Healthcare in the United States is a complete nightmare. The inherent power struggle that a for-profit healthcare system presents is a horrific reality for millions of Americans.
Healthcare is one of the largest industries in Utah. The University of Utah Hospital and Intermountain Healthcare consist of two of the biggest employers here. The U is also the 35th best medical research school in the United States. In addition, the University Hospital is also considered one of the best teaching hospitals in the country.
About 30 million people in the U.S. don’t have any access to healthcare, causing roughly 40,000 deaths annually. Even with access to it, people face issues caused by the for-profit model we currently employ. Prior authorization is, ironically enough, a disease affecting the entirety of the healthcare industry, and is a perfect example of why we need universal healthcare.
Why is Prior Authorization an Unjust Policy?
Prior authorization is a policy that works exactly how it sounds. An insurance company will authorize treatment based on several factors, such as cost. In this case, the word treatment is extremely ambiguous and can mean anything from lab tests to cancer screenings. The ambiguity itself is a serious issue since an insurance company can delay vital treatments or tests for minimal reason. In the worst case, delay can mean patients miss critical treatment windows — the range of time when treating an illness is viable.
This idea is rooted in the falsehood that prior authorization saves money for the average policyholder. Alternatively, prior authorization can at least ensure the correct steps are taken in the treatment of a patient. There isn’t much evidence to suggest prior authorization has actually brought down healthcare costs — however, there’s a rich literature that says the opposite.
To put it plainly, this is an archaic policy. In the best case, it is an inefficient way to spend money while simultaneously spitting in the faces of doctors. However, in the worst case, this policy causes preventable deaths. It is constantly pushed upon healthcare professionals as a necessary step in patient care when it simply isn’t.
The healthcare industry has framed prior authorization to sound like a minor thing that isn’t deliberately used to make as much profit as possible for the company. It’s easier to do this rather than acknowledge that prior authorization is an inefficient policy choice that just burns money. In reality, prior authorization is actively implemented in ways that target the most vulnerable people in our society — while simultaneously peddling this poison as a miracle cure. The use of AI with prior authorization can easily be the most transparent way a healthcare company can show its patient priorities.
What a Bad Solution Looks Like
A quick way to solve this mess is through basic legislation and regulation. Obviously, AI being used for all authorization should immediately be made illegal, or at least require extreme amounts of oversight. Prior authorization should be used only for things that are actually unnecessary, such as writing prescriptions for name-brand medicine rather than generics or ordering excessive lab work.
The board of the American Medical Association has supported a regulated version of AI’s use in prior authorization, stating, “The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes. But AI is not a silver bullet.” This is an untenable position that misses the necessary analysis required to approach an effective solution. Saving time means saving costs, which is the stated goal of prior authorization. Any amount of regulation put into place surrounding AI’s use in the healthcare industry will inevitably be skirted around as companies try to cut corners to increase profits.
Ideally, prior authorization should be outlawed entirely. This is a stupid, outdated system, and we shouldn’t pretend that it makes sense to employ such a needlessly cruel policy. We can’t keep allowing a room full of business majors, or some AI chatbot, to make decisions about what treatment someone needs.
The proposed solutions are absolutely terrible. They’re essentially the band-aid we would have to put on a gunshot wound — but only because we couldn’t get prior authorization for proper care. Getting rid of preauthorization would certainly eliminate a massive source of stress for patients and healthcare professionals. But it wouldn’t address the bleeding hole caused by for-profit healthcare.
What a Good Solution Looks Like
Realistically, we should be treating the source rather than the symptom. This failure is a direct result of companies putting profit ahead of the needs of patients. Healthcare companies can use disasters of their own making to maintain their terrible policies. Justifying the necessity of prior authorization by pointing to the fact that healthcare can be done cheaper is an inherently invalid argument.
The solution to preauthorization is universal healthcare. Anything other than that is an inadequate solution that doesn’t address the actual root cause of the issue. A for-profit healthcare system is what has allowed prior authorization to become such an issue in the first place — so maintaining our current system without addressing the root cause will inevitably lead to something similar or worse. Universal healthcare is irrefutably the best solution for this problem.
Every advanced democracy in the world, with the exception of the United States, offers universal healthcare with great success. Rather than stopping preventable deaths, we’ve opted for a system that incentivizes profit over people. Prior authorization is just one example of this – other examples include relevant issues like drug prohibition and the lack of health services making addiction worse, ambulances being expensive for no reason and many more. This situation is untenable and needs to change.
It’s time for universal healthcare in the U.S. — prior authorization is just one example as to why. By ridding our country of such an archaic policy, we’ll begin to see how many companies will put their patients first, for a change.
