American Harmcare: The System Working Exactly As Designed

I’ve been a brain cancer survivor longer than most insurance executives have been in their jobs. In that time, medicine, technology, and survivorship have leapt from cassette tapes to streaming, from appointment reminder postcards to patient portals and apps. Health insurance, meanwhile, still feels like a mixtape you have to rewind with a pencil and hope the tape doesn’t snap.

Let’s be clear on something: insurance is not healthcare. It is a financial product whose business model depends on saying no more often than yes, or making “yes” so convoluted, delayed, and opaque that it might as well be a no. That’s not me being cynical; that’s me reading denial letters with people whose lives are on the line. Of course it works that way. Because #America. Good times.

Every year, insurers roll out new buzzwords that sound like innovation and choice: “value‑based,” “narrow networks,” “utilization management,” “step therapy,” “site of care optimization.” On paper, it’s a TED Talk about efficiency and outcomes. In real life, it’s code for “we’re going to make it harder for you to get what your doctor says you need, and we’re going to pretend it’s for your own good.” It’s the healthcare equivalent of blowing into a Nintendo cartridge and insisting that’s “maintenance.” We all know it never really fixed anything, but we kept doing it because what else were we supposed to do.

Patients don’t experience “policy levers.” They experience sabotage. They experience a prior authorization that takes longer than the time between scan and surgery. They experience a lifeline drug denied because someone, somewhere, flipped a spreadsheet cell from green to red and called it “updated criteria.” They experience a surprise out‑of‑network bill because the hospital was covered but the anesthesiologist’s LLC was not, a plot twist nobody asked for. They experience a “case manager” who calls once, leaves a voicemail, and then vanishes while the bills quietly march into collections.

None of this is a glitch. This is the product working exactly as designed. American healthcare isn’t broken; it was built this way, on purpose, to maximize profits over people and then gaslight us into believing that we, the patients, are the problem for not “navigating” it better. We don’t have healthcare. We have American Harmcare.

Thirty years into this, I’m not asking the system to find its conscience; it doesn’t have one. What we can do, and what I will keep doing, is name the harm, document every denial and delay, and use our collective rage as leverage. We stop treating these stories as unfortunate one‑offs and start treating them as evidence. We stop begging the machine to be nicer and start insisting it be rewired in our favor.

Don’t fix the system. Rig it. File this under We The Patients. And no, we’re not done making it uncomfortable.