“The High Cost of Care: How Consumerism and Insurance Profits Are Breaking Mental Health”
by Lauro Amezcua-Patino, MD, FAPA
In 2005, a health insurance executive stood on the stage, pitching a new strategy to company leaders. The concept, called “consumerism,” was spun as a revolutionary solution to rising healthcare costs. It promised that by shifting more financial responsibility to patients, they would become savvy shoppers, making informed choices that would, supposedly, bring down costs across the board. But as the presentation unfolded, it became clear that this wasn’t about empowering patients but protecting profits.
This meeting marked a pivotal moment for the American healthcare system, especially in mental health care, where barriers to access have always been steeper. “Consumerism” was a wolf in sheep’s clothing. It was designed to offload costs onto individuals, leaving insurance companies with higher margins and shareholders with soaring profits. But for patients, particularly those with psychiatric conditions, it has led to heartbreak, financial ruin, and sometimes even death.
The Consumerism Illusion: Selling a False Solution
The marketing spin was brilliant. By calling it “consumerism,” insurers framed the shift as giving patients control and responsibility. It was a cynical ploy to reduce payouts while forcing people to shoulder more of the burden. Most Americans had modest cost-sharing obligations at the time — maybe a $300 deductible and a $10 co-payment. But under the new model, deductibles ballooned into the thousands, creating an untenable system for anyone who wasn’t healthy or wealthy.
For mental health patients, the impact was especially severe. Therapy sessions, psychiatric medications, and inpatient treatments suddenly required significant out-of-pocket payments before insurance would cover a dime. Those with chronic conditions like bipolar disorder or major depressive disorder found themselves drowning in bills they couldn’t pay. And the idea that patients in crisis could “shop around” for care? That was as absurd as it was cruel.
The Real Cost of Financial Barriers
The human cost of consumerism became painfully clear during a visit to a free medical clinic in Wise, Virginia. At a county fairground, lines of desperate people stretched out of view, waiting for care in converted animal stalls. Many had insurance, but their deductibles were so high that their plans were useless.
Imagine someone battling debilitating depression, unable to afford therapy because they haven’t met a $5,000 deductible. Now imagine the ripple effects: the depression deepens, relationships fracture, job performance falters, and financial stress compounds. It’s a vicious cycle, one that pushes people further into despair and sometimes, tragically, into acts of self-harm or violence.
Psychiatric Care Under Siege
Psychiatry has been hit particularly hard by this profit-first model. Despite a growing mental health crisis, insurers have made accessing care more challenging than ever. High deductibles, prior authorization requirements, and arbitrary denials have created a perfect storm of inaccessibility. The consequences? They’re written in the statistics — and in the stories we hear far too often.
Suicide After Denial of Care
A young man with severe depression sought electroconvulsive therapy (ECT) after medication and therapy failed. His insurer denied the claim, calling the treatment “experimental” despite its long-standing efficacy. Left untreated, he took his own life.
Escalating Violence
A woman with untreated PTSD and substance use disorder was denied inpatient care because her insurer required her to fail outpatient treatment first. Her condition spiraled, culminating in a violent altercation that left her partner severely injured.
Vulnerability to Exploitation
A teenager with undiagnosed ADHD and a history of trauma couldn’t access therapy due to her family’s high deductible. She dropped out of school and was lured into human trafficking — a tragedy that could have been prevented with timely intervention.
These stories aren’t anomalies. They’re the direct result of a system that treats psychiatric care as a luxury rather than a necessity.
Profits Over People: The Insurance Playbook
Over the years, insurers have perfected their playbook for maximizing profits:
- Reducing Medical Loss Ratios (MLR): This metric, which reflects the percentage of premiums spent on patient care, has steadily dropped. Where insurers once spent 95 cents of every dollar on care, that figure now hovers around 85 cents, thanks to high deductibles and claim denials.
- Prior Authorizations as Roadblocks: Insurers delay care by requiring extensive documentation and reviews for psychiatric treatments, often until it’s too late.
- Vertical Integration: Companies like UnitedHealthcare have bought up clinics, pharmacies, and physician groups, consolidating power and further limiting patient choice.
This isn’t just about cutting costs; it’s about maximizing shareholder returns. Annual investor meetings reveal the true priorities: protecting the bottom line rather than improving patient outcomes.
