Simplifying healthcare: Why complexity is failing patients and providers
Fixing the system isn’t about minor tweaks — it’s about a complete overhaul of how care is delivered, paid for and managed.
For decades, the U.S. healthcare system has buried patients and providers under layers of unnecessary complexity. The result is they have to cope with a system that’s difficult to navigate, more expensive to operate and frustratingly inefficient.
From bloated billing processes to hidden pricing schemes, this bureaucracy doesn’t improve care — it drives up costs, erodes trust and slows everything down. If we want healthcare to serve the people who need it, not just those who profit from it, we need to rethink how the business side of healthcare operates.
The high price of complexity
Healthcare’s red tape isn’t just a headache — it’s a trillion-dollar problem. Administrative costs consume 25 percent to 30 percent of U.S. healthcare spending, nearly twice the rate of other developed countries. That’s about $1 trillion that could be redirected toward patient care instead of paperwork.
A major culprit is the insurance claims process. Physicians and their staff spend hours submitting, resubmitting and appealing claims, with the average primary care doctor shelling out $70,000 a year just to deal with insurers.
Worse, this administrative bloat leads to billing errors, denied claims and delays that can seriously harm patients. A 2024 survey by the American Medical Association found that 93 percent of doctors say prior authorization delays have led to negative patient outcomes, and more than a third report these delays have caused severe health complications, hospitalizations or even death. Meanwhile, nearly 40 percent of patients abandon their prescriptions when faced with prior authorization barriers.
Patients are trapped in a broken system
For patients, healthcare is a black box. They don’t know what services will cost, whether insurance will cover those services or how much they’ll owe until the bill arrives — often containing surprise charges and out-of-network fees. Even those with insurance aren’t immune, as they get blindsided by denied claims and endless bureaucracy. The result is medical debt, financial anxiety and people avoiding necessary care because they can’t afford the uncertainty.
A simple medical procedure shouldn’t generate a pile of separate bills from the hospital, surgeon, anesthesiologist and lab — all with vague line items that no one can explain. Yet, that’s exactly what happens. Even the savviest patients get lost in a system designed to be opaque and unmanageable.
The fix isn’t complicated; what’s needed is clear, upfront pricing and a payment system that works like any other industry. When patients understand costs before receiving care, they can make informed decisions without fear of financial ruin.
Fixing the payment mess
One of the biggest barriers to accessible care is the convoluted payment process. Healthcare is the only industry where providers deliver a service without knowing when — or even if — they’ll be paid. Traditional insurance-driven models are riddled with inefficiencies, forcing providers to chase down payments while patients battle surprise bills.
The current system forces providers and patients to navigate unnecessary hurdles. By shifting to real-time, direct-payment models, the industry can cut out the waste and make sure more dollars go where they belong — into patient care, not administrative overhead.
In industries like retail or hospitality, customers know exactly what they’re paying for before they buy. Healthcare should be no different. A direct-pay model would eliminate the guesswork, ensuring patients receive care at a clear price and providers get paid in full within days — not months.
Lessons from other industries
Other industries have already solved the problems with which healthcare struggles.
The path forward
Fixing healthcare isn’t about minor tweaks — it’s about a complete overhaul of how care is delivered, paid for and managed. Cutting out unnecessary bureaucracy, improving price transparency and modernizing payment models are critical steps toward a system that actually works for the people it’s meant to serve.
Streamlining claims processing and reducing administrative bloat means providers spend less time on paperwork and more time on patient care. Transparent pricing empowers patients to make informed decisions without fear of surprise bills. And shifting to real-time, direct-pay systems removes financial uncertainty, making the entire process more efficient for everyone.
We need to leverage technology to remove inefficiencies and put the focus back on patient care. The current system isn’t just outdated — it’s broken. A simpler, more transparent approach will lead to better outcomes and lower costs for everyone involved.
Change won’t happen overnight, but real reform is possible. The industry must move beyond outdated, overly complex processes and embrace smarter, more efficient solutions. The tools are already here — it’s time to use them.
Mark Newman is CEO of Nomi Health.