The Big Squeeze: Why the For-Profit complex gate keeping in American health care is Untenable

By: Saryna Young, MD | Young Skin Dermatology

As both a practicing physician and a family member of a Medicare Advantage (MA) recipient, I have witnessed firsthand how the transition to private management has compromised the core strengths of Medicare. For years, the "for-profit paradigm" of big insurance carriers has been squeezing the American healthcare system—tightening the grip on patients and providers alike. Now, that squeeze has reached an untenable level as private carriers dip their hands into the federal healthcare funds of Medicare.

While traditional Medicare is defined by transparency and broad access, the "layers of provision" inherent in MA plans have become a significant barrier to care. In recent years, as the privates dip their hands into the federal healthcare pot, I have failed to define the “advantage” in Medicare Advantage (MA) plans. It seems more fitting to stand for “More Administrative” work to interpret plan policies for clinicians and patients alike! [1]

Clinicians as Secretaries and Debt Collectors

In practice, the administrative burden of navigating disparate private plan requirements is staggering. Clinicians and their teams have essentially been forced into the roles of unpaid secretaries and involuntary debt collectors.

There is a systematic transfer of "bill collecting" from multi-billion dollar insurance companies to medical offices. By increasing patient copays and responsibilities, MA and private plans force clinical teams to choose between their revenue and their relationship with the patient. This not only compromises financial independence and livelihoods—as healthcare bills remain the leading cause of default in America—but fundamentally dilutes the team's focus and poisons the patient-doctor relationship.

Decision-Making Without Liability

Through prior authorization, insurance companies have become a central part of medical decision-making. Yet, while they dictate care, they shoulder none of the risk. This hypocrisy was recently highlighted in Congress by Rep. Neal Dunn, M.D. (R-FL), who argued that if insurance companies are going to practice medicine via prior authorization, they should be required to carry medical malpractice insurance and share in the professional liability.

The Industry-Wide Exodus

In dermatology, elective fee-for-service models act as a small "pressure release valve" from this squeeze. However, even with that buffer, more clinicians are rejecting private insurance entirely to move to a 100% fee-for-service model.

We are seeing a massive flight from this model across the board:

• Psychiatry currently has the highest Medicare opt-out rate in the nation.

• Internal Medicine is seeing a surge in "Direct Primary Care" to restore the patient-doctor bond.

• Elite Institutions are walking away. Starting January 1, 2026, Mayo Clinic will be out-of-network for most individual Medicare Advantage plans. [2] 

When world-renowned, elite institutions and highly trained clinicians are forced to abandon the insurance system just to maintain their standard of care, you know the system is fundamentally broken. It is the ultimate "canary in the coal mine" for American healthcare. [2] 

Bedside Care Over Bottom Lines

The efficiency of Medicare should be measured by patient access, outcomes, and provider ease—not by the complexity of private-payor gatekeeping. We cannot allow for-profit tactics to dismantle the core promise of Medicare.