Private health insurance can’t be fixed. Of most concern, it’s insanely expensive. And, corporate health insurers are either unable or unwilling to bring down costs. Moreover, private insurers are inherently conflicted, putting their shareholders’ financial interests ahead of their enrollees who need costly care. If Democrats regain power and don’t guarantee every American access to public health insurance, like Medicare, they are failing our country.
Here are seven additional serious issues with private health insurance:
- Insurers hide critical information. They routinely conceal prior authorization requirements and denial and delay rates from enrollees. Insurers can change their coverage rules at any time, making meaningful oversight nearly impossible. Americans have more information about their restaurant choices than about their health plan choices, even though the health plan they choose could determine whether they live or die.
- Insurers have a strong financial incentive to deny care. They profit more when they deny or delay treatment.. And, they face almost no consequences when they do. This isn’t a flaw in the system. This is the system.
- Insurers design their networks to exclude people with costly conditions. Top specialists and leading hospitals are systematically shut out of insurer networks. When you get seriously ill, you’re left scrambling for in-network care. If you need to move to be near a caregiver, you are likely to be out of network and without coverage.
- Insurers exclude specialists and specialty hospitals to maximize profits. Narrow networks are not an accident; they’re deliberate. By keeping top specialists out of network, insurers deter people with complex conditions from enrolling. In that way, they limit what they spend on care. Sicker enrollees mean lower margins.
- Insurers cannot or will not control hospital and physician costs. Higher costs mean higher premiums, which means higher insurer revenue. Many providers wield monopoly pricing power. Even when able, insurers have little incentive to fight it.
- Insurers cannot control prescription drug prices. Insurers often profit from steering people to costly drugs, even when there are generic alternatives. They have little incentive to bring prices in line with what other wealthy countries pay.
- Insurers are rarely accountable for their bad acts. Government enforcement too often lacks teeth. Neither federal nor state governments have the resources to monitor insurer abuses effectively.. When government finds abuse or fraud, insurers litigate. When the government imposes penalties, they are minor compared to the harm caused and provide no meaningful deterrent.
Here’s more from Just Care:
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
- Ten ways to improve Medicare Advantage
- Medicare Advantage insurers face few penalties for their bad acts
- You still can’t trust Medicare Advantage plan provider directories
- Hospitals increasingly opt out of Medicare Advantage networks
