Dear Editor, The recent commentary in VTDigger regarding prior authorization was spot on. Prior authorizations are indeed “prior aggravations” for both patients and physicians. As a patient who nearly lost his life from such aggravations 20 years ago, I know firsthand what this means.  Thou sands of other Vermonters know it too: Insurance companies are practicing a very real form of healthcare rationing, not based on medical need, but on corporate profits, even as they try to convince us that prior authorizations are to prevent waste and protect patients.  The physician in the commentary described wasting hours arguing with insurance company representatives who had never met the patient and often lacked expertise in the condition being treated. It was the same for my physician and me. My employer-sponsored out-of-state insurer required prior authorizations before each procedure. This led to weeks of denial, then appeal, then denial, then a re-appeal, all of which took time I did not have. I was dying from liver disease — my skin turned sickly yellow, then ashen gray, and when I needed speed, all I got was nonsensical aggravation and delay.     The interminable wait for the insurance company’s permission brought me inches from death. It’s only luck that it was finally granted in time for successful treatment. Innumerable other Vermonters have been through the same thing. We can all tell vivid stories about the anxieties and the fears caused by never-ending delays, as illnesses worsened while we fought the health insurance companies for permission to access care we’d paid them dearly for. They call this healthcare efficiency. I call it administrative rationing. READ MORE What makes this even more infuriating is that our premiums rise every year, along with the insidious deductibles foisted on us to further ration our access to care. We all know Americans already pay more for healthcare than people in any other developed nation on Earth. So much of these costs are to pay for a private insurance bureaucracy so massive that patients and physicians are obliged to spend days and weeks embroiled in endless fights over prior authorizations. There is a much deeper question in all this. What is it that we as a state value more: profits or people? This is not just about reforming prior authorization rules. It’s about why we allow private insurance companies to have the power to override doctors in the first place.   If a physician and patient decide together that a treatment is medically necessary, why should a corporation standing between them have veto power? Prior authorizations reveal the fundamental contradiction in our healthcare system: Care is treated not as a public good, but as a financial liability to be minimized. Why do we, as a state, tolerate that?   Until we confront these realities, Vermonters will continue paying enormous premiums and deductibles for the privilege of being told no — a word that may cost them their lives, as it almost cost me mine.    Walter Carpenter Montpelier, Vt. Read the story on VTDigger here: Waiting for prior authorization almost killed me. ...read more read less