“Order is the barrier that holds back the frozen death.” — Snowpiercer

Japan’s bond market unraveling and the demise of the yen carry trade has ignited a Snowpiercer uprising in American healthcare portending a sudden and brutal transition from U.S. healthcare stability to imminent U.S. healthcare collapse. For decades, ultra-low Japanese interest rates allowed global investors to borrow yen cheaply and plow that capital into higher-yielding assets worldwide, including U.S. artificial intelligence (AI) insurance companies like Blue Cross Blue Shield, private equity-funded hospital systems like Steward Health Care, corporate-run nursing homes like United Healthcare, and venture-backed digital healthcare platforms like Cerebral/ Done Global. But as Japan tightens monetary policy and yields spike, that easy money pipeline evaporates. Refinancing becomes a death sentence for debt burdened marginal players.  Rural hospitals, overleveraged staffing firms, and “innovative” but cash-burning AI health technology unicorns will fall first. What now follows is a rapid unwinding of the illusion of solvency, propped up by cheap liquidity. Just as Hyman Minsky warned, stability breeds complacency, leverage, and fragility, now America’s eternal economic engine teeters. When capital flees and the debt can’t roll over, the entire edifice of American medicine starts to crack not with a whisper, but with a siren’s wail.

In the tradition of Smedley Butler’s “War Is a Racket”, which exposed how profiteers thrived off the machinery of war, Dr. William E. Flanary, better known by his sardonic alter ego “Dr. Glaucomflecken”, has become modern medicine’s court jester, skewering the American healthcare industrial complex from the inside out. A practicing ophthalmologist in Clackamas County, Oregon, Dr. Flanary began crafting sharp-edged medical satire on Twitter in 2016, naming his account after a telltale sign of acute angle-closure glaucoma. What started as conference boredom evolved into a viral phenomenon, with millions of followers across TikTok and YouTube laughing and cringing at his uncanny portrayals of smug specialists, burned-out residents, and the bureaucratic absurdities that define U.S. healthcare. Alongside his wife Kristin, Lady Glaucomflecken, he now hosts the podcast “Knock Knock, Hi!”, blending dark humor with searing insight. As commentators like Robert D. Putnam and Céline Gounder observe, Dr. Flanary is part of a growing movement of satirists using irony to diagnose an American healthcare system whose eternal engine is now in terminal decline, and where laughter might be the last medicine that still actually works.

In Snowpiercer, the most haunting moment isn’t the carnage or cannibalism, it’s a school classroom. A pastel-colored train car, cheerful on the surface, masks one of the most disturbing scenes in dystopian cinema. American schoolchildren, bright-eyed and chirping, sing hymns to the great Mr. Wilford, the Snowpiercer train’s messianic engineer. “The engine is eternal. The engine is forever.”  This isn’t just Uncle Sam’s mythic storytelling, but a chilling cinematic allegory. The Snowpiercer train is our collective American society. The eternal engine is American power. The classroom is America’s indoctrination machine.

Dr. Glaucomflecken videos bring laughter to the tens of thousands of medical students who step into the brightly lit lecture halls of medical schools across the United States, filled with hope and a desire to heal. But from the first day, the process begins, not of education, but of assimilation. They’re taught to repeatedly repeat the mantras: “Evidence-based medicine.” “High-value care.” “Cost-effective outcomes.” These aren’t inherently wrong ideas, but Dr. Glaucomflecken argues that in practice, they’re stripped of their nuance and weaponized as control mechanisms, shields for insurers, hammers for administrators, and blindfolds for doctors.

Dr. Glaucomflecken delivers his sharpest satire with a scalpel of truth— young American medical students aren’t taught to question the system, they’re trained to obey it. Eventually American doctors are devastated to discover that they were never liberators of disease, but only a pawn in a predetermined cycle designed to sustain a corrupt equilibrium.  Their physician professors, often themselves survivors of the same machine, become smiling conductors on a train they no longer control. Instead of nurturing critical thought or patient advocacy, they instruct students on how to decode ICD and CPT hieroglyphs, how to bow before the almighty AI of insurance algorithms, and how to accept that coverage, not care, defines the boundaries of medicine. “You’re lucky to be here” hangs unspoken in the air like a threat wrapped in gratitude. Through his biting humor, Dr. Glaucomflecken exposes a profession that reveres the eternal engine of Blue Cross Blue Shield, UnitedHealth, Optum, coding sheets, and faxed prior authorizations as if they were divine texts. Medical denials are treated as acts of providence, utilization reviews as sacred rites. In this cold, humming temple of healthcare, healing is no longer the sole mission, only the eternal running of the machine.

