The power of health insurers to deny care must be abolished. In the case of for-profit insurers, it constitutes a conflict of interest that can inflict huge financial debt on patients and sometimes carries deadly consequences. America’s largest health care insurer reveals the conflict in sharp relief. UnitedHealthcare is five times the size of its nearest competitor. Under the recently assassinated CEO Brian Thompson, its claim-denial rate hit 32%, twice the industry average. The company covers 50 million Americans, with over 120,000 in Maine, making this our problem. Every Mainer has either faced fear of health care insurance denial or knows someone who has.

None of these facts justify Thompson’s murder. He paid the ultimate price – as have too many of his patients. Other insurance CEOs have removed their online profiles, fearing retribution. If we are going to seize this moment for change, we owe it to everyone to succeed.

Because corporations have a fiduciary duty to make profits for their shareholders, the conflict of interest cannot be corrected by imploring insurers (or raging at them) to act in the patients’ best interests. With health care insurers, investors come before patients. Pleas to reverse these priorities, even if temporarily successful, will hit the brick of this structural reality.

Nonprofit health care insurers have fewer incentives to deny care, but they can still abuse that power. No patient should face denial if a doctor has approved a treatment. And especially not after it has been administered.

But today, doctors can offer no such assurance. Any prescribed treatment can lead to hours of both patient and doctor battling insurers to secure needed care. All too often, they fail.

Insurers must treat patients as customers. It’s our money; we have the right to know what treatment will cost us, if anything, before we buy. Achieving that simplicity will take time. Ending insurers’ right to deny is an important step forward.

Banning claim denials would leave insurers with one recourse: take the provider to court. But the onus would be on insurers to convince a judge or jury that it should not cover a treatment. Court-mandated denials would carry the independent stamp of approval from the justice system.

However, restricting insurers’ ability to deny could worsen a health care-provider conflict of interest. Our fee-for-service system, where the more providers treat the more they get paid, creates a built-in incentive to bill for unnecessary care.

One solution is capitation payments, where providers are paid lump sums to look after a group of patients, reducing incentives to overtreat. Another tool is medical review boards to assess provider practices. Adjustments are made for the future without saddling patients with surprise bills after treatment. There is precedent for these: review boards already exist in some states to monitor excessive opioid prescriptions.

But if raging against health care insurers won’t provide lasting relief, how do we eliminate insurers’ power of denial? Social movements – including marriage equality and overturning Roe v. Wade –  provide lessons, regardless of whether their victories align with our politics. In the case of marriage equality, the idea kept being reintroduced over years until public approval shifted. The tide turned and President Barack Obama switched his position. Initially, during his 2008 campaign, he opposed gay marriage. In 2010, he acknowledged that “attitudes evolve, including mine.” By May of 2012, likely recognizing the LGBTQ community’s large constituency, he switched. Backing same-sex marriage helped him win reelection.

Anti-abortion activists also spent decades, in their case, chipping away at Roe by pushing state restrictions and legislation banning so-called partial birth abortion instead of focusing solely on overturning the decision. They helped set the stage for President Donald Trump’s election and his appointment of Supreme Court justices instrumental to Roe’s defeat.

The lessons are clear: patient persistence can change the world. Any campaign to abolish insurers’ power to deny care must transcend the heat of this moment to forge a lasting movement.