Out of Patients
with Matthew Zachary
Welcome to 2026: The Year of the Patient where the sick shall inherit the ballot.
The Denial Machine: Why America’s Health Insurance Appeals System Rewards Patient Exhaustion
More than 80% of appealed Medicare Advantage prior authorization denials are overturned, yet fewer than 0.2% of ACA Marketplace denials are ever appealed. The problem is not only denial. It is a system that profits when patients run out of time, energy, and hope.
When Denial Becomes the System: Jace Yawnick
US healthcare does not fail when it denies care. It performs as designed. This essay involving the life of Jace Yawnick examines how insurance incentives, prior authorization, and employer based coverage shape access, delay treatment, and shift risk onto patients while increasing total cost.
$1.7 Trillion Dollars. $54 Billion in Profits, 10 Million Fewer People.
In 2025, seven insurers generated $1.7 trillion in revenue and $54 billion in profit while covering 10 million fewer people. Premiums hit $26,993 for families. Public funding expanded. Consolidation deepened. The incentive structure driving American health insurance stands exposed.
Out of Patients?
Join the recurring Out of Patients dispatch from Matthew Zachary covering the latest American healthcare shenanigans. Essays, podcast episodes, media appearances, book updates, and live events delivered with a sardonic Gen X perspective from a patient who simply refuses to shut up.
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