The U.S. healthcare system is meant to serve its people, yet millions of Americans struggle with rising costs, limited access, and a system that feels more burdensome than supportive.
At the root of the problem is a legacy insurance model that prioritizes profit over patient well-being, making it nearly impossible for consumers to make informed decisions. A lack of price transparency and meaningful incentives to shop smart means patients often don’t know the cost of care until after they receive it — driving up expenses and leaving many feeling powerless. Let’s break down the five key reasons why this happens and what needs to change:
1. The Cost Problem: Healthcare Is Unaffordable
Healthcare in America is more expensive than anywhere else in the world. According to the Centers for Medicare & Medicaid Services, national health expenditures reached $4.9 trillion in 2023 yet outcomes haven’t improved proportionally. The problem isn’t just high costs, it’s that these costs are often hidden until after care is received. This is a payment structure unlike anything else consumers purchase in their lives — truly unique to medicine. Patients have little transparency into what they will pay until they get the bill. Legacy insurance models contribute to this issue by negotiating secretive rates and adding administrative costs that drive prices higher, all while shifting more financial burden onto patients through high deductibles and out-of-pocket expenses.
2. The Access Problem: Restricted Networks Limit Choice
Most Americans are boxed into restrictive provider networks, forcing them to either accept limited options or pay exorbitant fees for out-of-network care. This creates a system where insurers — not patients — decide which doctors and hospitals are available to them. The result? Delayed treatments and fewer opportunities for individuals to choose the best care for their needs. No one should have to sacrifice quality care because of a network boundary drawn by an insurance company.
3. The Denials Problem: A System Stacked Against Patients
Legacy insurers reportedly deny more than 19% of claims, leaving patients stuck with unexpected medical bills and limited options for recourse. But the problem runs even deeper — many denials never even appear in official statistics because they’re hidden behind prior authorizations that prevent care from ever being delivered in the first place.
Doctors complete an average of 41 prior authorizations per week, adding an administrative burden that takes time away from patient care. The financial impact is just as staggering — prior authorizations cost the healthcare system $35 billion annually. Patients and providers alike face an uphill battle navigating these hurdles, often spending hours on paperwork and appeals just to get the care that should obviously be covered. This system doesn’t just create financial and emotional stress — it actively undermines access to timely, necessary medical treatment.
4. The Transparency Problem: Opaque Pricing and No Motivation to Shop
One of the biggest failures of the U.S. healthcare system is its complete lack of price transparency. Patients are typically blind to the cost of care before receiving it, making it impossible to compare prices or make informed decisions. The reality is that prices for the same procedure can vary wildly — sometimes by hundreds or even thousands of dollars — depending on the provider or location. A routine MRI might cost $300 at one facility and $3,000 at another, but consumers have no way of knowing that upfront.
Even if patients were aware of these drastic cost differences, they have no real motivation to shop around. Traditional insurance plans shield consumers from the true cost of care through fixed copays and deductibles, meaning they often don’t feel the financial impact of choosing a more expensive provider. This disconnect removes any incentive to consider price, allowing providers to charge exorbitant rates without pushback. In contrast, most industries — like travel and retail — empower consumers with upfront pricing information and the ability to shop for the best value. While some exceptions exist, such as legal fees and car repairs, even in those cases, consumers typically receive upfront quotes before committing. Healthcare remains uniquely opaque, with unpredictable pricing and a lack of transparency that continues to drive rising costs.
5. The Confusion Problem: Unintelligible Complexity
The current healthcare system is overly complex, riddled with confusing rules and endless paperwork that leave patients struggling to navigate their own care. Understanding insurance shouldn’t require a law degree — especially when the average American adult reads at a middle school level — yet millions face surprise medical bills, denied claims, and opaque coverage terms that lead to financial hardship. Instead of empowering patients, insurers insert themselves into medical decisions, dictating treatments, requiring prior authorizations, and often delaying or denying necessary care.
A Better Way: Putting Patients Back in Control
The solution is simple: give people the power to choose and the transparency to know what they’re paying — just like they do in every other aspect of life. At Sidecar Health, we eliminate restrictive networks, provide upfront pricing, and ensure that medical decisions are made by patients and their doctors — not insurers.
By bringing real prices to healthcare and allowing members to pay providers directly, we remove the layers of red tape that drive up costs and limit access. The result? More choice, lower costs, and a system that works for people — not against them.
The traditional healthcare model is failing Americans, but we don’t have to accept it as the only way. With transparency, choice, and the right incentives, we can fundamentally change how people access and pay for care. It’s time to stop accepting complexity as the norm and start building a system that puts patients first and drives down costs for everyone.
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