Out of Patients
with Matthew Zachary
Welcome to 2026: The Year of the Patient where the sick shall inherit the ballot.
Prior Authorization Works Exactly as Designed and That Is the Problem
Prior authorization persists because it works for the system that created it. This essay explains how cost control, risk management, and delay shape patient outcomes, why reform keeps falling short, and what must change to align financial incentives with timely care.
What Happens If More Patients Appeal Insurance Denials?
Only 0.2% of patients appeal insurance denials, yet 80% succeed. This article examines how even small increases in appeals could shift insurer behavior, raise costs, influence Wall Street expectations, and reshape the economics of American healthcare.
Out of Patients EP437: First in (Wo)Man: Jessica J. Federer
Women were excluded from U.S. clinical trials until 1993. That decision shaped drug safety, outcomes, and cost for decades. This essay breaks down the incentives, capital flows, and regulatory gaps that sustained it and what must change next.
Blue Cross Blue Shield Got Caught Rigging The Market. The Penalty? $2.67 Billion. The Timeline? Six Years And Counting.
Blue Cross Blue Shield settled a 2.67 billion antitrust lawsuit in 2020 after restricting competition for more than a decade. Payments begin in 2026. Six years later, customers get checks while insurers move on. Here is what happened and why it keeps happening.
Medicare Advantage Works Until the Math Changes
UnitedHealth dropping Medicare Advantage plans for 600000 beneficiaries exposes a structural flaw in how private insurers manage public healthcare risk as costs from emergency care and specialty drugs accelerate faster than payment models can adjust.
Breaking Up Big Medicine
The new bipartisan proposal to separate insurers, PBMs, and providers targets the financial structure behind rising costs and denials. This piece explains how ownership concentration reshaped care, why regulation failed, and what structural separation could change for patients.
Freedom to Go Broke
After surviving brain cancer at 21, Matthew Zachary examines how modern healthcare policy repackages risk as freedom. From cash subsidies to math free promises, this essay exposes why consumer style healthcare fails the moment illness enters the room.