Not just the healthcare system. Everything in the US is like this: Government bureaucracies (especially the ones the poor need to use), the legal system, the tax code, the educational systems. It goes on and on. Everything operates on the principle of "you better be able to fight for yourself, because no one else is going to." I'm always shocked when I encounter the rare instances when people in these positions actually help the people they're supposedly being paid to help, instead of putting in the absolute minimum of effort and cashing their paycheck.