Let me start with something that might piss you off.

The system isn't broken. I need you to hear that. It's not broken. It's functioning perfectly — it's just functioning for the insurance companies, the hospital networks, and the surgeons with the lake houses. Not for you. Never really for you.

I know this because I spent 17 years inside it. Interning at a chiropractic and sports injury clinic starting in 2000, back in the system in 2009 running my own practice — insurance, workers' comp, personal injury, the whole circus. I watched it from the inside. I played the game. And then, in 2017, I table-flipped and walked out.

Best decision I ever made. Second best was probably not becoming an orthopedic surgeon, but we'll get to that.

The system isn't broken. It's just optimized for everyone except the person who actually needs help.

Your Insurance Company Has Eight Visits and a Hoodie

Here's a thing I watched happen constantly: a patient comes in with a real injury. Real pain. Real problem. Insurance approves eight visits.

Eight visits. Eight. Not seven, not twelve. Eight.

Not because eight visits is what they need. Not because some clinical algorithm determined that eight is the magic number for healing a herniated disc. Because that's what the insurance company typed into the box. And patients — bless their hearts — would accept that as gospel. Like the insurance company had received a divine revelation about their specific lumbar spine.

So what happens? They do eight visits, they feel a little better, insurance runs out, and they stop. Done. Case closed. Pain comes back two months later, they reopen the case, they get eight more visits. Lather, rinse, repeat. For years.

Meanwhile, nobody is actually fixing the reason they hurt. We're just keeping them comfortable enough to keep paying their premiums. Which, now that I think about it, is kind of a genius business model if you're the insurance company.

Less genius if you're the patient who's been in pain for six years.

Patients started believing that their health was their insurance company's responsibility. The insurance company, for the record, does not share this belief.

The Part Where I Tell You About the $12 Visits

Okay. I'm going to tell you something that nobody in healthcare will ever say out loud at a conference or put in a newsletter or frame on the wall of their waiting room.

Reimbursement rates are wildly different depending on your insurance plan. And those differences — quietly, systematically, without anyone ever saying it to your face — determine the quality of care you receive.

I once had patients where the insurance reimbursed $12 a visit. Twelve dollars. After overhead, after billing staff, after the administrative odyssey of claims and appeals and re-submissions and the letter you have to write justifying why you saw someone for longer than six minutes — twelve dollars. You know what $12 buys in a healthcare practice? An adjustment and a handshake and please don't let the door hit you.

Then there were patients whose insurance paid $400 a visit. Those patients got two hours. They got the full workup, the detailed history, the thorough exam, the follow-up calls. They got treated like they were paying $400 a visit. Because they were.

Did anyone tell the $12 patient what was happening? Absolutely not. Are you going to walk into a room and say, 'Hey, heads up, I'm making basically nothing off you, which is why your visit is going to feel a little rushed'? No. Of course not. It just happens. Every day. In clinics all over the country.

The secret price tag on your insurance card — the one you never see — is determining how much of a damn anyone gives about your recovery. I'm sorry. It's true. And it's gross.

The quality of your care is determined by your coverage tier. That's the reality the system will never admit — usually because admitting it would require actually doing something about it.

Personal Injury: Now We're Really Having Fun

If you want to see the medical system operating at its most unhinged, look at personal injury cases. Car accidents. Slip and falls. Workers' comp.

The game in personal injury is not: how quickly can we heal this person? The game is: how big can we make the bill? Because the bigger the medical bill, the bigger the settlement. The bigger the settlement, the bigger the attorney's cut. The more visits, the more procedures, the more imaging, the more referrals — everyone wins. Except the patient, obviously, but they're not really at the table for this part of the conversation.

I watched people get pushed through treatment for months — not because they needed it, but because there was a settlement on the horizon and everybody wanted a bigger slice. I watched surgeries get recommended that had maybe a 40% chance of making things worse, because the surgery billing code was worth more than six months of conservative care combined.

Back braces! Don't get me started on back braces. You know why a lot of patients get prescribed back braces they don't need? Because the provider often owns the DME — the Durable Medical Equipment company — supplying the brace. So they're prescribing something to themselves. But like, legally. It's a thing. It happens.

And the whole time, the patient thinks they're getting comprehensive care. They're getting comprehensive billing. There is a difference.

It's not about how fast you heal. It's about how long you stay in the system. Those are not the same thing — they are, in fact, opposites. And everyone in the room knows it except you.

The Comfort Trap (Or: Feeling Better Is Not the Same as Getting Better)

Here's the part that kept me up at night and eventually drove me out the door.

The entire medical model — and I'm including chiropractic, physical therapy, pain management, surgery, medication, injections, massage, electrical stim, all of it — is built around one question: how do you feel?

Not: how do you move? Not: what is your body actually doing mechanically that is causing this problem? Just: how do you feel? Here, let's make that feeling quieter. Here's an injection. Here's a muscle relaxer. Here's some passive manual therapy while you lie there. Here's a surgery. How do you feel now?

And people feel better! Temporarily. Sometimes significantly better. Right up until the thing that actually caused the pain — the movement pattern, the loading mechanics, the way they bend and sit and walk and lift every single day — brings it all roaring back.

