Opinion: Open enrollment is health care's most expensive lie

"Today, we've built a multibillion-dollar theater production called open enrollment that costs more to stage than many small countries spend on their entire health care systems. American health care wastes approximately $248 billion annually on excess administrative costs, and open enrollment sits at the heart of this hemorrhage. Broker commissions, marketing materials, comparison portals, HR staff hours and the entire infrastructure of manufactured choice siphons money that could pay for nurses, doctors and actual patient care."

"But here's what actually happened: We created a system in which insurers pay brokers a commission for the employers they sign up usually a healthy 3% to 6% of the total premium, potentially $50,000 a year for a midsize company incentivizing them to sell higher-cost plans regardless of quality. We built elaborate comparison tools that let consumers agonize over premiums and deductibles while hiding the only number that actually matters: denial rates."

Employer-based insurance historically provided stable coverage without annual open enrollment changes. Annual open enrollment has evolved into an expensive, multibillion-dollar production that contributes to roughly $248 billion in annual administrative waste. Open enrollment drives costs through broker commissions, marketing, comparison portals, and HR hours that divert resources from clinical care. Insurer-paid broker commissions of about 3% to 6% of premiums create incentives to sell higher-cost plans regardless of quality. Comparison tools emphasize premiums and deductibles while obscuring denial rates, the metric most relevant to access. A 2018 experience with aggressive breast cancer exposed widespread denials, appeals, and unexpected out-of-pocket costs, prompting the creation of free AI tools to address these problems.

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