In the wake of the shooting of UnitedHealthcare CEO Brian Thompson, many people have cheered the assassination as a well-deserved comeuppance. I completely understand, and I have plenty of issues with how all health insurance companies operate. Quite frankly, I detest these people.

Tempting though it may be, street justice is always a dangerous precedent and won’t pay for a single person’s healthcare. Sadly, I doubt we will be able to intimidate our way to a more just and equitable health system. I do hope this awakens executives in the health insurance industry to what I used to hear on the phone every day when I worked there: the level of extremely justifiable anger toward their practices.

One of the accompanying stories about this regards the reversal of a policy my former employer, Anthem Blue Cross and Blue Shield, planned to implement regarding anesthesia. Was Anthem scared straight after the CEO of one of their competitors was gunned down? Was the shooter a vigilante hero who actually accomplished something positive?

We may not like the idea of obtaining prior authorization for medical services, but it is an important check on providers wasting money on unnecessary services. Anthem’s unpopular medical policy about anesthesia time is actually important to force anesthesiologists to follow standards of care. With so much money on the line, not all doctors are working with your best interests in mind.

Health insurance is an inflection point in our healthcare system, but we should also understand that everything we hate about health insurance is a result of the skyrocketing costs that underlie healthcare. If your premiums go up, you’re angry. If the insurance industry denies your claim, you’re angry. If your deductible goes up, you’re angry. If your doctor goes out of network, you’re angry.

But remember that insurance is strictly regulated. The Patient Protection and Affordable Care Act actually added more regulations for insurers that require them to spend at least 80% of the premiums they receive from a group on claim payments or issue refunds. It’s not 80% of what they get from each individual because insurance is about spreading risk among many individuals.

Insurers are also required by law to maintain large cash reserves so they can be relied upon to pay out claims, even if those are larger than their actuaries expect. This is for good reason. If claim payouts are higher than expected, premiums must increase in order for them to stay afloat. Even non-profit insurers face these same issues and tradeoffs.

So, what’s the bottom line? People need to be realistic about the power health insurance companies have and how they may be the symptom rather than the disease. The real disease is that healthcare services in the USA cost much more than they do abroad.

Personally, I don’t blame health insurance companies for following their legal obligations to balance premiums, deductibles, and claim payments based on actuarial value. It really is just math, and they really are bound by the law.

Where I do fault them is in their political activity. Like many industries, the health insurance lobby (particularly a group called America’s Health Insurance Plans) aggressively lobbies the government to support industry profits.

Clearly, the system (or non-system) that the USA employs has failed patients and left them in mountains of debt. As much as health insurance companies want to control costs, when doctors and hospitals threaten to leave their networks, their members get angry and call in to people like me (in my previous life). But those members don’t understand that the network dispute is about how much the doctor or hospital is going to get paid. The more the insurance pays out in claims, the more they have to raise premiums and deductibles just to keep up with the claim payments and their legal obligations.

These providers play the different insurance companies off each other to give themselves leverage against the insurance companies. The largest provider organizations continue to swallow up smaller clinics, smaller hospitals, and smaller physician groups so they can grow larger and larger. The larger the provider group, the greater the disruption if they go out of network. It becomes an arms race with the insurance companies that also grow ever larger so they can have more leverage in the opposite direction. But that hasn’t played out, as healthcare costs continue to skyrocket.

And so, the health insurance industry needs to resign itself to the fact that it can’t solve our nation’s problems. It should stop pretending otherwise.

What can solve it? A single-payer system that forces doctors and hospitals to accept lower reimbursement rates, risk-adjusted capitation instead of fee-for-service payments, and puts a lid on unnecessary procedures. Fraud is a real and expensive problem in Medicare and Medicaid, and it usually comes from doctors.

A single-payer system also has the advantage of being redistributive. We can tax people based on how rich they are instead of charging everyone the same amount whether they can afford it or not. So, the rich subsidize the poor, and I think the redistribution is the best part of all.

In the meantime, perhaps we should cut the health insurance industry at least a little slack and attack the root causes of the USA’s inept, wasteful healthcare system.