A System That Devours Its Own: Why Patients Are Set Up to Fail
Part I: What Patients Already Know
“Experience declares that man is the only animal which devours his own kind…”
— Thomas Jefferson
If you’ve ever felt like the system is working against you—it’s not just a feeling. You’re navigating a structure that wasn’t built with your clarity or continuity in mind. Instead, it’s a layered machine where each part—insurance, hospitals, pharma, providers—moves in pursuit of its own metrics. And when those layers misalign, it’s the patient who gets crushed.
Healthcare rewards those who already understand how to use it. Not because they’re better patients, but because they’ve figured out the system’s unspoken rules. They know who to call, when to ask, and how to phrase a request so it doesn’t get dismissed. They know to say “I’d like to escalate this,” rather than “Can someone help me?” because language, in this system, signals power—and persistence.
“A bad system will beat a good person every time.”
— W. Edwards Deming
We tell patients to “advocate for themselves,” but we rarely teach what that means. Too often, it becomes another way to offload responsibility: if you can’t get an appointment, can’t get your records, can’t get coverage—well, maybe you didn’t try hard enough. Maybe you weren’t organized. Maybe you didn’t ask the right way.
But many patients who “succeed” in getting care only do so because they’ve had to learn the system the hard way. They’ve been bounced between departments. They've waited on hold through lunch breaks. They’ve sent follow-up faxes, tracked down referral coordinators, and documented every call. They didn’t get better care because they were more compliant. They got it because they became system-fluent under pressure.
And this isn’t just about personal initiative. It’s about structural design.
“Be it said in passing, that success is a very hideous thing. Its false resemblance to merit deceives men… Everything lies in that [silver spoon].”
— Victor Hugo
We mistake system literacy for moral worth. We see someone who gets the appointment or the test or the callback and assume they must be doing something right. They must be organized, respectful, proactive. But more often, they’re just lucky—or experienced. They’ve been through this before. Or they have time off work. Or they have a spouse who helps coordinate care. Or they live close enough to the clinic to drop in when the portal fails. Success in healthcare isn’t about virtue. It’s about access.
And that access is often shaped by incentives the patient never sees.
The Economics Behind the Frustration
What the system doesn’t say out loud is that many of its inefficiencies are not accidental—they’re built-in. Insurance companies often benefit from delay. A 2022 KFF report found that one in six in-network claims is denied by insurance companies under ACA plans, and even more are delayed for prior authorization—a process that often disproportionately impacts patients with complex or chronic conditions1.
On the provider side, payment models reward complexity. A study in Health Affairs noted that current fee-for-service structures often incentivize more intensive care for sicker patients, while preventive care and coordination remain undervalued2. So when your symptoms aren’t “severe enough,” you may not get priority—not because you don’t need help, but because the system doesn’t yet see you as “billable enough.”
“Let us never fear robbers nor murderers. Those are dangers from without, petty dangers. Let us fear ourselves. Prejudices are the real robbers; vices are the real murderers.”
— Victor Hugo
The danger isn’t a single rude staff member or missed message. It’s the inertia of a structure that works just well enough to continue, while quietly wearing down the people it’s supposed to serve.
What Patients Need to Know
In a better system, none of this would be your job. But until then, being your own advocate means learning the language, tools, and escalation pathways that make the system take you seriously.
It’s okay to:
Ask who is responsible for a next step.
Clarify what department you need to speak with.
Use firm, direct language: “I’d like to escalate this issue,” or “Can I get a reference number for this request?”
Keep a record of who you spoke with, when, and what they said.
“The guilty one is not the person who has committed the sin, but the person who has created the shadow.”
— Victor Hugo
The person on the phone isn’t your enemy. They’re often just another human inside a broken workflow. You can offer them grace and still expect action. You can be respectful and persistent. That’s not being a difficult patient—it’s being an informed one.
You don’t have to fight. But you do have to show up prepared.
What We Believe at Storyline
We created Storyline because we’ve seen too many good people—smart, caring, organized people—fall through the cracks of a system that expects them to know too much and ask too little.
We believe your health shouldn’t hinge on whether you know what CPT code to ask for or how to phrase your top concern. We help patients:
Organize their medical records and appointments in a way that’s clear to them and their providers.
Understand the structure behind their care so they can ask better questions, earlier.
Create summaries and documentation that spotlight the right issues at the right time.
Move from feeling overwhelmed to feeling equipped.
Because your story matters. And it deserves to be told clearly.
Clarity isn’t just a luxury—it’s a form of safety. And we’re here to help you claim it.
References
Tolbert, J., Rudowitz, R., & Ammula, M. (2022). Coverage Denials and Appeals in ACA Marketplace Plans. Kaiser Family Foundation. Retrieved from: https://www.kff.org/medicare/issue-brief/coverage-denials-and-appeals-in-aca-marketplace-plans/ ↩
Berenson, R. A., & Ginsburg, P. B. (2020). Improving Payment for Primary Care: Lessons from the Field. Health Affairs. https://doi.org/10.1377/hlthaff.2020.00761
