Read text on white background with the initials HJM and the text Health Justice Monitor, and a red circle with a white line as seen on a hospital heart rate monitor.From the Health Justice Monitor, current news in context from Jim Kahn, Emeritus Professor of Health Policy, Epidemiology, and Global Health at the University of California, San Francisco, and Don McCanne, a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues.

The NY Times posted a powerful video editorial on the major distraction, high cost, doctor-frustrating, and patient-harming effects of rising prior authorization requirements by private health insurers.

Denying Your Health Care Is Big Business in America
NYT Opinion Video (on YouTube)
March 14, 2024
Video by Alexander Stockton
Full opinion piece on NYT

“This issue is ultimately about the role of insurance companies in American health care: Should they have more power than your doctor to decide what’s medically best for you?”

Comment by: Jim Kahn

In my opinion, thoughtful and well-circumscribed prior authorization has an appropriate role in medicine. It can work with other methods (e.g., training and peer review) to advance effective and quality care, weeding out clinically unnecessary services. As a health economist, I even understand its careful use to help wisely and equitably spend health resources.

Yet that’s not what’s happening in the US currently, according to various reports, both anecdotal and quantitative. The NY Times video effectively captures the burdens that prior authorization increasingly imposes on doctors (who spend far too much time pleading with insurers) and patients (whose care may be delayed and denied).

What’s the difference between ideal and problematic use of prior authorization? To paraphrase a famous political slogan, “It’s the profits, stupid.” When the financial well-being of insurance company executives and shareholders is conflated with fairness and efficiency in medicine, the balance will surely tilt away from optimization of health care for patients.

As the video says, other countries get it right. We can too, with single payer.