The Ripple Effects of Neglect
When psychiatric care is inaccessible, the consequences extend far beyond the individual:
- Overburdened Emergency Rooms: Patients denied routine care often end up in crisis, flooding emergency departments ill-equipped for mental health issues.
- Workplace and Community Impact: Untreated mental illness contributes to job loss, homelessness, and increased encounters with law enforcement.
- Generational Harm: Parents unable to access care pass on untreated trauma to their children, perpetuating cycles of dysfunction.
The financial cost of untreated mental illness is staggering, but the human cost is incalculable.
Systemic Failures and Opportunities for Change
It doesn’t have to be this way. Our system was built by human hands, and it can be rebuilt. However, it will require a fundamental shift in priorities — from profits to people.
1. Make Mental Health Care Affordable
High deductibles and out-of-pocket costs must be addressed. Policymakers can cap these expenses and expand subsidies for mental health care. Meanwhile, insurers should be incentivized — or mandated — to design plans that prioritize comprehensive psychiatric coverage.
2. Simplify Access
Prior authorizations for psychiatric treatments often do more harm than good. Regulators must limit these requirements and penalize insurers for unnecessary delays. Patients in crisis need immediate care, not bureaucratic red tape.
3. Strengthen Community Programs
Community mental health centers are lifelines for underserved populations. Increased funding and support for these programs can provide early interventions that save lives and reduce societal costs.
4. Enforce Parity Laws
Mental health parity laws exist to ensure psychiatric care is treated equally to physical health care, but enforcement has been lax. It’s time for regulators to hold insurers accountable, with steep penalties for non-compliance.
5. Change the Narrative
Mental health care is not a luxury. Public awareness campaigns can help destigmatize psychiatric conditions and emphasize the importance of early intervention. Policymakers, providers, and insurers must take charge of reframing mental health as integral to overall health.
Balancing Profit and Purpose: A Win-Win for Shareholders and Society
Balancing profit and purpose isn’t just an idealistic notion — it’s a blueprint for long-term success that benefits everyone. When companies prioritize reinvesting profits into innovation and community development, the results speak for themselves. Imagine an insurer using its earnings to simplify claims processes, expand access to mental health services, or fund telemedicine platforms that make care more affordable and accessible.
These efforts not only build trust with customers and providers but also position the company as a forward-thinking leader in a competitive industry. At the same time, fair treatment of employees, patients, and stakeholders is essential. A workforce that feels valued will perform better, driving innovation and loyalty. Providers, freed from excessive red tape and supported by timely reimbursements, can focus on delivering quality care, creating a virtuous cycle where patients receive the help they need, insurers reduce long-term costs, and communities thrive.
Compliance with laws and ethical practices is the foundation of this approach. Companies that prioritize transparency in how premiums are spent or actively address disparities in mental health care access gain the trust of shareholders and customers alike. Ethical behavior and reinvestment aren’t just good optics — they attract loyal customers, engaged employees, and stable partnerships, ensuring growth that’s both sustainable and impactful.
For shareholders, the message is clear: Purpose-driven companies are better positioned to weather challenges and deliver consistent returns. For patients, it’s a matter of dignity — knowing their care isn’t a commodity but a priority. And for everyone involved, it’s about recognizing that a balanced system isn’t just good for the bottom line; it’s good for humanity. When profits are pursued responsibly, the ripple effects can transform industries, rebuild trust, and create a healthier, more equitable future for all.
This isn’t just a policy problem — it’s a profound moral failure. Every life lost, every family shattered, and every future derailed by a system that prioritizes profit over people is an unforgivable indictment of our collective values. These are not abstract statistics; they are real human beings whose suffering is a direct result of greed masquerading as progress. Reforming this system is not optional — it is an urgent necessity.
We must confront an uncomfortable truth: a healthcare system built to serve shareholders will always betray its patients. The choice before us is stark and unavoidable — do we value human lives or quarterly earnings? The answer should be painfully obvious, yet action has been paralyzed by the relentless pursuit of stock prices. This dishonesty isn’t just unethical; it’s lethal. The time to act is now. Anything less than transformative change means we are complicit in perpetuating a system that sacrifices lives for financial gain. Enough is enough.
