I think this is a bit of a naive take. First off I agree 100% that their employees are not deserving of death so let's get that out of the way here. I'm not trying to argue that murder here is justified.
But the take that purchasing insurance is a simple two-party agreement of willing participants who have options to go elsewhere is just purely naive. This is not a simple financial product like buying life insurance or car insurance or fire insurance for your house where you go shopping and buy or don't buy.
In the United States, there are just no other choices. You get health insurance as part of your employement (typically), which is insane on the face of it. The government (basically) does not provide health as a service, even though it would seem that health is as fundamental a service as it gets.
Health Insurance companies are for-profit entities whose absolute incentives are to maximize financial return to their shareholders, not maximize health in their policyholders. And whether they say it explicitly or not, the way you maximize financial return as an insurance company is take in more money than you pay out. And in situations where you have some amount of leeway over whether to pay out or not, the way you do that is try to pay out as little as possible and deny claims as much as possible. That's just pure logic.
This is not "did your house burn down" or "did you car crash" or "did you die" binary type of stuff with typical insurance. This is nuanced decision-making, all with an overarching goal is maximizing financial return and minimizing claims paid. Period.
While a specific person at a health insurance company may not be evil, and while the business itself may not be evil, the net result of the entire end-to-end system can absolutely be quite evil.
Again, the default state of the world is "no insurance or free healthcare at all". You absolutely have a choice – to not buy health insurance and always pay for your own healthcare costs.
The result of health insurance is that people who could otherwise not afford to pay their own healthcare costs frequently can (but not always, when claims are denied). In turn, people who are healthy (and lucky) subsidize those less fortunate than themselves. This is not evil, this is good. This is something humans have invented to make us stronger as a collective.
You can argue that a society should do more to proactively provide healthcare so that you don't need a private health insurance system, but that doesn't then make the private system bad.
Why should the rates always be the same? Different insurers can make different decisions about who they insure and what they insure and how they insure. This would (entirely reasonably) result in different rates of claims and whether or not they are accepted/denied.
