All sushi is not created equal.

If I brought you a tray of gas station sushi, you’d have a different experience than if we went to the best sushi chef in town. So different that it’s a stretch to even consider them the same food. One will probably make you sick, and the other is good for you.

The cartelized, monopolized, credential-driven world of health care operates under the fiction that all sushi is interchangeable. Except not sushi, but providers and specialists.

You see a doctor. They ask questions, don’t listen too well, check a few items off their list like robots, and do one of two things: tell you to take some drugs or go see a specialist. They don’t know much about the risks and effectiveness of the drugs, as they’ve outsourced most of their critical thinking to standards and practices imbibed in the system. And they act as if the specialists offer uniform ability and quality; like every source of sushi is the same.

Since you can’t see a specialist without a referral – a practice largely intended to give generalists more business and ration specialists time since price-rationing is all but non-existent in the quasi-socialized system – you need to see a general practitioner first. They send some paperwork to a specialist office and tell you you’ll get a call for scheduling. It doesn’t matter which office or which specialist within that office. They tell you nothing about their ability or quality and you’re not supposed to ask. The entire medical profession must maintain the fiction that each practitioner in their field – since they all memorized the same dated, badly incentivized, doubtful textbooks – is an interchangeable widget.

The absurdity of this notion may be better expressed with spouses than sushi. Is every woman an equally fit spouse for every man and vice versa? “Here, marry this person. They are a woman/man.” That’s pretty much how it goes in health care.

But the deviation in quality of care is extreme. Granted, a majority of doctors are likely to provide the same brand of WebMD quality disinterested regurgitation. But the right doctor can literally save your life, while the wrong can take it. This is not exaggeration. Medical error is the number three cause of death in the US. And that’s just direct error. How many lengthy treatment regimes result in a death that is not technically “medical error” but could’ve been avoided with a better doctor?

There’s not much in the way of market accountability, price transparency, or responsiveness to the customer. The health care industry is too intertwined with bureaucrats whose every edict is backed by threat of violence and who have the ability to confer massive money to anyone who jumps through their hoops, regardless of the outcomes they produce for patients.

Humans are radically different. Bodies are incomprehensibly complex and unique. The uniformity of the medical market is a government failure. Often a deadly one.