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.

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.