And just like Snowpiercer, the healthcare system is stratified. At the front of the train sit the elites— insurance CEOs, hospital executives, and pharma activist shareholders. As they dine on data dashboards, they orchestrate the journey, though they’ve never set foot in a medical ward. Behind them are the functionaries and the academic administrators who’ve learned to play the game. They are rewarded with prestige, titles, maybe even a parking spot.  But in the back of the train, the tail, are the medical residents pulling 28-hour shifts. The nurses whose compassion is exploited and whose breaks are fantasies. The Medicaid patients, the uninsured, the disabled are the people fed the protein bars of denied care and moral injury. They are told their suffering is inevitable, that their struggle is a feature of the healthcare system, not a failure. And when they speak up, the answer is clear, be quiet or be replaced.

What’s more insidious is that revolt, too, has been engineered into America’s eternal engine. In Snowpiercer, Mr. Wilford, an iconic representative of Uncle Sam, allows uprisings. They are controlled demolitions, designed to release pressure and reaffirm Uncle Sam’s authority. American Medicine has its own rituals of rebellion, wellness modules for burnout, “streamlined” prior auths that still funnel through the same gatekeepers, resilience training sessions that blame individual doctors for systemic collapse.  America’s eternal engine permits just enough dissent to keep the train moving.  But then came COVID. The lie cracked open. Something changed.  The great resignation wasn’t just about burnout. It was a collective shudder of realization. A whisper that began to echo, this system is a lie. America’s engine isn’t eternal.  America’s engine is a trap.

Many conformists still chant that, “The engine is eternal”.  But America’s economic tracks are melting.  America today is barreling down the tracks of a metaphorical Snowpiercer, a sealed, self-perpetuating system where healthcare, education, and public discourse have become tools of indoctrination rather than liberation. Like the children in Mr. Wilford’s classroom, future American doctors are taught to worship the system that exploits them, trained to see prior authorizations as sacred trials and bureaucratic delays as moral virtues. The parallels are chilling.  Insurance executives are gods and administrative dictates are gospel.  In this classroom of American life, the ruling class doesn’t just own the resources, they script the narrative, turning science into dogma and dissent into pathology. The result? A public conditioned to believe that the healthcare they receive—degraded, rationed, and data-mined—is both the best and the only way.

And now America’s tracks themselves are shaking. As Japan’s bond markets falter, the ripple threatens to become a tsunami.  America’s healthcare train, built on debt, pharmacy benefit managers, and artificial intelligence algorithms, is vulnerable.  America’s dependence on financial stability makes it brittle. If global markets spiral, the economic collapse won’t be gradual, it will be catastrophic.  And what then? Will the solution be more artificial intelligence modules, more dashboards, more gratitude seminars?  No. The solution is to jump off the train.  We don’t need a better insurance denial computer system. We don’t need streamlined suffering. We need to stop pretending that the eternal engine can be fixed.  It was built to control, not to care.   And as the train continues to shake, the middle cars, those with just enough comfort to stay silent, are beginning to stir. Nurses are striking, medical residents are walking out, and patients are no longer content with being fed Snowpiercer insect-protein policy fixes.

At its core, Snowpiercer explores the haunting question, what kind of cruelty is deemed necessary to maintain order in a closed system? The train serves as a microcosm of Earth, where resources are finite and population control becomes a brutal necessity, enforced through engineered starvation and orchestrated revolts.  Even rebellion is part of the design, a pressure valve to sustain the status quo. The system sacrifices the few to save the many, masking tyranny as necessary. In the end, it’s not just control of resources that matters, but control of hope, despair, and the illusion of change. As in Snowpiercer, America’s health system’s brilliance lies in its ability to co-opt resistance, offering burnout modules and mental health apps to its physicians as sedatives rather than solutions. Yet COVID was the canary in the coal mine, shattering illusions of benevolent control and exposing the cold calculus of a healthcare industry willing to sacrifice human dignity. The American train may still be running, but it’s rusting at the joints, its passengers increasingly aware that no reform may come from the front. And like Dr. Glaucomflecken, many are now beginning to ask ourselves: What if the only way forward is off the rails entirely?