Kill thousands for profit -> no need to care, move along, no one is at fault and nothing of importance really happened

Kill one that is responsible for the former -> you must preface your discussion with hundreds of references to murder being bad, and clearly and unambiguously condemn the monster that did this

Humans really do have a bias where doing something small-scale but visceral causes horror and outrage, but doing 1000x that harm by building slow and boring bureaucratic machines of death is not noticeable because, after all, the machine isn't literally putting a gun to the face of the victims, so it's all fine.

Yes. It's the cost of doing business. Why is it that when we talk about the justice system, we think it's better to let a hundred criminals go free to avoid punishing an innocent, but in healthcare suddenly it flips and now it's better to have a hundred people be denied life-saving treatment to avoid one person getting an unnecessary one?

Your hypothetical is frankly insane - nowhere in the world, despite the dozens of types of medical systems, is there a crisis of doctors ordering frivolous multimillion dollar treatments just for fun. There is no incentive for them to do so. Your entire argument hinges on something that doesn't actually happen, just to defend an evil that already exists in the world.

Outrageous idea, but we should trust the people who studied for over a decade to administer medication to decide what medication a person needs, and pry the hands of private business off that process entirely. If someone misuses the system or prescribes obviously wrong treatment, go after that individual. If in 30 years it turns out that doing this does actually cause doctors to order random treatments for fun, then we can talk about scaling it back. Until then, for-profit healthcare is not to be trusted.

Most people do not get to choose their own insurance company, they just get whatever their job picks. Most big companies have directors and officers that personally benefit when a particular insurance company does well. The market is completely broken.

Insurance is an arbitrage leach at best, and extortion at worst. It provides no value to society.

Without insurance Market prices would drive down the cost of healthcare.

In the real world, not a hypothetical, your market driven approach ensures they approve the minimum necessary to prevent customers from leaving. They require patients to to fight them for coverage while they're undergoing cancer treatment, because a dead patient they didn't pay out for is more profitable. Paying for insurance in a for-profit marketplace isn't paying for health coverage, it's paying for a CHANCE at health coverage, and you better be willing and able to fight for that chance while you're undergoing cancer treatment/surgery, or be willing to go bankrupt, or not get the treatment and die. That's the choice the insurance marketplace presents to you.

Not hyperbole, many such stories. My own father in law died in part because his private medicare advantage plan refused to approve in-patient rehab after a brain surgery that every MD working on him said he needed, but would have cost 6 figures out of pocket that nobody could front. The grim irony is he later tried to get out of bed to use the bathroom, couldn't support his own weight and suffered a skull fracture that resulted in a second brain surgery inside of a week, and that was fully covered.

I'll take the bureaucrats. The real world shows they're simply better at this, and Ayn Rand is simply wrong.