What is a well known 'public secret' in the industry you work in that the majority of outsiders are unaware of?

[in the US] your insurance dictates your healthcare, not your disease, deformity, symptoms etc. If your insurance pays for an allergy test, you're getting an allergy test (even if you came in for a broken arm). If insurance pays for custom orthotics, you're getting custom orthotics (even if you came in for a wart removal). We will bill your insurance thousands of dollars for things you don't need. We're forced to do it by the private equity firms that have purchased almost all of American healthcare systems. It's insane, it's wasteful. The best part is the person who needs the allergy test or the custom orthotics can't afford it, so they don't get the shit we give away to people who don't need it.

I would gladly kill myself if it meant we got universal healthcare, but private equity firms can't monitize a martyr so it would be pointless.