What's Actually Broken in U.S. Healthcare Right Now — And What Physicians Would Change First
By the MedStory News Editorial Team | Expert Commentary: Dr. Omar Khokhar, Gastroenterology
The American healthcare system spends more per capita than any other nation on earth, yet consistently underperforms its peers on core measures of patient outcomes, access, and equity. For patients navigating a denial letter from their insurer or a physician fighting to get a medically necessary procedure approved, the dysfunction is not abstract — it is immediate, costly, and sometimes fatal. To understand what is truly broken and what might actually fix it, MedStory News turned to frontline clinicians who live inside the system every day. Dr. Omar Khokhar, a practicing gastroenterologist, offered a perspective that is equal parts candid and urgent.
At the core of Dr. Khokhar's frustration is a fundamental breakdown in the contractual promise healthcare insurance is supposed to fulfill. Patients pay premiums, sometimes substantial ones, with the reasonable expectation that medically necessary care will be covered. That expectation, he argues, is being systematically violated.
"Individuals are paying for a service, and that service is consistently denied or rebuffed. If I order a test or medication that's medically necessary, it should be covered. How much profit does an insurance company need to make at the expense of the common man and community hospitals?"The question is rhetorical, but the numbers behind it are not. Major U.S. insurers have reported tens of billions of dollars in annual profit in recent years, even as prior authorization denials have climbed and community hospitals — the safety-net institutions that serve the most vulnerable populations — have faced closures and budget crises at an accelerating rate.
The prior authorization process, in particular, has become a flashpoint in the broader debate over who actually makes clinical decisions in American medicine. Physicians across specialties report spending hours each week navigating insurer bureaucracies to justify treatments they have already determined are necessary. That administrative burden does not simply drain physician time and morale — it delays care, and delayed care has measurable consequences. When a gastroenterologist cannot promptly secure approval for a diagnostic scope or a biologic therapy for a patient with inflammatory bowel disease, that patient's condition can progress, sometimes irreversibly. The physician's clinical judgment, trained over years of education and practice, is effectively subordinated to an algorithm designed with cost containment, not clinical excellence, as its primary variable.
On the question of structural solutions, Dr. Khokhar does not shy away from territory that many in the medical community have historically approached with caution. He raises the possibility of a single-payer system — acknowledging the political sensitivity directly.
"As much as this is a faux pas, we may need to consider a one-payer solution. Remove all the middlemen taking a piece."The single-payer debate in the United States has long been mired in ideological conflict, but Dr. Khokhar's framing centers not on ideology but on economic logic. Every layer of the current multi-payer system — brokers, third-party administrators, utilization review organizations, pharmacy benefit managers — extracts margin from the healthcare dollar before it reaches a patient or a provider. Eliminating or dramatically consolidating those intermediaries would not, by itself, solve every problem in American healthcare, but the administrative savings alone are estimated by health economists to run into the hundreds of billions annually.
Perhaps the most sobering element of Dr. Khokhar's assessment is its diagnosis of the system's foundational incentives.
"Our current healthcare system appears to be geared toward profit, not outcomes."This is not a novel observation in academic health policy circles, but it carries particular weight coming from a clinician who sees its consequences in the exam room. A system oriented around outcomes would reward early detection, preventive intervention, and care coordination. The system that currently exists, by contrast, reimburses volume and procedure, creates financial incentives for fragmentation rather than integration, and allows insurance companies to profit by managing the denial of benefits. The result is a paradox: a nation that spends the most on healthcare but, by many measures, receives among the least value for that expenditure.
What physicians like Dr. Khokhar are asking for is not radical in concept — it is, in fact, quite simple. They want clinical decisions to be made clinically. They want patients who have paid into a system to receive the care that system promised them. And they want a structural reckoning with the reality that profit motive and patient outcome, in the architecture of American healthcare, are too often in direct opposition. Whether policymakers have the will to act on that reckoning remains, as ever, the defining question.