Hospitals, insurers and agencies rarely say, “We’re letting you die because you’re too expensive.” Instead, they funnel people (those with disabilities, chronic illness, deep poverty, or a refusal to “fit in”) into application loops, waitlists, or defunded community programs. Meanwhile, officials bemoan “funding shortfalls” or “tight resources,” even as expansions cater to less costly demographics and executive salaries balloon.
Entire populations get labeled “unprofitable” and culled via friction-based gatekeeping.
It’s not a historical glitch; it’s the same pattern with new language. Nazi Germany’s T4 program secretly murdered disabled people it branded “life unworthy of life” and a financial burden on the nation. American eugenicists once forced “undesirables” into sterilizations, alleging they protected public coffers. Victorian workhouses claimed “poor relief” but forged conditions so punishing that only the desperate would comply.
Beneath all these cultural spins, the logic stands: once labeled “too expensive,” you’re shunted out, sometimes overtly, sometimes under an avalanche of red tape.
In today’s friction-based approach, no one explicitly says “You’re not worth saving.” Instead:
- Hospitals use “risk-scoring” to flag “complex” cases, then make them prove their eligibility over and over.
- Insurers champion “anti-fraud” efforts, stalling real claims with perpetual re-checks.
- Agencies promise “universal coverage” but design eligibility rules whose paperwork and deadlines penalize the chaotic and under-resourced.
- Workplaces tout “inclusivity” while disclaimers and ROI metrics edge out employees who need actual accommodations.
The refrain is always, “We want to help, but we just can’t.” Scarcity gets trotted out as an alibi to bury the fact that expansions, top salaries, or rebranding are plentiful, just not for “unprofitable” folks.
Historical parallels run deeper. Forced relocations of Indigenous peoples, debtors’ prisons, or “Olympic beautifications” bulldozing poor neighborhoods: these were all justified with “We can’t sustain them,” “We can’t accommodate them.” The same dynamic emerges at a larger scale in, say, Israel’s occupation of Palestine. “Security” there functions much like “profit” here: branding entire communities as “inconvenient,” gating them behind walls, checkpoints, or indefinite permit restrictions. A militarized, friction-laden apparatus does the job of quiet removal.
Minor reforms (friendlier forms, staff training) do little if the core premise stands: once your needs exceed what the system deems “manageable,” friction-based culling kicks in.
The only real fix is to build institutions that literally can’t discard someone for being “too expensive.” That means guaranteed essentials, no cyclical re-verifications for permanent conditions, budgets managed collectively (so nobody profits by excluding high-need folks), and success measured by how well the toughest cases are handled instead of how cheaply the easy ones get rushed through. Yes, it’s radical, but continuing centuries of eugenic or colonial logic is far more so.
If this cost-based moral boundary stays in place, AI will apply it faster and at greater scale.
Across time, from forced sterilizations to indefinite re-check mania, the message remains: “They cost too much.” The historical cases share a valuation — humans measured against expense — and that is the link being drawn here. They do not all share the same mechanism, the same intent, or the same outcome. Administrative exclusion can cause grave harm and can raise mortality risk among those excluded, and that is what should be named. Whether it amounts to extermination in any given case, or is a eugenics in mechanism rather than in intent, needs to be specified case by case rather than asserted of all of them.
Reject that entire notion. If we keep asking “Can we afford you?” we’ll keep replaying eugenics, just wrapped in disclaimers or AI code.
The personal face: fear of being an ask
The political mechanism has a personal cost that keeps it running. People who get squeezed out often blame themselves—“I didn’t push hard enough,” “I missed deadlines,” “I fell through the cracks”—when the deadlines and re-checks they failed were designed into the eligibility rules. And before the system even rejects you, you learn to reject yourself: the fear of being too big an ask, the internalized arithmetic that says your needs are a burden someone must absorb, the rehearsed apology for existing in a shape the institution calls expensive. That self-screening does the sorting in advance, because people who expect to be refused often never apply. As long as people keep asking themselves whether they are too big an ask, the hospital, insurer or agency never has to say whether it will pay for them.
Further Reading
- When Your Illness Has No Billing Code—the medical case of this argument
- Kids These Days Just Want to Be Disabled
- ABA Is a Capitalist’s Wet Dream
- Fraud Crackdowns Flag the Wrong People
- How to Build Institutions That Can’t Coerce
- Jains Everywhere Must Stand With Palestinians
- Zionism and Incelism