By Decay or Design
Note: I recognize there are more pressing issues in American politics right now—like the deportation of U.S. citizens to a Gulag in El Salvador. That one deserves its own post. For now, pin it. Protest it. Call your representatives. We’ll circle back to it later. On with today’s post:
I went to the doctor the other day—finally. I’d been putting it off, but I made sure to go to an in-network provider. I called both my insurer and the doctor’s office to confirm.
The visit went well. I liked the doctor. They ordered lab work, so I went to Labcorp and gave them my blood.
And then I got a bill for $700.
Turns out, while the doctor was in-network, Labcorp wasn’t.
For fuck’s sake.
Then, during the same phone call—where I learned about the $700 bill—I also found out my insurer wasn’t covering the doctor’s visit. No reason. That’s literally what they said.
$500 more.
So why the FUCK do I pay for health insurance?
The arbitrariness, unfairness, and sense of being repeatedly sucker-punched by health insurance conglomerates is enough to make anyone want to burn the whole system down. But it also raises the obvious question:
Why the hell do we do it this way?
And then I remember: because the people in charge make a lot of money.
This is what the U.S. system is designed to do. It’s an extractive machine—purposefully or coincidentally—built to move wealth from the bottom to the top.
Once you accept that, a lot of things start to make sense.
Our system isn’t broken. It’s working exactly as intended. You just have to ask: for whom?
Remember your Howard Zinn. Your Naomi Klein. Your Noam Chomsky. This system was never intended to optimize for the health, leisure, or well-being of the average American. If that was ever part of the deal, it's certainly not anymore. Our institutions increasingly bend to the whims of oligarchs and billionaires.
But here’s the thing: it doesn’t have to be this way.
There are two obvious ways to notice this:
Look at how other developed countries do things.
Look at where the U.S. ranks on international metrics that matter—lifespan, infant mortality, crime, happiness, peace, etc.
I like to ask myself this thought experiment:
Let’s say you got to choose what country you were born in—but nothing else. Not your race, gender, income level, or health. Just the country.
Would you pick the United States?
Or would you check some stats first?
Let’s see.
Average lifespan in the U.S.? 77.5 years. Around 50th in the world. (Monaco is #1 at 87 years.)
Healthspan gap—that is, how long people live with chronic disease or disability at the end of life? In the U.S., it’s 12 years—about 30% worse than the global average. Twelve years of misery at the end of life. Yikes.
Let’s check the basics. Maslow’s hierarchy: food, water, shelter.
Food security? According to the Global Food Security Index (which factors in affordability, availability, and quality), the U.S. ranks 13th. Not awful. But considering we have the biggest economy on Earth? Should be better.
Water security? We’re 3rd. That tracks—most of us don’t think about water scarcity on a daily basis.
Shelter? Let's talk homelessness. The U.S. ranks 47th globally. That means 46 countries have fewer homeless people per capita than we do. That's not just disappointing—it's shameful.
How about something more abstract, like happiness?
World Happiness Report: The U.S. ranks 24th.
Freedom Index: 56th.
Safety? 89th.
Global Peace Index? 132 out of 163.
Yeah. That tracks.
We don’t just redistribute wealth from poor to rich domestically—we do it internationally too. That’s part of the U.S. brand.
So what the hell is going on here?
Are we just a nation of bad people? No—I don’t buy that. I firmly believe most Americans are good. But something went wrong.
Or maybe nothing went wrong. Maybe it was designed this way.
Does it matter?
In recovery circles, there’s a saying: When your house is burning down, that’s not the time to figure out how the fire started. It’s time to get out of the house.
That doesn’t mean leave the country.
It means: turn on the goddamn fire hoses.
Whether by design or decay, we’re in an ugly place. But we can do better.
And we have the money. We definitely have the money.
The U.S. GDP is $27 trillion.
China, in second place, is at $18 trillion.
On a per capita basis, we’re still top 10.
So if other countries—who spend less—get better outcomes, the problem isn’t money.
So what am I proposing?
Not that I move to Denmark (though it’s tempting). I’m proposing two things:
Reverse the direction of wealth flow.
Start learning from the countries that outrank us.
That’s the journey I’m beginning here.
Call it a “superficial comparison” if you want—this is just me Googling for a couple hours. But I’m going to dig into how other countries handle the things that we clearly don’t. How we might reimagine our society—not in some utopian fantasy—but in ways that make life objectively better for a lot of people.
Not tonight, though. Tonight, I’ve got to go call my insurance company.
Thanks for reading. Good night.
— The Next Night —
So, I called my insurance company.
Turns out the mistake was partly mine. I fixated on the term “in-network,” assuming that meant coverage. But apparently, even in-network services are only covered for urgent or emergency care when you’re out of state.
Kinda my bad.
But the rep I talked to was kind and helped me file an appeal.
Does that mean my argument about the broken system no longer holds?
I don’t think so. There are innumerable instances of people being denied coverage unjustly. For example after example, watch Michael Moore’s documentary Sicko and me know what you think.