The image above shows the bill for an emergency room visit that a man without insurance incurred after he was bitten by a snake. It’s been floating around Twitter, where a lot of users assume that it is fake—particularly users from countries that offer some form of socialized medicine, if anecdotal reading is any indication. But this bill is real. CBS News confirms that Todd Fassler got it in 2015, when he posed for a selfie with a rattlesnake and got bitten. That’s a very dumb thing that Fassler did. But the stupidity of taking a picture with a rattlesnake pales in comparison to the evil of charging $83,000 for the antivenom CroFab, which Fassler required to live.

Only one US manufacturer makes antivenom for rattlesnake bites, so they can charge what they want. So can the hospital, which first treated Fassler in its emergency room before moving him to intensive care for a few days. All this stuff is expensive because of concrete market forces, but from the perspective of the person who actually buys health care—the guy with a puffy arm whose heart will stop if he doesn’t agree, in advance, to pay whatever the hospital charges—the system is completely arbitrary.

Imagine if a man dragged himself to your door in the night, dying of an injury that you had the power to treat. “I’ll save your life,” you say, “but you have to buy a house and give it to me. Alternatively, you can become my indentured servant.” You would be an asshole. It’s immoral to extort dying people for more money than the median American household makes in three years. But because this process happens through a series of billing companies and office functionaries, we think of it as unavoidable. No single person is responsible, so it’s nobody’s fault. We have invented a system that ruins lives in the process of saving them, because the alternative is to do the difficult work of overhauling a broken system.

But what about personal responsibility? If Fassler didn’t want so much debt, he shouldn’t have gotten bitten by a snake. I say unto you, dear reader, that this kind of appeal to personal responsibility is a dodge. People are going to get bitten by snakes. They’re going to do really stupid stuff and incur injuries they easily could have prevented, because this is the way of the world. Saying sick people are responsible for what happens to them abdicates our responsibility to treat the sick. It posits an imaginary world without illness, when illness has been an aspect of human life since the beginning. The problem is not that people need medical treatment. It’s that we refuse to think of a fair and decent way to give it to them.