The middleman you can't vote out™

The problem with American healthcare, said plainly, is too many middlemen; and the sharpest form of it is the one you can't vote out. Between you and your doctor sits an insurer, a pharmacy-benefit manager, a billing company, a claims-approver; you chose none of them, you can remove none of them, and each is paid on the spread between the two ends. That is why care curdles into selling and phishing: the middleman's incentive was never your health; it's the transaction. You fund the entire apparatus, premiums and taxes and all of it, which is the obligation of a citizen; but over the middleman you hold only the power of a customer, and in a system you cannot actually leave, that is no power at all. Representation turned inside out: you pay like a citizen and you're governed like a subject, by an office the Constitution never named and the ballot can't reach. One human, one vote; except there is a corporation in the middle nobody elected, holding a veto over your care that can't be voted out because it was never voted in (the invulnerability test: the thing that can't be hurt, standing between you and the thing that can). The fix is subtraction, not addition; cut the middleman and the vote comes back. That is the honest core under Medicare-for-all, and under handing your records back to you instead of the portal. Count the hands between you and your care; every one is a toll you pay and a vote you don't get. (His coin; machine's read, refine to his.)