“Delay, Deny, Defend.” These chilling words were reportedly engraved on bullet casings found at the scene of the barbaric murder of UnitedHealth CEO Brian Thompson. While the public was rightfully shocked by the brutality of the crime, some could not help reflecting on the system that might have inspired such actions.
Despite the alleged motivation behind Thompson’s horrifying murder, some have asked if this crime is partly the tragic and predictable consequence of a healthcare system that has handed life-and-death decisions over to ethically-challenged impersonal bureaucracies. How did we get here?
For much of human history, medical decisions were deeply personal, made by individuals and their families who controlled their resources and bore the consequences of their choices. However, in the past century, we’ve embraced a flawed assumption: that healthcare resources are infinite and that outsourcing their allocation — whether to governments or private insurance companies — could eliminate the hard realities of scarcity.
By placing these decisions in the hands of third parties, we’ve deluded ourselves into thinking we’ve avoided tough choices. Instead, we’ve ceded control over life-altering decisions to disinterested third parties, whose decisions may engender anger and resentment.
This abdication of responsibility stems from a collective discomfort with rationing. We insist that “no one should have to make these kinds of decisions” — and so governments, eager to appease voters, have stepped in with supposed solutions. Yet, these efforts only shift the burden elsewhere. Unable to directly manage the complexity of rationing care, governments have outsourced this responsibility to private insurance companies, which are then left to grapple with the same dilemma: limited resources versus infinite needs.
To avoid being seen as villains, insurers have developed strategies like “pay-for-performance” programs, which incentivize doctors to reduce costs. While seemingly pragmatic, these programs erode the doctor-patient relationship, replacing trust with suspicion. Doctors become reluctant to ration, patients feel betrayed, and the adversarial dynamic undermines the very foundation of effective care.
In our attempt to shield patients from the realities of rationing, we’ve instead subjugated them to the whims of faceless bureaucracies. The result is a system rife with frustration, anger, and, in extreme cases, violence.
The only rational and ethical solution is to return decision-making power to the patients themselves. This does not mean abandoning insurance or government assistance. Rather, it requires reimagining these systems to support — not supplant — patient autonomy.
Promising approaches like indemnity plans and Health Care Sharing Ministries, are more cost effective and demonstrate how this can work.
Indemnity plans, such as those offered by Atlas Direct, reimburse patients a fixed amount for medical needs — e.g., $3,500 per day for hospitalization — without dictating how or where the care is provided. Patients can then decide how to allocate these funds, with any additional costs covered through personal resources, family, friends, charitable contributions or other inexpensive supplemental catastrophic expense coverage similar to short-term limited-duration plans.
This approach places control back into patients’ hands. For instance, would a patient choose a $4,000 MRI knowing their plan reimburses only $1,000 when a $350 alternative is available? Would they prioritize competent care over luxury, selecting a hospital with reasonable costs over one with marble countertops?
Similarly, Health Care Sharing Ministries, such as Samaritan Ministries, reimburse patients for medical expenses while leaving care decisions entirely to the individual. These models ensure patients remain central to the decision-making process, rather than sidelined by insurers.
Both systems emphasize reimbursing patients — not providers — aligning healthcare coverage with its original purpose: a hedge against financial catastrophe. They reject the notion that insurers or bureaucracies should act as surrogate decision-makers.
The murder of Brian Thompson was a barbaric act. Yet it also symbolizes the frustration and despair fostered by a system that denies individuals control over their own healthcare. By ignoring the reality of finite resources and outsourcing critical decisions, we’ve created a system that often produces inefficiency and resentment.
To move forward, we must accept the uncomfortable truth that rationing is inevitable. But instead of entrusting these decisions to faceless entities, we must empower patients to make choices for themselves. Only by acknowledging these realities can we design a healthcare system that is both humane and sustainable.
Chad Savage, M.D. (chad.savage@
This Story originally came from humanevents.com