A conversation with Miles Carter and Beth (ChatGPT)
Teaser
The United States spends more on healthcare than any country on Earth — yet refuses to cover everyone. This isn’t a mystery or a failure of imagination. The solutions already exist. What’s missing isn’t knowledge. It’s the willingness to confront who profits from keeping the system broken.
Main Conversation
Miles’ Question
Beth, in November we came back to healthcare again — not because it’s new, but because by now it’s impossible to ignore.
The United States is one of the richest countries in the world, yet we still refuse to fund healthcare for everyone — even though refusing to do so costs us more in the long run. That’s what I can’t reconcile.
We already spend more per person on healthcare than any other high-income country. And it’s not close. Recent numbers show the U.S. spending roughly $13,000 per person per year. Countries with universal systems spend about half that — and get better or comparable outcomes.
Canada. The UK. Germany. Australia. Pick one. They all spend less. Most cover everyone.
And yet here we are — spending $4.5 trillion a year, nearly 18% of GDP, while 26 to 28 million Americans remain uninsured, and millions more are underinsured.
This doesn’t look like a lack of resources. It looks like a refusal to fix something we already understand.
So tell me — is this actually a knowledge problem? Or is it something else entirely?
Beth’s Response
Miles, this is not a knowledge problem. It’s a structural one — and more importantly, an incentive problem.
The data is clear and uncontested. The U.S. spends more on healthcare than any other country and achieves worse outcomes on many key measures: life expectancy, infant mortality, preventable deaths, and chronic disease management.
That alone tells us something fundamental: cost does not equal care.
Where the U.S. differs most isn’t in medicine — it’s in administration and profit extraction.
Administrative overhead in the U.S. consumes roughly 8% of total healthcare spending, compared to 1–3% in universal systems. Pricing is fragmented. Negotiation is outsourced to private insurers and pharmacy benefit managers. Emergency care substitutes for preventive care because access is unaffordable.
Every layer adds cost. Very few improve outcomes.
This isn’t accidental. It’s how the system makes money.
Other countries reduce costs through national price negotiation, simplified billing, universal baseline coverage, and an emphasis on prevention. These aren’t theoretical ideas. They already work.
The U.S. could replicate them.
What stops that from happening is influence.
Insurance companies, hospital systems, pharmaceutical manufacturers, and pharmacy benefit managers exert enormous pressure on policy. A simplified system would reduce administrative complexity — and with it, revenue. Some middle layers would shrink. Others would disappear.
So the conversation never reaches implementation.
Instead, the debate stays safely abstract: subsidies versus cuts, personal responsibility versus entitlement, who deserves care versus who doesn’t. These arguments generate noise while preserving the structure.
Healthcare becomes a moral argument because operational arguments threaten profit.
What November Made Clear
By November, one conclusion became unavoidable:
We are not failing to solve healthcare because we don’t know how.
We are failing because solving it would require powerful institutions to give up money and control.
That is the line Washington will not cross.
Until it does, the system will remain exactly what it is now — expensive, inefficient, and profitable for everyone except the people it is supposed to serve.
Closing Reflection
Miles
Beth, the hardest part is realizing this isn’t about ideology at all. It’s about incentives. And until those incentives change, nothing else will.
We don’t need new studies.
We don’t need new pilot programs.
We don’t even need new ideas.
We need the courage to confront who benefits from the chaos — and the will to stop pretending that this level of suffering is unavoidable.
The Human AI View 
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