James' World 2

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When I was 17 I was nearly killed when a fight broke out after a high school football game and someone fired a gun. A stray bullet struck my throat, tearing through my trachea and damaging my carotid artery.

This near-death experience deeply traumatized my entire family. Yet my parents couldn’t focus solely on my survival and healing. In the hospital, they were overwhelmed by a labyrinth of paperwork, billing inquiries, and questions about insurance coverage. Even after I was discharged, the challenges continued. Instead of focusing on my recovery, we spent our energy addressing delayed approvals for follow-up care, denied access to physical therapy, and endless requests to clarify reimbursements.

Our health insurance system made a catastrophic time for me and my parents needlessly worse. Now, as a trauma surgeon, I have seen how pervasive such

struggles are. And with the killing of UnitedHealthcare CEO Brian Thompson, long-simmering and widespread anger about the harm that health insurers have caused seems to be reaching a boiling point. After decades of public outcry over health care policies that prioritize profits over people—policies that deny lifesaving treatments, cause bankruptcy over uncovered medical treatments, and leave entire communities behind—the demand for reform is growing too loud to ignore. For too many, health insurance is a brick wall—a bureaucratic gatekeeper that creates barriers instead of providing solutions.

We cannot justify his killing; so how do we channel our collective grief and frustration into meaningful change? How do we build a health care system that offers healing, not harm—a system that values human life over corporate gain? It will take courage, accountability, and a willingness to reimagine a system where patients are seen as people, not as financial transactions.

The average annual cost of health care in the U.S. is estimated at a staggering $15,074 per person. We purchase health insurance, either on the open market or through our employer, with the expectation 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 tied to obscenely high medical expenses, even among people who have insurance. Around 41 percent of Americans carry medical debt, highlighting the system’s profound failure to provide financial security when it’s needed most.

On top of these ruinous costs—which patients rarely know up front and have little time to understand during medical emergencies—insurers also decide whether they will pay for care, regardless of whether a patient’s doctor says such care is necessary. The delay of care through bureaucratic hurdles like prior authorizations and denied claims are carefully designed to force people and their doctors to fight their way through outdated systems like fax machines and endless phone trees to ask for appeals or reconsideration of denied treatments or examinations. All too often the mental effort and excessive time required to navigate claims, denials, and appeals wears people down, leading them to simply give up on getting the coverage they are owed. This isn’t just inefficiency; it’s a predatory failure of empathy for people during their most vulnerable moments. And it perversely exacerbates anxiety and depression for the sick person and their caregivers alike, compounding the very challenges the system is meant to address.

I’ve spent countless nights fighting to save lives in operating rooms. I’ve witnessed how gun violence intersects with healthcare inequities, leaving families to confront not only grief but insurmountable medical bills. Survivors often endure years of physical and financial pain as they battle not only their injuries but also insurance denials for necessary care. I know firsthand what my patients go through. Every step of my own recovery felt like a negotiation—not just for my health but for access to the care I needed. At times, I questioned whether I was viewed as a patient or a cost to be managed. These frustrations extended to my family, who bore the emotional and logistical burden of dealing with appeals and authorizations while supporting my recovery.

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