Plenty of executives are being investigated for backdating options. But no one is getting as much attention as Dr. William McGuire, who is retiring as chief executive officer of United-Health Group Inc. after doubts arose about the scheduling of $1.8 billion in options he received.

The reason for this scrutiny is clear to anyone who has ever ripped open an envelope with an insurance carrier’s emblem on it. Dr. McGuire and his board and management allies pinpointed dates to maximize Dr. McGuire’s gain. Time and money were at the center of a game played to give the former pulmonologist exquisite advantage.

Time and money are also at the center of a game that gives many Americans exquisite disadvantage — the health-insurance game. Every adult has a story about hours lost working through insurance approval regimes, and another about the anxiety over procedure coverage, or how and when a company will pay for a procedure that it has approved.

Some of the most unpleasant seconds of modern life are spent listening to a hospital payments department refuse responsibility for chasing elusive insurers.

Last June, around the time the McGuire story was heating up, Physicians Practice, a trade magazine, published an index that it had created with athenahealth, a physician-billing service.Looking at thousands of claims by doctors at seven national insurers, the authors quantified the grim counterpart to Dr. McGuire’s timing game.

They found that the average time from when a doctor billed an insurer to date of payment was more than 37.7 days, seven days longer than the standard period among merchants and tradesmen. In the West — Colorado, Utah, California — doctors waited 44 days for payment. Many insurers demanded that numerous bills be resubmitted, another way of delaying payment.

Insurers also denied coverage for one in 10 procedures already completed, buying themselves a break by forcing even legitimate claims to appeal.

Right there among the master stallers was Dr. McGuire’s UnitedHealth. UnitedHealth denied more claims, on average, than five of the other insurers including Cigna Corp., Champus/Tricare, and Humana Inc. Only Aetna Inc. was worse.

UnitedHealth was more likely than any other insurer except Cigna to say that a claim submitted by a physician was “not on file” — lost in the system. This even though the category included electronic claims — and electronic claims systems are the sort of innovation that earned Dr. McGuire praise.

The rebuttal here is “Hey, that’s the market.” Dr. McGuire was so highly compensated precisely because he made UnitedHealth so successful at such tactics.

That argument made sense in the past.

Back in the early 1990s, everyone knew that something was wrong with the growth of Medicare and Medicaid, the governmentbacked medical insurance plans for the elderly and the poor. In those years the country bet that forgoing traditional fee-for-service for more cost-conscious insurance would yield a better deal for everyone over the long term.

Politicians would write strong free-market laws on health insurance, or at least preclude the expansion of the public sector. Innovative insurers and health-maintenance organizations also were part of the bet. Only with the aid of clever regional companies from places with quaint names like Minnetonka could Washington take on the somnolent giant of Medicare. In a number of instances, doctors like McGuire were involved, which lent credibility to the exercise.

It is time we re-examine the terms of that contract. It is safe to assume that no one expected an insurance CEO to claim 10,000 times more in compensation than the average doctor’s annual take-home pay — Dr. McGuire’s feat — before the health-care market became free and competitive.

Yet that is what happened because Washington failed to write sufficiently free-market laws. Even today many Americans find it hard to switch providers without switching jobs. President Bush and Congress increased government’s role in the health-care market with their Medicare program for drugs.

None of this has been Dr. McGuire’s doing. But he and other industry leaders did go along, talking the language of entrepreneurs even as they wrote lucrative contracts with Washington. In its second quarter this year, United-Health saw strong enrollment by its customers in Medicare’s new drug benefit, helping to drive up profit by 27%.

UnitedHealth now covers 70 million citizens. Such growth hasn’t come in the way everyone imagined. The new millions in health-care profits were supposed to be the result of scientists’ innovations, not expert dunning and cost shifting.

Dr. McGuire is emblematic of the self-deception of the era. It’s telling that he made his money not from the practice of medicine but for management.

“When a physician goes to United to say ‘pay me more,’ and United says ‘no,’ the physician has no recourse,” Pamela Moore, author of the Physicians Practice story, said. “The physician needs United because United has all the patients. To say ‘no’ to United is to say ‘no’ to a large percent of the business.”

To make a scapegoat of one figure or company is wrong. If Dr. McGuire’s backdating action was legal, he shouldn’t be punished. The drop in UnitedHealth’s share price since Dr. McGuire’s troubles began suggests that shareholders believe that his interests aligned with theirs.

The McGuire story has its own timing, which reminds us that health reform is itself overdue. The envelopes keep coming, so why wait?

Miss Shlaes is a visiting senior fellow at the Council on Foreign Relations and a columnist for Bloomberg News.