes an economic issue, a workforce issue, and eventually a societal one.
There are two futures available to us.
We can continue building a healthcare economy where complexity is profitable, and sickness keeps the financial conveyor belt moving.
Or we can build one where efficiency is profitable, and health keeps the engine running. Where we don’t fear the financial consequences of receiving the help we not only deserve but have already paid for.
The Importance of Transparency
I believe the first step is transparency, but transparency has to mean something more than another government webpage buried beneath layers of fine print.
Insurers and providers should be required to make negotiated rates, reimbursement structures, denials, and billing logic genuinely understandable to the people financing them.
Employers should have clearer visibility into where their healthcare dollars go. Patients should have enough information to question the price before they are trapped by the bill.
Will transparency solve American healthcare? No. But it is one of the first steps to give people the information required to understand and demand a better system.
The measure of a healthcare system has long revolved around how efficiently it moves money or how successfully it manages a patient through another round of treatment.
Now, it needs to evolve to determine whether people get healthier and whether families can seek help without first calculating the financial damage.
That is the standard we deserve and the one we should demand.
Joshua Resnikoff is the founder of Sunstone Health, an AI-powered precision health platform aimed at reducing diagnostic time for genetic conditions.
The views expressed in this article are the writer's own.
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