There is so much entropy in health care right now.  So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock.  Shock at prices, shock at waiting times, shock that doctors don’t know how to increase referrals, shock that doctors aren’t doing more to help.  What gives?

In triage, you don’t spend time with the expectant.

Doctors are keeping their heads down.  They are still seeing patients.  They are still going to work and taking the calls.

But they are tired.  They are frustrated by the system that puts the system of care before the people doing the caring and those needing care.  They are tired of the empty promises.  Like the promises that staring at a keyboard will fix things, do things better, save money.  It’s complicated, this health care thing, right?  We are told we need more automation.  We need more quality managers.  We need more safety officers to see more people with less to keep it safe.  We need more administrators to implement the rules: more people willing to take less to make it work.  Complicated, I tell you.

But the promises, we’re learning, have been part empty, for they have enriched the system for the system’s sake while leaving the people the system is supposed to help, increasingly broke.  We’re $500 billion over budget so far and counting.

Promises are for politicians and business people.   Real health care workers don’t make promises, they do the best they can with what God gave us.  As patch after destructive patch of interweaving laws and back-slapping favors are handed out in Washington, corporate board rooms, and union meeting halls, a silent health care majority watches from their peripheral vision, trying not to notice, trying not to be disgusted, for the work for them never ends.

The silent majority is waking to the fact that the business part of health care was, is, and somehow forever shall be, broken.  There is simply too much money involved, too much economic return that can still be made, too many opportunities to deceive others for personal gain, too many people, too many workers, too much of our economy, to accept that things will ever really change.  Too very, very big to fail.

Like Detroit.

I sit before a computer screen that says, “Order entry:”, I no longer need a pen thanks to handsome government subsidies and a push to centralize and nationalize.  Let others do the deciding.

I type in an order.

Five choices instantly appear based an a sophisticated word-search algorithm.  I find what my patient and I, as their caregiver, need.  I click on the item.

But a price never shown.  So there is never a discussion about cost.   That’s the intent.  There is never a word about the difference of retail price and what it really costs or what you’ll really have to pay.  Like a shopping spree without the prices.  Because, according to others, doctors should not think of these things when health care is involved, nor should Congress – it’s about your health, remember?

So thousands and thousands of your dollars are put at risk, dear patient, with a single click of a button. Courtesy of government subsidies.  And you will never know.   Nor will I, as I load the gun of your economic destruction.

So efficient.  So clean.  So tidy.

How was I supposed to know I ordered a collection agency for you, too?

But the silent majority is stirring.  They are upset they must pay their mandate, upset the corporate guys don’t.  The are seeing the bills, the denials, and the undecipherable bills.  They are seeing the cost.

The silent majority is stirring.

Because they have a check box, too.

In November, 2014.

Wes Fisher is a cardiologist who blogs at Dr. Wes.