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An allegory for the broken U.S. health care system

Bhargav Raman, MD, MBA
Physician
December 9, 2025
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A Guide and a Seeker walk into a bar.

The Seeker says, “I’m so glad I’m here, I’ve been searching far and wide for good beer to slake my thirst, and you, my Guide, have finally brought me here!”

The Guide says, “Ah, I know just the thing. I’ll get you some Dos Equis. A merchant’s representative told me it’s the most interesting beer in the world!”

The Guide tries to order a pint of Dos Equis. The bartender goes into the backroom, then comes back and says, “The ledger says it’s not on your Seeker’s approved menu.”

The Guide half-expected this would happen, so he says mildly, “What must I do to get it approved?”

The bartender looks behind the Guide and points to a table where two suited figures sit. A few hundred-dollar bills lay carelessly on the floor below them. He says, “The one on the left is from the Beer Trader’s Guild. Ask him.”

The Guide approaches the table, “We’re having trouble securing beer for my Seeker.”

The Guild representative looks at the Guide without expression. “Dos Equis is not approved. Sam Adams is.”

“Sam Adams? But that’s not what she needs! I want to speak to another Guide!”

The representative gestures to another table. An older Guide in a tweed suit stands up and reads from a prepared statement. He doesn’t look like he’s ever served beer in his life. “There is no necessity for Dos Equis.”

The Guild representative checks his perfectly manicured fingers and says simply, “See?”

The Seeker, hearing all this, shouts, “I want to appeal! This is outrageous!”

Another Guide from yet another table approaches and reads from a prepared letter. “There is no meaningful difference in thirst-quenching between Dos Equis and Sam Adams. Determination upheld.”

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The first Guide, dejected, returns to the Seeker. He apologizes and gestures helplessly at the Guild. The Seeker draws a caricature of the representative and posts it on the bar notice board. “This man denied my Dos Equis that my Guide tried to get for me!!”

The outrage from the other Seekers in the bar was immediate, with comments like “How dare they!” and “Down with them!”

The Guild representative speaks briefly with the other suited figure, an unknown woman, sitting at his table. Then, he walks over and says, “Congratulations, we’ve made an exception for you. Dos Equis it is.”

The Seeker is ecstatic. Who wouldn’t want “The most interesting beer in the world”? She’s seen the ads all over the market square.

The Guide gets the beer from the bartender and tries to hand it to the Seeker. The representative says, “What are you doing? We will deliver it to you, and then you may give it.”

“But why? I can give it right here!” the Guide says.

The representative says, “No. You’re just trying to profit from the Dos Equis. Don’t think we don’t know.”

At this point, another figure wearing a Sam Adams-branded suit walks into the bar with a large bag of money labeled “Rebates” and drops it on top of the Guild representative’s table. Hundred-dollar bills fly everywhere, adding to the ones already lying ignored on the floor.

The Guide looks at the Guild representative with a smirk and says, “So are you.”

Meanwhile, the Master of the House, who owns both the Guide and the bar itself, overhears the conversation. He says, “It’s a safety matter, and we can charge whatever we want because we’re the only bar in this town!” He brings out a massive, dusty ledger titled the Charge Master and points to the Dos Equis price of $500 per pint. As he does that, the dim bar light catches the gold on his Swiss watch that’s just peeking out from his shirt sleeve. His gold watch just peeks beyond his shirt sleeve as he lays his hand on his heart, “We are a non-profit, charitable establishment, after all.”

The Guild representative laughs heartily, spittle splashing on the Master of the House’s face. The heated words quickly lead to a brawl. More and more suited figures who have nothing to do with actually serving beer join the fight. Crisp Benjamins fly everywhere, littering the floor just as much as they line pockets.

A lawmaker, wearing an ill-fitted suit clearly purchased on discount, tries to stop the fight, but a stack of bills is shoved in her pocket as she is told to stay out of it and do nothing. Instead, she stands on one of the tables and begins delivering her “five-point” plan to “fix everything,” the same speech she gives every election cycle, with minor variations.

Meanwhile, the unknown other woman at the Guild representative’s table is sitting quietly, a calculator in her hand. Her suit, resplendent and lined with gold thread, bears the insignia of the Purse-Keeper. She has been adding up the costs of everything from the beer to the brawl while conveniently forgetting the large bag of rebates on her table. Then, crucially, she adds 15 percent for herself.

She stands up and yells, straining to be heard above the din of the fight, addressing all the Seekers in the room. “Hear ye, Hear ye! I’m going to have to increase everyone’s membership fee by $50 so we can maintain free beer at this bar!”

Everyone groans, but they all continue drinking their Guild-approved Sam Adams. This happens every year.

Then she adds, “And it’s all HER fault.” She points to the wide-eyed lawmaker, and everyone, even the other suited figures, stops fighting and starts yelling at the lawmaker while clamoring for “more oversight” of everyone else except themselves.

Meanwhile, the Seeker still doesn’t have her beer, and she is now standing because her stool has been thrown across the room during the brawl. So, she walks out into the bitter winter cold and goes to the bar just across the border. The bar is quiet, friendly, and the beer is free. But she is not from here, so she pays just $5 in cash for Miller Lite.

It’s still beer, and she is thirsty.

Bhargav Raman is a physician executive.

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