Prior Authorization: A Corporate Veto Over Healthcare

A personal and professional account of the devastating effects of prior authorization in healthcare was shared by Hannah Garden-Monheit, senior fellow at the American Economic Liberties Project. Her father, Michael L. Monheit, underwent an amputation but was denied rehab due to UnitedHealthcare's bureaucratic maze of paperwork.

The family's experience is not unique; it's a symptom of a larger problem where private health care conglomerates profit by overriding doctors' judgments and denying necessary care. Prior authorization has mushroomed into a pervasive corporate veto over healthcare, consuming the equivalent of 99,000 full-time clinicians' worth of time each year at a cost of up to $32.7 billion annually.

Medicare Advantage plans, which rely heavily on prior authorization, have been shown to cost taxpayers 22% more per patient than traditional Medicare in some cases. Furthermore, nearly one in four physicians report that prior authorization has led to serious adverse events for patients in their care.

Garden-Monheit advocates for structural reforms, including banning health insurance conglomerates from owning or affiliating with companies that adjudicate prior authorization requests. She argues that this would eliminate the financial conflict of interest and reduce administrative costs.