Promises Aren't Policies, Policies Aren't Promises

Cutting through bureaucratic red tape barriers to healthcare can't just be symbolic.

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“RFK Jr. and Dr. Oz say health insurers will cut red tape on ‘prior authorizations.’”

I admit this headline stopped me in my tracks for a moment. Could it be possible that I agree with something Dr. Oz and RFK Jr. are doing?

Not really.

This big development in the supposed cutting of red tape is just “a coalition of private health insurance companies [that] voluntarily pledged to standardize and reform” the prior authorization process by the end of this year.

So we’re meant to believe that in half a year, one of the most harmful aspects of the health insurance industry, which has been in practice since the 1960s, will finally be eased?

I’ll believe it when it happens. I’m quite confident it won’t, though, because promises aren’t policies. For that matter, policies aren’t even actual legal protections anymore, it seems. And to be honest, the reality is that long before this administration began, policies weren’t promises anyway.

The Americans with Disabilities Act (ADA) is a prime example of this. Next month, the ADA will be 35 years old. I’ve never known life without the ADA, and as a disabled person, the law’s existence is something I definitely don’t take for granted. I know for certain my life is better because of it. But I often say that while you can create a policy, you can’t legislate an attitude. Stigma against disabled people remains pervasive, and so too does a lack of understanding about why it’s so vital to adhere to the ADA.

Beyond that, the ADA doesn’t have strong enough enforcement mechanisms in place, so plenty of people take it as a suggestion rather than a law. It’s largely reliant on the promise that a person’s understanding will be stronger than their biases, and they’ll willingly follow legal guidelines.

There’s also a financial angle to the comparison between upholding the ADA and the prior authorization reform pledge. Unfortunately, many hold the (primarily false) assumption that adhering to the ADA is a financial burden. Similarly, I imagine insurance companies, which deem prior authorization to be a matter of cost savings, will ultimately see reforms as a financial burden (also primarily false).

I asked AI to generate an image that illustrates the concept of bureaucratic red tape and honestly…this kind of feels spot on. (Image description: A large, snake-like tangled mass of red tape with paper forms interspersed all throughout the tangles.)

Anyway…considering the government doesn’t enforce or uphold actual laws, I can’t say I’m jumping for joy over a non-binding pledge. As this administration is trying to slash access to healthcare and add administrative burdens like Medicaid work requirements, announcing what amounts to a group hangout to discuss reforming prior authorization is like putting lipstick on a pig. (Side note: what a ridiculous saying that's quite frankly rude to pigs. A pig wearing lipstick would be utterly adorable.)

Clearly, this administration’s refrain of eliminating “waste, fraud, and abuse” continues to ring hollow here. Prior authorization is 100% a waste of time and resources, and it’s most definitely an abusive practice. Were you at my doctor appointments, insurance employee? (Or should I say AI-powered agent?) Do you know what it’s like to be inside my body? Are you a medical expert? No, no, and no.

As a person who uses multiple kinds of durable medical equipment (like, for example, wheelchairs), I’ve long known the reality of insurance denials and appeals (though my mom, who is incredibly skilled at dealing with such trouble, has been the one to help me through). More recently, as I’ve been navigating some chronic health conditions while paying through the roof just to stay insured, the prior authorization process keeps an inextinguishable fire of frustration burning in me.

Obviously, I’d like to be wrong about this pledge. I’d like to see it lead to meaningful change. And according to the press release about the pledge, the Centers for Medicare & Medicaid Services “encourage continued innovation and collaboration but reserves the right to pursue additional regulatory actions if necessary.”

So, I’d like to have a glimmer of hope that as this administration wields their power like an axe, they’ll actually use it to do something—anything—good. Even so, the healthcare system isn’t in need of bandage solutions like pledges. It’s in need of a massive overhaul. Unfortunately, this administration thinks so, too, except their vision is destructive rather than reparative.

There’s still time to hold on to hope, I think. Maybe. You can call or email your representatives and demand no cuts to Medicaid.

It shouldn’t be a bold statement to say that access to healthcare and making decisions about your own body are human rights.

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