OPINION:

The assassination of UnitedHealthcare CEO Brian Thompson triggered a disturbing avalanche of sympathy for his accused killer, often laced with sarcasm about health insurance systems for prior review for many services and claims reimbursement.

UHC is a large multistate insurer subject to scrutiny for its generally high denial rates. A Senate Committee concluded that UHC, Humana and CVS, which owns Aetna, were denying claims for nursing care for patients recovering from falls and strokes to boost their profits.

Dealing with health insurance companies to preauthorize treatments and address claims issues, even when resolved favorably, can be tedious and frustrating.

Doctors complain that headaches from dealing with insurance companies are getting worse. Many have sold their practices to private corporations and become employees to avoid the hassles.

Critics have used the Thompson tragedy as an indictment of Obamacare. A recent Gallup Survey indicates that only 44% of Americans rate our health care system as good or excellent, down from 62% just before the 2010 passage of the Affordable Care Act.

What is overlooked is why we have this system and the difficulty of making the decisions about pricing and rationing needed to reform it.

The ACA was intended to provide quality coverage for virtually all Americans, either through mandated employer group coverage or private insurance for individuals with income-defined subsidies, and to bring health care costs under control.

The poor and elderly have Medicaid and Medicare, with seniors accessing well-defined supplemental plans for provider fees and drugs.

The share of uninsured Americans is about 8%, approximately half of what it was just before the ACA, but on costs and quality, it’s a mixed bag.

Before the ACA, health care spending was rising as a share of the gross domestic product. Since its inception, it has held steady at about 17%, even as the population increased by about 10%.

We spend 40% to 63% more than peer nations such as Germany, the Netherlands and Britain as a share of GDP.

We compare with the quality of care quite favorably. Still, we rank near the bottom on accessibility, such as imposed by insurers’ approval processes, and outcomes, measured by avoidable deaths and life expectancy.

Competition alone can’t fix the system because we don’t let prices ration health care.

We view it as a basic entitlement like elementary and secondary education, not a commodity like designer shoes. But the system can’t permit everyone to receive the care they want.

For example, 42% of the population is obese. Letting everyone who wants Wegovy, at $1,350 a month, have it becomes a cost and emotional issue. Is overweight a problem of weak character or a medical problem?

Rationing is inevitable, for example, by setting age limits for treatments such as kidney transplants and limiting access to certain drugs.

In the public debate leading up to the passage of the ACA, it became apparent that many Americans who had insurance did not want to give it up in favor of a public, single-payer system like the British National Health Service. They sure didn’t want a government bureaucracy making decisions about treatments.

A complicated, arcane system emerged, like in some places in Europe, but with important omissions.

In Germany and the Netherlands, mandatory systems of nonprofit funds and private companies are funded by a payroll tax, and employer and employee premiums are adjusted according to income.

Prices are capped. That’s why they get away with paying much less than we do for drugs that are costly to develop, and we implicitly subsidize their prescription drugs. The treatments covered are fairly well-defined: The government coordinates the rationing through those requirements.

Here, insurers compete on price, range of coverage — subject to minimum requirements defined for bronze, silver, platinum and gold plans — scope of in-network physicians and facilities and how tough they are in applying coverage rules.

An insurer can be tough with high denial rates or by making approval processes so time-consuming that patients give up. That’s our crude and nasty form of private rationing.

The only real answers to high costs, bureaucratic hassles, arbitrary treatment and claim denials are for the government to regulate prices and arbitrate exactly what people are offered.

On prices, it has been so long since we have had anything resembling free markets that the best solution may be to impose on providers, hospitals and facilities competition with their German counterparts by setting our prices and coverage standards equal to theirs.

That would impose wrenching adjustments on the business practices, incomes and profits of doctors, hospital bureaucracies and drug companies.

Ultimately, we might find that drug companies would be inspired to demand higher prices in Europe and other high-income countries, but we shouldn’t subsidize them.

• Peter Morici is an economist, emeritus business professor at the University of Maryland and a national columnist.