of course the system was designed. of course there were design choices. it's a system implemented and executed by human beings at every step, constantly. every functional atom of this implementation was a conscious choice by someone. if nothing else, a choice is constantly being made to persist with the present system.
yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context.
this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives.
yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented.
we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
Sure, the healthcare system is "designed and perpetuated" by all of its participants, in the same way that poor labor practices in Asia are perpetuated by Walmart cashiers.
Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it.
The only people who can change it are voters and congress themselves.
> The only people who can change it are voters and congress themselves.
Most of the participants in the system are eligible voters, so asserting that voters can change the system is very much asserting that nearly everyone in the system has agency to change it.
(The fact is “voters can change it” is optimistic, because the US is not a direct democracy and, due to gerrymandering, campaign finance, and other factors, only loosely a representative one, being functionally more of a plutocracy. The people who benefit from its inefficiencies and inequities have disproportionate power over its structure.)
yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context.
this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives.
yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented.
we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.