When he was 17, a fight broke out after a high school football game and someone fired a gun, nearly killing him. A stray bullet hit him in the throat, tearing out his windpipe and damaging his carotid artery.
This near-death experience deeply traumatized my entire family. But my parents couldn’t just focus on my survival and healing. At the hospital, they were overwhelmed with complex paperwork, billing inquiries, and insurance coverage questions. The challenges continued even after I was discharged from the hospital. Instead of focusing on my recovery, we spent our energy dealing with delays in approvals for follow-up care, denials of access to physical therapy, and constant requests for clarity on reimbursement.
Our health insurance system has put me and my parents into unnecessary misery. Now, as a trauma surgeon, I have seen firsthand how prevalent such struggles are. And with the murder of UnitedHealthcare CEO Brian Thompson, long-simmering widespread anger over the harm caused by health insurance companies appears to be reaching a boiling point. Calls for reform after decades of public outcry against health care policies that put profits over people – policies that deny life-saving treatments, drive bankruptcies with uninsured medical care, and leave entire communities behind. The voice is now too loud to ignore. For too many people, health insurance has become a brick wall, a bureaucratic gatekeeper that creates barriers instead of providing solutions.
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We cannot justify his murder. So how can we channel our collective grief and frustration into meaningful change? A health care system that heals rather than harms, one that values ​​human life over corporate profit. How do we build a system that values ​​patients? This will require courage, accountability, and a willingness to rethink systems that view patients as people rather than financial transactions.
Average annual health care costs in the United States are estimated to be $15,074 per person. We buy health insurance on the open market or through our employers with the expectation that when we need a doctor’s visit or treatment, our insurance will cover most, if not all, of our costs. But nearly two-thirds of bankruptcies in the United States are related to prohibitively high medical costs, even for people who have insurance. Approximately 41 percent of Americans have medical debt, highlighting the system’s profound failure to provide financial security when it’s needed most.
In addition to these catastrophic costs (which patients rarely know about in advance and have little time to understand during a medical emergency), insurance companies have to decide whether the patient’s doctor says the treatment is necessary or not. Regardless of whether or not you decide whether to pay for your treatment. Delays in treatment due to bureaucratic hurdles such as prior authorization and claim denials mean people and their doctors have to rely on faxes, endless telephone lines, and other channels to challenge or request reconsideration of denied treatments or tests. Carefully designed to force you to struggle through outdated systems. Too often, the emotional effort and excessive time required to file a claim, denial, or appeal can leave people so exhausted that they simply give up on receiving the compensation they are entitled to. This is more than just inefficiency. It is a predatory failure of empathy when people are at their most vulnerable. And it exacerbates anxiety and depression for sick people and their caregivers alike, exacerbating the very challenges this system is meant to address.
I spent countless nights in the operating room fighting to save lives. I have witnessed how gun violence and health care inequities intertwine, leaving families facing not only grief but also insurmountable health care costs. Survivors often endure years of physical and financial suffering, battling not only their injuries but also the denial of insurance to receive the treatment they need. I know firsthand what patients are going through. Every step of my own recovery felt like a negotiation, not just for my health, but to get the care I needed. At times, I wondered if I was seen as a patient or as a cost to be managed. These frustrations extended to my family, who took on the emotional and logistical burden of dealing with appeals and approvals while supporting my recovery.
For many, financial burdens force impossible choices. Families forego optimal treatment and rehabilitation plans. It’s not because they don’t understand, it’s just because they don’t have the money. These compromises worsen patient outcomes (and increase systemic costs), exacerbating suffering that could have been avoided if appropriate care had been received. Too often, hope is eroded by a system that values ​​profit over happiness.
Fixing this system will require a fundamental rethinking of its foundational principles of care, equity, accountability, and cost. Addressing costs is essential. It threatens the stability of our health care system, and the economic burden should not fall disproportionately on people who need health care and their families.
Our policy decisions must reflect our values. Therefore, we must ask ourselves: Are we ready to expand insurance coverage so that all Americans have access to affordable, quality care? Can we accept higher premiums and co-payments to create a system that prevents medical care and wasteful care? Beyond insurance coverage, simplifying and streamlining processes that overwhelm patients and families? We need to eliminate unnecessary bureaucratic hurdles. Equity must be a core pillar not only in access, but also in the quality of care provided and the financial protection provided.
Recognizing the important role of the mind in physical recovery and overall well-being, mental health needs to be integrated and prioritized alongside physical health in care and protection. The insurance industry’s excessive profits, soaring drug prices, and opaque billing practices demand accountability and shared responsibility among healthcare providers, insurers, pharmaceutical companies, and policy makers. And finally, insurance companies and clinicians alike must be held accountable. Rather than short-term cost savings, we must take responsibility for improving outcomes, providing compassionate care, and ensuring that patient health initiatives do not lead to financial ruin. Must be. These reforms are not only necessary if we are serious about building a system that values ​​human dignity over profit. They are long overdue.
The return of Donald Trump to the presidency and Republican majorities in both houses of Congress raises the prospect of such sweeping health care reform over the next four years, especially expanding access through government programs. Possibilities become more limited. Rather, the focus is likely to shift further toward deregulation, market-driven solutions, and reducing government involvement in health care, rather than the pursuit of universal health coverage and increased subsidies. Efforts to repeal or even weaken the provisions of the Affordable Care Act (ACA) may resurface, along with predatory policies promoting short-term health plans and ineffective state-level controls over Medicaid. is high.
Reducing prescription drug costs may remain a bipartisan goal, but broad reforms aimed at equity, simplification, and expansion of mental health care may stall unless aligned with cost-reduction strategies. be. The challenge is to ensure that patient needs, especially those of the most vulnerable, are not sidelined in policies that prioritize fiscal conservatism and market efficiency over systemic change.
We urgently need to build a fairer system. Insurers should limit out-of-pocket costs, eliminate lifetime limits, and expand income-based aid so Americans who are suffering can focus on healing and recovery.
My own dissatisfaction with the system shaped my determination to drive positive change. Although these times require difficult reform and introspection, they also present an opportunity for change. Our health care system should bring hope, not increase suffering. Patients, clinicians, policymakers, and payers must come together to prioritize care over complexity, outcomes over optics, and people over profits.
This is an opinion and analysis article and the views expressed by the author are not necessarily those of the author. scientific american.