When I was 17 I almost got killed when a fight broke out after a high school football game and someone fired a gun. A stray bullet hit my throat, tearing my windpipe and damaging my carotid artery.

This near-death experience deeply traumatized my entire family. Yet my parents couldn’t just focus on my survival and recovery. At the hospital, they were overwhelmed by a maze of paperwork, billing requests and questions about insurance coverage. Even after my release, the challenges continued. Instead of focusing on my recovery, we spent our energy dealing with delays in approval for follow-up care, denial of access to physical therapy, and endless requests for reimbursement clarification.

Our health insurance system unnecessarily made a catastrophic time worse for me and my parents. Today, as a trauma surgeon, I have seen first-hand how pervasive these struggles are. And with the murder of UnitedHealthcare CEO Brian Thompsonwidespread, long-simmering anger over the harm caused by health insurers appears to be reaching a boiling point. After decades of public protest against health policies that prioritize profits over people – policies that deny life-saving treatments, bankrupt people from uncovered medical treatments, and leave entire communities behind – the The demand for reform is becoming too strong to ignore. For many, health insurance is a brick wall, a bureaucratic gatekeeper that creates obstacles instead of providing solutions.

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We cannot justify his assassination; So how can we channel our collective grief and frustration into meaningful change? How can we build a healthcare system that offers healing, not harm, a system that values ​​human life over corporate gain? It will take courage, responsibility and will to reinvent a system in which patients are seen as people and not financial transactions.

The average annual cost of healthcare in the United States is estimated to be a staggering amount. $15,074 per person. We buy health insurance, either on the open market or through our employer, hoping that if we need to see a doctor or undergo treatment, our insurance will cover most, if not all, of the expenses. Yet nearly two-thirds of U.S. bankruptcies are linked to obscene medical expenses, even among people with insurance. Around 41 percent of Americans carry medical debt, highlighting the system’s profound failure to provide financial security when it is needed most.

In addition to these ruinous costs – which patients rarely know in advance and have little time to understand in the event of a medical emergency – insurers also decide whether they will pay for care, even if the patient’s doctor believes that care are necessary. Delay in care due to bureaucratic hurdles like prior authorizations and denied requests is carefully designed to force people and their doctors to navigate outdated systems like fax machines and endless phone lines to request appeals or reconsideration of refused treatments or examinations. Too often, the mental effort and excessive time required to deal with claims, denials and appeals exhausts people, causing them to simply give up on getting the coverage they are owed. It’s not just about inefficiency; it’s a predatory failure to empathize with people in their most vulnerable moments. And it perversely exacerbates anxiety and depression in the ill person and their caregivers, thereby worsening the very challenges the system is designed to address.

I spent countless nights fighting to save lives in operating rooms. I have witnessed first-hand how gun violence intersects with health care inequities, leaving families facing not only heartbreak but also insurmountable medical bills. Survivors often endure years of physical and financial suffering as they struggle not only with their injuries, but also with the denial of insurance for necessary care. I know first-hand what my patients are going through. Every step of my own recovery felt like a negotiation, not only for my health, but also for access to the care I needed. Sometimes I wondered if I was considered a patient or a cost to manage. These frustrations extended to my family, who shouldered the emotional and logistical burden of processing appeals and authorizations while supporting my recovery.

For many, financial hardship forces impossible choices: families forgo optimal treatments or rehabilitation plans, not out of lack of understanding, but because they simply cannot afford them. These trade-offs lead to worse patient outcomes (and even higher systemic costs), thereby worsening suffering that could have been avoided with adequate access to care. Too often, hope is eroded by a system focused more on profits than well-being.

To fix this system, we must radically reconsider the principles of care, equity, accountability, and cost that underpin it. It is essential to tackle costs; it threatens the stability of our health care system, and the financial burden should not fall disproportionately on people in need of health care and their families.

Our policy decisions must reflect our values, and so we must ask ourselves: Are we prepared to expand coverage so that every American has access to high-quality, affordable care? Can we agree to higher premiums or shared costs to build a system that guarantees subsidies to those who need them most while avoiding wasteful or unnecessary medications? Beyond coverage, we must simplify and streamline processes, eliminating unnecessary bureaucratic hurdles that burden patients and their families. Equity must be a key pillar, not only in terms of access, but also in the quality of care provided and financial protections offered.

Mental health must be integrated and prioritized alongside physical health in care and coverage, recognizing the essential role of the mind in bodily recovery and overall well-being. Excessive insurance industry profits, rising drug costs, and opaque billing practices demand accountability and shared responsibility among providers, insurers, pharmaceutical companies, and policymakers. Finally, insurers and clinicians must be held accountable, not for reducing short-term costs, but for improving outcomes, providing compassionate care, and ensuring, within reason, that no treatment pathway patient’s health does not lead to financial devastation. If we are serious about building a system that values ​​human dignity over profit, these reforms are not only necessary; they are long awaited.

With Donald Trump returning to the presidency and Republican majorities in the House and Senate, the likelihood of such sweeping health care reform over the next four years becomes more limited, particularly with regard to expanding access through government programs. Instead, the focus will likely be more on deregulation, market-driven solutions, and reducing government involvement in health care, rather than on seeking universal coverage or an expansion of subsidies. Efforts to repeal or further weaken provisions of the Affordable Care Act (ACA) will likely resurface, as will predatory policies promoting short-term health plans and ineffective state control of Medicaid.

Although reducing prescription drug costs remains a bipartisan goal, broader reforms aimed at equity, simplicity, and expansion of mental health care risk stalling unless they align with strategies cost reduction. The challenge will be to ensure that the needs of patients, particularly those of the most vulnerable, are not left behind amid policies that prioritize fiscal conservatism and market efficiency over systemic change.

We urgently need to create a more equitable system. Insurers must cap out-of-pocket spending, eliminate lifetime limits, and expand income-based assistance, so affected Americans can focus on healing and recovery.

My own frustrations with the system have shaped my determination to bring about positive change. This period requires difficult reforms and introspection, but it also offers an opportunity for transformation. Our health system must inspire hope, not increase suffering. Patients, clinicians, policymakers and insurers must come together to prioritize care over complexity, outcomes over optics, and people over profit.

This is an opinion and analysis article, and the opinions expressed by the author(s) are not necessarily those of Scientific American.