Paying for the trifecta of doom

The U.S. is one trigger away from a catastrophic financial collapse

I read a Quora answer the other day about “the most absurd charge” seen on a hospital bill. It was a daily $800 charge for use of the patient’s own CPAP (used for sleep apnea). He was so incensed that he disputed the charge, even though insurance paid 100 percent. After much fighting, according to the post, the hospital relented and removed the charge. This struck me, because recently I was in the hospital for five days (I will post about it in my other Substack, Risky Tales, when I get a chance). I also use a CPAP, and brought my own. And there it was: under Respiratory Services, $4,240 for “HC Adult CPAP/per Day,” or about $848 a day. Yes, they did it to me. Maybe I’ll try to dispute the charges, if I have the fortitude to deal with the layers of bureaucracy set up to resist such efforts.

But that isn’t what I want to talk about today. It’s just one of the exhibits in my menagerie of doom. I’ve used Destin Sandlin’s grill cleaner as an example before. The Smarter Scrubber costs $79. Besides being a good grill cleaner, that won’t shed shards of metal wire into your food like the cheap ones you buy at the hardware store, it is notable for the designers’ effort to manufacture it using 100 percent American-made parts. Until someone tries to make something physical, a consumer good, using no Chinese, or Vietnamese, or any foreign part or design, down to screws, nuts and washers, I don’t think they can know how giant a challenge it is.

Back in the 1950s, 60s, and even the 70s, it was easy to find metal shops, tool and part manufacturers in the United States. That is not true now. We have lost much of the ability, and the knowledge and skill, to make these things. We are too dependent on computers, CNC machines, 3D printers, and cheap Chinese supply chains to understand that our economy has fundamentally changed in the last half century.

We are no longer a manufacturing powerhouse, except in a few areas like military hardware and passenger aircraft. We don’t make ships anymore. We don’t make “white goods” like kitchen appliances. We don’t make televisions. We don’t even make computer chips; most are made overseas in Taiwan, mainland China, or South Korea. We are number four, with about 10 percent of the market.

America now relies mostly on services for our economic output. According to the St. Louis Fed, the services sector provides about 72 percent of American jobs. It accounts for $24.32 trillion, or 83.3 percent, of our GDP. Manufacturing, by contrast, contributes just $2.96 trillion, or about 10 percent. Services continues to grow at about a 2.3 percent rate, while manufacturing continues to shrink by about 1.8 percent, according to Q4 2025 figures.

There’s nothing wrong with being a services powerhouse, but the problem is services relies on recurring revenue, not goods and supply chains. There’s no real inventory for services, no “work in process” (WIP) goods. It’s based on contractual relationships, data, and people. That’s a problem in that U.S. public debt now exceeds our entire GDP. Kevin D. Williamson noted that we owe $31.27 trillion, while our GDP is $31.22 trillion. Our government debt is choking our nation, and mortgaging our children’s futures.

As of March, 2026, public sector employment accounts for 14.7 percent of U.S. non-farm employment. So, of the services sector, a giant chunk is consumed by taxpayer money, which is financed by debt, a debt we cannot pay even if we committed 100 percent of our entire economic output to paying it for a whole year. Uncle Sam is eating our entire economy bite by bite. And our elected officials do nothing but whistle past the graveyard and crow about how they are going to cut taxes and increase services at the same time (if you don’t know, that’s not possible unless you increase the debt).

Picture a three-legged stool, like the ones used to milk cows. One leg is the public service sector, one is healthcare, and the final one is education. These three services areas are cutting the legs from beneath our economy.

In 1980, public college tuition and fees averaged $1,679 per year, and private college was about $7,200. By the year 2000, it had risen to $7,040 and $25,700 respectively. Today it’s $11,950 and a whopping $45,000. Most of this is paid through scholarships (some public money, some private endowments), student loans, and from the pockets of parents. No wonder schools are failing. Hampshire College in Massachusetts was founded in 1965, and 2026 is its last year. Since 2024, the percentage of colleges merging or closing has increased from the historical 1 percent to between 2 and 2.5 percent. That’s a significant bump, and you can’t really say it’s all related to COVID-19. Costs and economic misery simply can’t support the same number of colleges that we’ve had in the past.

Where does the money go? Well, for education, it goes to the middle management, the deans, and the college presidents. In the years since 1999, college president salaries have increased 75 percent. In 2011, the New York Times revealed that Constantine Papadakis of Drexel University’s estate was paid $4.9 million (he died in office). William R. Brody of Johns Hopkins earned $3.8 million; Donald V. DeRosa of University of the Pacific earned $2.3 million; and the president of Northwestern University earned $2.2 million. The average salary for a college president is now just over $300,000 a year.

In healthcare, for-profit corporations buying up hospitals grab money by the bushel. And sometimes, they rape their victims and walk away with the cash. Steward Health Care bought public non-profit hospitals in Massachusetts, while its CEO, Ralph de la Torres lived on a private ranch in Waxahachie, Texas, and cruised in a $30 million superyacht. Steward went bankrupt and de la Torres walked away with $80 million. The hospitals that used to serve the public as non-profits, their land stripped and sold, can no longer afford to pay rent for their facilities, and now many have to close, so residents in those cities get less health care.

And large corporations, like the one that owns the hospital I was in (I got very good care), charge $19,006 in “Coronary Care Unit” fees, for “HC Telemetry.” What they did is hook me up with leads and a little box to monitor my heart. I was not in the hospital for a heart problem. After four days, they removed the leads. I had my own prescription medicine, which costs $15 for a bottle at Publix, but the hospital pharmacy insisted on giving me the same pills and charged $5.90, or $4.80, or $5.70 for each pill. I had a CT scan and they billed $3,255. If you go to a clinic and pay cash, you can get a CT scan for as little as $300.

Medical costs and the layers of administration sucking the money out of the system, along with insurance companies complicit in the scam, are hiking the prices of everything in our service sector economy.

One day, it can all crash very quickly. All those jobs, those good jobs with good pay, can come to a fast end. All those tech jobs that we think AI will replace, that’s a drop in the bucket compared to the collapse of healthcare, education, and public sector.

We are in trouble in America. We have to get back to making things, and employing people to make things. Our economy is having the legs sawn from under us, and it’s our kids who will be falling to the ground to rebuild what we have so weakened.

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