Healthcare in America Series II, Part 6 – Insurance Is Not Healthcare
One of the most persistent misunderstandings in healthcare is the idea that insurance and care are the same thing.
They’re related — but they are not interchangeable.
This confusion shapes expectations, frustration, and even how people judge their own experiences inside the system.
What Healthcare Actually Is
Healthcare is delivered by:
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Clinicians
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Facilities
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Equipment
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Time
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Coordination
It exists where people practice medicine, provide treatment, and manage illness.
None of that is created by an insurance card.
What Insurance Actually Does
Insurance is a financial tool.
Its purpose is to:
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Spread risk
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Manage costs
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Decide how and when payments occur
Insurance does not diagnose, treat, or heal. It determines coverage, not care.
That distinction matters more than most people realize.
Why Coverage Doesn’t Equal Access
Having insurance does not guarantee:
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Timely appointments
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Available specialists
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Nearby providers
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Approval for recommended care
This is why someone can be “insured” and still struggle to receive treatment — or wait weeks or months for services that feel urgent to them.
The system is working as designed, even when it feels broken.
Prior Authorization and Delays
Prior authorization is often described as interference in medical decisions. In reality, it is a cost-control mechanism built into insurance design.
It exists to answer one question:
“Will we pay for this?”
That question may align with clinical judgment — or it may not. But it is fundamentally financial, not medical.
Understanding that difference doesn’t make delays less frustrating.
It does make them less confusing.
Why This Confusion Persists
Insurance became tightly coupled to healthcare access over decades, especially through employers. Over time, the two concepts blurred in the public mind.
As a result:
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Denials feel personal
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Delays feel arbitrary
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Frustration is aimed at clinicians who don’t control the process
This misdirection erodes trust on all sides.
A Clearer Way to Think About It
Healthcare delivers care.
Insurance controls when and under what conditions that care is paid for.
They interact constantly — but they are not the same system.
Recognizing that difference is essential before we talk about costs, efficiency, or reform.
In the next post, we’ll look at a layer of healthcare most patients never see — but pay for every day: the administrative machinery that operates between care and payment.
