Is the Healthcare System Broke?

You hear that often. Yes, it is, and has been, for quite a while. Our healthcare system is a complex, complicated system, and not for the light of heart.

We have insurance companies, providers of all types, Medicare, Medicaid, the Affordable Care Act ( not really affordable), and of course we, the consumers.

Many politicians talk about what they are going to do to improve it, but never do. Is it possible that it is just too complex, that it is impossible to change? Maybe!

My wife and I have regular Medicare plus supplemental coverage for the 20% that Medicare doesn’t cover.

She recently received an explanation of benefits report, from her supplemental insurance carrier, for her last appointment with her Primary Care Physician, at the University of Virginia Medical Center.

Her appointment was on February 23, 2026, and was her regular six month examination. The visit lasted less than half an hour. The billing was for four (4) services as follows:

Billed Approved Paid

Wellness Visit $318.00 $135.16 $135.16

Medical Services 51.00 18.40 18.40

Medical 25.00 17.08 0

Doctor’s office Visit-long 339.00 133.10 0

Total $733.00 $303.74 $153.56

As you can see, UVA Health billed a total of $733.00, but Medicare’s rates for such services amounted to only $303.74. Medicare only paid $153.56, because the other $150.18 was applied to the annual Medicare deductible. However, the supplemental did pay the $150.18.

In the above case, the provider billed $318.00 for a “wellness visit” as well as $339.00 for a “long” office visit.

That makes no sense. The total visit was less than half an hour.

If my wife had no insurance, she would have been billed $733.00 (billed charges) by UVA Health. This is where there is an inequity. Why shouldn’t those, who have no insurance, be billed for what the provider receives from other insurance organizations, for the same services?

What has occurred here is only more complicated by specialists services, like cardiology, ophthalmology, oncology, etc.

Where will this end? How will it end? Is it no wonder that health insurance coverage, through an insurer, for a single individual, is almost $2,000. per month.

Health insurance for most is not affordable, and companies cannot afford to continue offer it as an employee benefit. It is time for Congress to stop “putting it under the rug,” and go to work on a solution. It will take Congress, insurance providers, the medical profession, and we the consumers, to find a solution. Even then, it will not be easy.

Jess Sweely

Madison, VA

April 13, 2026