Because the pain isn't the problem. The pain is the report card. The problem is the pattern that keeps earning that grade. And if you spend your entire healthcare career treating the report card, the grades never change.

The disc keeps loading the same way. The joint keeps compressing in the same direction. The body keeps doing what the body does. You feel a little better. And then you don't. And then you go back.

And honestly? From a business model perspective, that's ideal. A patient who keeps coming back is a great patient to have. A patient who fixes the root cause and never needs you again is a terrible business model. I'm not saying every provider is consciously thinking this. I'm saying the system rewards the former and ignores the latter. The incentive doesn't care about your intentions.

The medical system is helping you feel better as the plane crashes toward the ground. Nobody is teaching you how to fly the plane differently. Also, you're still on the plane.

Physical Therapists: I Said What I Said. I Stand Behind It. Mostly.

I know this section is going to generate some strongly worded emails from PTs. I respect that. Send them. I'll read them.

The majority of physical therapists are functioning as a holding tank — a very well-credentialed, often genuinely caring waiting room — for higher-billing procedures. You go to PT, you do your exercises, you get some hands-on work, you feel better, you plateau. And when you plateau — because nobody has addressed the actual movement pattern underneath everything — you get referred up the chain. To pain management. To the surgeon. To the spinal cord stimulator that costs more than a car.

This isn't because most PTs don't care or don't know what they're doing. Many of them are brilliant. It's because they're handcuffed to medicine. They need a referral to see you. They operate within a billing structure designed by insurance companies. They're measured on outcomes defined by symptom reduction, not movement quality. The system has them. They're playing the game with the hand they were dealt.

The best physical therapists I've ever met are the ones fighting the current every single day — who see through the hamstring stretch protocol and go straight for the root cause. Those people exist and they're incredible. They're also exhausted. Because the system does not reward them for what makes them excellent.

It rewards them for throughput. Stack 'em, treat 'em, next.

Most of the system is a very expensive, very well-meaning, medically sanctioned way of keeping you comfortable while nothing actually changes. It's comfort care in a nice building with better lighting.

Why I Left in 2017 (And Started Saying 'Fix Your Shit' for a Living)

Running an ethical practice inside the insurance system is not just difficult. It is - in practical financial terms - nearly impossible.

Here's the joke nobody tells in medical school: if you see a patient for a full hour, do a thorough evaluation, provide genuine care, and then bill honestly for exactly what you did — you get paid almost nothing. Not nothing-but-meaningful. Literally almost nothing. Because the billing codes don't reward time or skill or thoroughness. They reward volume and procedure count and whichever codes happen to reimburse well this quarter.

So to survive as a practice, you have to overbill. You document in a way that justifies higher codes than what you actually did. You add procedures. You see more patients per hour than you should. And slowly, one compromise at a time, you become the thing you didn't want to become.

I didn't want to become that thing. So I left and built MoveU. I started teaching people how to actually fix the way they move — not manage how they feel. And look, it's not a normal career path. Most people don't quit a successful insurance practice to go make videos on the internet explaining disc mechanics to strangers. But here we are. And I'm not even a little bit sorry.

The premise is almost embarrassingly simple: fix the reason you have symptoms, not the symptom. Fix the pattern. Fix the loading. Fix the movement. The pain addresses itself. Turns out when you stop doing the thing that breaks you, you stop breaking.

Revolutionary, right? Someone should write that down.

Fix your shit. Not the symptom — the reason you have the symptom. That's the whole philosophy. You're welcome.

What I'm Up Against (Spoiler: It's a Lot)

I'm going to be honest about the degree of difficulty here because I think it's important.

On one side: a multi-trillion-dollar industry with hospital systems, pharmaceutical companies, insurance lobbyists, and a century of institutional credibility all pushing one message. You need us. Stay in the system. Take the medication. Get the injection. Book the surgery. We're the experts. We wear coats - white ones.

On the other side: me, a guy on the internet in a t-shirt telling you that you can fix this yourself, that understanding how you move is more powerful than any intervention they can bill you for, and that the pain you've been managing for years has a root cause that nobody in the system has any financial incentive to actually address.

It's a little asymmetric, I'll admit.

But here's what I know: every person who has that moment — that 'oh my god, THIS is why I've been in pain' moment — is one step closer to getting off the treadmill. And that moment doesn't cost a co-pay. It doesn't require a referral. It doesn't have a deductible. You just have to be willing to look at why you hurt instead of just how much.

That's the whole thing. That's why I do this.

Now go fix your shit.

The system isn't going to fix you.

You're going to fix you.

And I'm going to show you how. (Also, you probably have too much anterior tilt.)

About the Author

Dr. Mike Wasilisin: Chiropractor, movement specialist, and founder of MoveU. Left the insurance-based healthcare system in 2017 after deciding he'd rather help people actually fix their problems than bill insurance companies for the privilege of not doing so. MoveU has reached millions of people worldwide. His approach is simple: fix how you move, fix how you feel. It works embarrassingly well.

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