Healthcare in America, whether we are talking about the provider costs or the insurance that does not cover all the provider costs, is outrageously expensive. Paying the bills after your treatment is often a worse experience than the emergency that brought you into the doctor’s office to begin with.

Everyone wants an easily identifiable enemy for their woes (It’s all Trump’s fault, right?), but attempts at demonizing individuals inevitably overlook the fact that most of our problems result from people “just doing their jobs” at hospitals, clinics, and doctor’s offices where the incentives are not in the patients’ best interests—a problem that has been many decades in the making.

Our nation’s healthcare systems are, on the whole, staffed by nice, normal, caring people who are stuck with following priorities that boil down to the following: maximize profits and avoid being sued. Unfortunately, these goals are largely divorced from the business of patient care, and produce outcomes that are frustrating and costly when someone’s body breaks down. 

For example, if you call your doctor and indicate you are suffering from terrible back pain, the instant response will be that you must schedule an appointment. It does not matter that you just spent 2 hours shoveling the snow out of your driveway and are likely suffering from muscle strain; to just call in a prescription for a pain reliever or muscle relaxer is out of the question because (a) the treatment protocol requires that you or your insurance company be billed for an office visit and (b) they need to ensure, 

so there is no chance a lawyer will be knocking on their door with a lawsuit, that you are not actually suffering from a rare form of bone cancer rather than the aftereffects of heaving snow around.

The sympathetic nurse you speak to on the phone is hamstrung by protocols that drive the average person dealing with normal health problems to despair because the patient’s options boil down to (a) continue to suffer while waiting for an appointment to become available in a few weeks or (b) pay through the nose to go to an Emergency Room and sit in a hard plastic chair for eight hours, waiting to be told you strained your back shoveling snow. Both of these paths will bullet-proof the provider against litigation while starting down the road to a parade of diagnostic tests and office visits that will maximize profits while eliminating the remote possibility that your back strain in actually a sign of a fatal condition. 

It is no surprise that the inevitable result of this runaround is that the vast majority of potential patients resort to a few beers and miss several days of work, but such is the reality of our incredibly expensive and often unresponsive healthcare system. Those who insist that the cure is more spending—pouring more money, for example, into the fiscally ruinous disaster of Obamacare—do not want to address the truth of the matter: Our healthcare systems are loaded with incentives and expenses that have little to do with the well being of patients or their wallets and consistently put even the most basic medical care tantalizingly out of reach for most.

Ensuring that health insurance and pharmaceutical companies enjoy continued record profits is not the same as helping Americans obtain prompt and reasonably-priced healthcare, but the campaign cash that wins elections is arriving thanks to the money generated by denying patients needed medical care and charging $500 for a bottle of pills that it costs 50 cents to manufacture. Your balky hip or chronic migraines are simply the vehicles for all manner of businesses to generate obscene profits from the slow decomposition of your body.

The pundits and experts who were shocked at the unmitigated glee that followed the shooting of United Healthcare’s CEO roughly a year ago, much less the celebrity treatment his accused murderer received, engaged in a lot of pearl clutching and tut-tutting about the lack of sympathy Americans felt for the victim, but they typically failed to understand that so many feel victimized by exorbitant premium payments, onerous co-payments, and inhumane denials of coverage for care. Many of us are just plain fed up, and the angry cruelty of those who obviously felt no sympathy for the overpaid head of a vast—and vastly profitable—healthcare company was wrong but understandable. 

The only person angrier than a serf who cannot afford medical care is a serf who cannot afford medical care for their sick child or spouse, which is as succinct an explanation as possible of how desperation turns into rage and an attraction to extremist politicians who are selling a Marxist fantasy to Americans who have reached the point of wanting revenge for all the ways our corrupt and wasteful leaders have failed them. Unless we want to continue to live in a nation where attorneys and accountants determine whether we or our loved ones live or die, we have to engage in a teardown and rebuild of our healthcare systems that will lead to howls of dismay from those currently enriching themselves—while double daring our well-bribed elected leaders to pull the rug out from under them. Wringing the unbelievable waste, fraud, and anti-competitive practices out of our healthcare systems is going to cut salaries and eliminate many, many jobs—and a refusal to continue to subsidize the death spiral of Obamacare is a good place to start—so we can expect a ferocious pushback from those who are currently making a mint on our misery. 

It is, sadly, more than likely that our nation will simply continue to limp toward a fiscal abyss because real reform will also expose just how deeply implicated our “caring” politicians have been in making certain we receive very little care for our money. It is horrible, but it is all true; follow the money and learn. The American healthcare is designed to do everything but keep us healthy—and financially solvent.