The incremental nature of change makes it difficult for us to notice how systems that once worked well with modest costs have transmogrified into broken systems that cost a fortune. Exhibit # 1 is higher education: 40 years ago, four-year public universities were affordable and two-year community colleges were almost free. Now students have to borrow $1 trillion to pay for the exorbitant privilege of higher education.

And no, the difference isn't that states don't provide the same funding--the difference is costs have soared while the yield on the investment has plummeted. Please read:

The Mafia State of Mind

Our Two Most Onerous Taxes: College Tuition and Healthcare Insurance

Our Middleman-Skimming Economy

America's Make-Work Sectors (Healthcare and Higher Education) Have Run Out of Oxygen

Longtime correspondent Ishabaka (an M.D. with 30+ years experience in primary care and as an emergency room physician) responded to this article with an insider's account of what happens when greed and cartels take over healthcare. After reading What's wrong with American hospitals?, a scathing deconstruction of for-profit healthcare, Ishabaka submitted this commentary:

I could have told you what was wrong with our hospital system by 1989 - nobody would listen to me back then.

Up til the '70's, almost all hospitals in the United States were not for profit COMMUNITY HOSPITALS. They were LOCAL. The Board of Directors was made up of some senior doctors, maybe the head nurse, and various other prominent local businessmen and professionals. Others (mostly Catholic), were run as non-profits by religious orders. A very few, mostly very small hospitals were for profit, usually owned by a group of doctors, or even one doctor.

The mission of these community hospitals was to provide for the LOCAL COMMUNITY - one and all. Payment was various - private insurance, Medicare, Medicaid, self pay - and the idea was to collect just enough money to keep the hospital going, and provide care for the poor who had no money to pay. If your grandma got bad care - you could go - in person - to the local, say, banker, on the Board of Directors, and tell him - and he would CARE.

THIS SYSTEM WORKED, and kept costs DOWN. Remember, the hospital just needed enough money to stay in the black. Often local wealthy people would will money to the hospital in which they had been cared for.

In the '80's - there was the arrival of the for-profit cartels - and I use the world cartels specifically - these were run by people with the sociopathic Goldman Sachs type mentality - their sole goal was to acquire huge sums of money for themselves, their hospital directors, and their SHAREHOLDERS. They used a typical sneaky technique - they'd come into town, and tell the locals they could run the hospital much cheaper, because of their economy of scale. People believed this, and the cartels bought out most of the community hospitals.

I worked at one such for-profit hospital and had a 21-year old indigent man come in who'd been struck by a car while walking, and was rapidly bleeding to death. The hospital administrator refused to open the operating room, even though I had a surgeon right there, willing and able to operate for free to save this young man's life. The surgeon threw a fit, and he was a big wheel at the hospital and the administrator backed down - otherwise I firmly believe the young man would have died. This was LEGAL back then, before the EMTLA law was passed because similar abuses were rampant NATIONWIDE.

Around this time, the administrators of the remaining community hospitals found out the administrators of the for-profit hospitals were making tens of times their salaries - and bonuses based on profits - and started demanding similar salaries and bonuses based on PROFITS - a contradiction of the old concept of community hospitals (the article does touch on this).

How do you increase hospital profits? Number one - avoid any care for the poor you can weasel out of. Number two - cut staff to the bone and beyond (one of hospital's biggest expenses). Most American hospitals now have UNSAFE nurse to patient ratios because of this.

As far as patient care goes, nurses are the most important people in hospitals. I know of one lady who DIED while in a monitored bed, and wasn't found dead until several hours later due to the criminally low nursing staff ratio in a hospital I worked in. I HAD complained about the dearth of nurses, and was threatened with the loss of my job. Another side effect of this is, nursing in hospitals has become unbearable for nurses who really cared about their patients - many good hospital nurses have left hospital work for other fields. The results are appalling.

I saved the life of a patient an unqualified, under-educated nurse gave the wrong medicine to - a medicine that IMMEDIATELY MAKES YOU STOP BREATHING, because it was cheaper for the hospital to hire her than a knowledgeable and experienced nurse. The medicine is pancuronium bromide, if you want to Google it. The nurse didn't know one of the effects was cessation of breathing - this is Pharmacology for Nurses 101, this drug is used all day long in every operating room in America (where doctors WANT patients under anesthesia to stop breathing, and put them on breathing machines during the surgery - which is very safe if done correctly).

I could go on and on. Simple things, like the instruments you use to suture cuts - community hospitals used to buy Swiss or German made ones that were of the finest quality, sterilize and re-use them over and over. This changed to disposable instruments that sometimes literally fell apart in my hands. Bandage tape that didn't stick, instead of quality Johnson and Johnson tape - anything to save a buck.

It is not getting better, it is getting worse. The nurses I know tell me hospitals are cutting staff even MORE now in preparation for Obamacare.

I will end with a story that illustrates the difference between Old School and New School hospital administrators.

I had the pleasure of working five years in a real community hospital. One of the senior administrators (R.I.P.) was a gentleman who'd made his fortune in the grocery business. In his late 80's, he would arrive at the emergency department entrance every morning between seven and eight am, and proceed to walk throughout the hospital. He would ask various and sundry staff how they were getting along - everyone from janitors to senior physicians. If something was amiss - HE RECTIFIED THE SITUATION. Tragically, this hospital was bought out, and is now part of a chain.

I had the displeasure of working in a "community" (really for-profit) hospital with a middle aged administrator who NEVER set foot outside his office or conference rooms - he NEVER appeared in the (very large and busy) emergency department once. This was in the early 90's, and one year it was revealed that his compensation was $600,000 - and a brand new Lexus as a "performance bonus". He was on the golf course by three pm every single day. That was the hospital where the woman who was being "monitored" (alarms and all that) was found very cold and dead after a delay of who knows how many hours.

Thank you, Ishabaka, for telling it like it really is. Needless to say, ObamaCare (the Orwellian-named Affordable Care Act--ACA) purposefully ignores everything that is fundamentally broken with U.S. sickcare and extends the soaring-cost cartel system, essentially promising to stripmine the taxpayers of however many trillions of dollars are needed to generate outsized profits for the cartels.

Only those with no exposure to the real costs of ObamaCare approve of the current sickcare system. Government employees who have no idea how much their coverage costs, well-paid shills and toadies like Paul Krugman, academics with tenure and lifetime healthcare coverage--all these people swallow the fraud whole and declare it delicious.

Only those of us who are paying the real, unsubsidized cost know how unsustainable the system is, and only those inside the machine know how broken it is at every level. Greed + cartels = Sickcare/ObamaCare. Love your servitude, baby--it's affordable, really, really, really it is.