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Without pre-auth, the patient has gotten the treatment and now "someone" is going to get stuck with the bill. With pre-auth, the patient can be denied treatment. Both of these are bad outcomes of course, but which is worse depends on the urgency of the treatment. When the insurance company lodges a (specious) objection to cancer surgery, their negotiation tactic could literally kill the patient. Also without pre-auth, the patient has more leverage; it's the provider who is on the hook if nothing is done, and the provider has lots more skill dealing with the insurance company. With pre-auth, the patient is just stuck it the provider won't dispute it and they can't deal with the company themselves. They have zero leverage dealing with the insurance company, since they're not the customer.
You could make a state-funded lender of last resort for such cases.
If you're denied then the state advances the funds at the same cost that would have been charged to the insurance company. The loan becomes non-dischargeable and the state is able to garnish wages and seize assets should it become necessary.
They also assume the right to represent the patient to the insurance company and demand payment. Should the treatment have actually been approved according to the insurance policy, the insurer has some penalty big enough to incentivize them not to play denial games and to keep the lender solvent.
This could lead to interest rates being a function of insurer denial accuracy. If it's very likely the state will recover from insurers, interest rates could be very low. If insurers are exceptionally accurate and you're very unlikely to recover, then insurance rates could approach the same as any unsecured loan for a person of your creditworthiness.
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I mean, the patient likely can get the treatment regardless (see also the main NYT article). Doing so with a not-yet-settled pre-auth battle is approximately equivalent to doing so without a pre-auth battle at all.
This isn't really true, though. If they get the treatment without the pre-auth completed and agreed (or none done at all), and the insurer ultimately denies it after-the-fact, the patient still owes the bill. There's still a whole range of things that can occur with the resulting cluster of a negotiation after-the-fact. The only thing that I see that has changed is that services have already been rendered, the patient is now potentially liable for a gigantic bill, and the negotiation for who actually pays what just hasn't happened yet. The patient has even less leverage, because they've already agreed to buy the thing. They almost certainly can't un-buy the thing. They're purely at the mercy of the other parties to decide how much they're going to get stuck paying.
If you do it without pre-auth, the insurance company's next move will be to say you violated their pre-auth policy so they're not obligated to pay in any case. They may or may not get away with that, but it's another line of defense between the provider and the insurance money.
Yes, the patient owes it. But they can simply... not pay it. Especially true if they can't pay it. Then the provider is stuck with the bill, or sells it to some shady medical debt collector for rather less than face value.
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