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Americans will not see single payer healthcare (Medicare for All or another iteration) any time soon due to greed. Too many people profit off the hard labor of clinicians, particularly of physicians. No, it is not physicians raking in the large paychecks, for that you will have to look to chief executive officers of insurance companies, hospitals, pharmaceutical companies, device manufacturers and healthcare systems. The profiteers. These are not the people delivering the care.

Physicians gave their power away decades ago, and our organizations did nothing to protect us. In fact, the larger organizations helped create the systems we now have. The only people benefitting are the executives and stockholders. Don’t expect it to improve anytime soon.

The way physicians are taught is not conducive to changing the system. Our focus is the patient, the disease process — we cannot dirty ourselves with profit and loss, or cost structures. We naively invited the business people in to do that work for us. They gleefully took over.

We have not learned. While the rest of the industrialized world enjoys universal healthcare and does not worry about how to pay for care when they are ill, Americans go broke. Physicians are treated as commodities and squeezed harder and harder as they break. Physicians are centered on empathy and compassion and capitalism has taken every advantage.

Fewer independent physician practices now exist, which is detrimental to patients (and costs). Reimbursement rates continue to decline with no recourse, which puts physicians in untenable positions: stop taking insurance plans, become an employee, retire, change careers, or find additional income. This is true insanity. With at least 11 years training for each physician this is also an incredible waste of talent and resources.

Now we have mid-level practitioners being churned out by online schools, which is not a replacement for physicians nor the answer to the increasing shortage of physicians. Mid-level practitioners, such as nurse practitioners and physician assistants order more tests, refer to more specialists clogging the pipeline for necessary care, and increasing costs. Where midlevels practice without supervision, care is often stunningly inadequate resulting in complications of chronic medical conditions that are otherwise preventable.

As long as we continue to elect politicians who are turning America into an oligarchy, our system will worsen. American medicine is but a symptom of the greater illness. The founders of the United States envisioned a Federalist Republic. They put in protections against the corruption humans are prone to. Despite this, we are witnessing our own downfall. We are watching as these checks and balances fail.

So yes, I am painting a depressing, realistic picture. Until we as a nation hold politicians accountable for representing everyone nothing will change. Unless physicians take medicine back the spiral continues. There are some small starts: direct primary care (physician run) is one answer to the catastrophe that has become American medicine, but the trajectory is worsening before improvement. Despite the fact that the majority of Americans would favor a single-payer system such as Medicare for All, we do not elect representation that will enact these proposals. Change takes action. Right now we have inertia.

Is this the end of America as we know it? Has capitalism failed all but a few? Are we witnessing the fall of the Republic? Time will tell. I do think things will get worse, particularly for our patients. Treatments will become harder to afford, not because those delivering the care are being paid better, but because money is diverted to those that have learned to work the system the best. American exceptionalism indeed.

Cathleen London of Milbridge is a family medicine physician.