- The health insurance system in the US isn’t serving doctors or patients.
- Providers, especially primary care physicians, are overwhelmed with billing and insurance red tape and stretched thin with patient visits.
- Patients are drowning in medical costs and discouraged from seeking preventive care.
- Better models are emerging. Tech-enabled companies are rethinking health insurance from the ground up, giving PCPs the freedom to focus on patients, while offering patients no-cost access to care that improves their health.
KEY INSIGHTS:
Imagine waking up with chest pain, calling your doctor, and learning they’ve retired early due to burnout. The next available appointment with another physician? Three months away.
This scenario isn’t hypothetical — it’s becoming increasingly common. By 2036, America is expected to face a shortage of as many as 68,000 doctors. Doctors aren’t quitting because they’ve stopped caring; they’re leaving the profession because the insurance system has turned medicine into misery.
Physicians now spend more time on administrative tasks, primarily related to billing and insurance, than treating patients. The country’s fragmented insurance system adds layers of work to healthcare, gobbling up doctors’ time. Today, the average physician spends a soul-crushing 28 hours a week, more than half their time, on busywork. It’s an unsustainable crisis, with insurance at its core.
“Today, the average physician spends a soul-crushing 28 hours a week, more than half their time, on busywork.”
A single-payer system could solve much of this, but political reality makes it unlikely in the near future. That’s why we need something different: a radical reinvention of the insurance model itself. One that turns insurers from cost-cutting gatekeepers into true partners who empower doctors and support patients.
If such reinvention is successful, healthcare could look dramatically different a decade from now. Imagine a healthcare system where doctors are unburdened from bureaucracy and free to focus on care, where patients enjoy easy access to unlimited primary care, and where insurers compete to improve outcomes, not deny services. We might even achieve the impossible: bring down America’s sky-high healthcare spending.
But if we don’t act? Today’s doctor shortage becomes tomorrow’s health catastrophe.
How did we get here?
Ironically, today’s problems began with attempts to make things better. In the 1980s, insurance companies introduced HMOs and PPOs to control costs. But since these models required pre-approvals and authorizations, they dragged doctors into paperwork and forced them to spend more time justifying patient treatments to insurers.
Then came the 1990s and the rise of electronic medical records and ever-expanding billing codes — intended to streamline care, but instead piled on complexity. Now, every patient encounter requires meticulous documentation just to get paid. One wrong code? A denial, audit, or delay.
Doctors are fed up. Many cite insurers as the reason they’re walking away, frustrated by the red tape and the idea that insurers can overrule their clinical judgment.
Patients aren’t spared either by the current system. Even with insurance, many are crushed by high deductibles, surprise bills, and narrow coverage. According to a recent survey, nearly 40% of insured Americans have avoided seeking care due to cost, and nearly 1 in 3 have skipped filling a prescription. Medical debt now accounts for 40% of personal bankruptcies in the US.
And for all this spending, we’re not getting healthier. America spends more per person on healthcare than any country in the world and still ranks near the bottom among wealthy countries on key metrics like life expectancy, maternal mortality, and chronic disease outcomes.
Reimagining insurance
Most doctors go into medicine to help people, not fight insurance company algorithms. As a tech entrepreneur, I saw an opportunity to fix the root of the problem. That’s why my co-founder Jeff Yuan and I started Mending, a new kind of health plan that puts doctors and patients back at the center.
We’re doing things differently in two big ways:
1. A new business model
Traditional insurers manage costs by denying care. The shooting death of UnitedHealthcare’s then-CEO brought this into the spotlight. UnitedHealthcare has the industry’s highest denial rate, at 33%.
We take a different path. Instead of hunting for surgeries, tests, and medications to deny, Mending controls costs by empowering primary care doctors and promoting preventive care. Why? Because primary care doctors are the secret ingredient for lower costs and healthier patients. Research shows that adults who regularly see a primary care doctor have 33% lower health care costs and a 19% lower risk of premature death compared to those who rely solely on specialists. Primary care doctors treat problems before they escalate into costly and complex treatments and help ensure their patients stay on track with medications and treatments. It’s not just compassionate care — it’s smart economics.
“Instead of hunting for surgeries, tests, and medications to deny, Mending controls costs by empowering primary care doctors and promoting preventive care.”
This is why we offer patients unlimited access to their primary care doctor, a rarity among insurance plans. And for other services, we make costs clear upfront — no surprises, no gotchas.
We’ve built a network of direct primary care (DPC) practices — doctors who have eliminated the insurance middleman to connect directly with patients. This model has been quietly gaining traction, growing 25% annually. In DPC practices, patients not only have unlimited access to their doctor, they get the benefit of longer appointments (often 30-45 minutes), same- or next-day visits, and no extra fees for routine services like labs, vaccines, or screenings. In a system that often feels cold and transactional, DPCs restore something rare: the peace of mind that comes from knowing your doctor is always just a call or message away.
2. Technology that works for doctors
Why would DPC doctors who’ve ditched insurance companies decide to work with another insurance provider? Because we don’t second-guess their decisions and rarely deny claims. In other words, we let doctors be doctors. Behind the scenes, our tech handles all the billing and reimbursement. No codes to decipher. No claims to submit. And definitely no faxes. We integrate directly with DPC systems so eligibility is automatic, relevant data is pre-populated, and payments go out every month — no chasing, no delays. The result is that physicians spend more time with patients and very little on paperwork. And our patients have access to a doctor who can help keep them healthy and engaged.
A proven path
At the heart of everything we do is integration. We align with doctors’ systems, processes, and values. It’s not just theory. We’ve seen this model work.
Kaiser Permanente, a nonprofit pioneer of integrated care, blends insurance and care delivery under one roof. Although Kaiser isn’t a high-tech innovator, its operations are inherently more seamless and aligned because doctors, hospitals, and the health plan all work together under one umbrella. The results speak volumes. Kaiser has one of the lowest claims denial rates in the industry — just 6%. And its members are healthier, with 33% less likely to die prematurely from heart disease. They also receive preventive care at significantly higher rates, including screenings for colorectal cancer (77% vs. 62% nationally) and breast cancer (84% vs. 77%).
A mission that matters
Kaiser operates in just eight states. Mending is still early in its journey. But we believe — and we hope others will join us — in building a system that works for doctors and patients alike. Major insurers like UnitedHealthcare and CVS (which owns Aetna) are aiming to better integrate care through the purchase of physician groups. But will they treat those doctors as partners, or just assets? That depends on whether they are willing to champion preventive care and can actually fix the administrative chaos.
We believe health insurance should never force doctors into early retirement or drive patients into bankruptcy. It’s time for insurance to serve the true purpose of healthcare: making people’s lives better. Our health depends on it.
