> This suggests a very fundamental misunderstanding of healthcare, treatments, and what insurance companies exist for. They are not about health policy or well being. They are about derisking profit loss. Their recommendations are to reduce cost, and nothing more. Doctors understand this, and will tell you this very plainly, as you fight to get required treatments covered.

I am someone who has worked for providers, worked as a paramedic, and worked for a company whose customers were health insurers, as we built claim benefits management systems for them, so literally the logic to calculate deductibles, handle accumulators, provider negotiated rates.

The issue is not my misunderstanding, it is that "health insurance" in the US is the worst of all worlds - health insurance when convenient (to the insurer), amortized healthcare when convenient. It used to be that about the biggest offering that health insurers could give you was better provider-negotiated rates, but that era is largely behind us with the vertical integration of supply chains, and a health insurance industry that can only make more money when prices go up (if your profits for premium administration are capped at 15%, the only way that number goes up is if premiums go up, because healthcare costs more - this is compounded by the fact that it's in everyone in the system's interests for it to cost more except the actual consumer).

Everything has had to be fought for - otherwise, to your point, why are actual clinical "annual exams"/"wellness" visits covered at zero cost, but incentives for weight loss (as in obesity reduction, even pre GLP-1s) or cardiac health are near zero while a gastric bypass is covered in toto.