Freedom and Equality in Health Care

This article was first published on LinkedIn on July 1, 2019.

Freedom and equality. Two words that define the American spirit. Two words that contradict each other when it comes to health care.

As we celebrate Independence Day, we reflect on our nation’s initial struggles, contemplate how we’ve evolved and consider whether we’re still living up to the dreams of our revolutionary forebearers. To do so, we look to the Declaration of Independence. It is our origin document, that which established us as an independent entity. Over time, some of the document’s words have been more emphasized than others, potentially skewing public perception about why the document was written. In particular, the phrase, “…all men are created equal…” makes many believe that the heart and soul of America is about establishing equality among citizens.

Applying the idea of equality to health care, we can understand why the notion of a single payer system is so popular. It provides equal access to care to all Americans. We crave equality because each of us is impacted by the capriciousness of health. Think about cancer. It strikes the wealthy, the brilliant, the poor, the criminal. It doesn’t discriminate. As a society, we want to correct nature’s flaws and striving for equality is one way to level-set the American community.

But the Revolutionary War wasn’t about establishing equality. It was about fighting tyranny. The colonists were being taxed, coerced and physically brutalized by the Crown. The Declaration of Independence enumerates these issues and myriad others, many of which relate to encroachments on our liberty.

In today’s health care system, we are being taxed, coerced and financially brutalized. The current system seeks equality by offering a number of insurance options that vary based on age, income level and employment status, yet over 10% of Americans are still uninsured. Medicare, Medicaid, private insurance, subsidies for premiums…all of this is funded through a wasteful financial structure that limits choice and for many, mandates over-payment into a broken system. Freedom and liberty are subjugated to an ill-conceived attempt to establish equality.

Of course there are downsides to freedom in health care. One person’s liberty can be another person’s burden, a function of moral hazard. When one person eats poorly and doesn’t exercise, these health habits impact everyone else directly (because we have to help pay for the higher cost of that person’s care) and indirectly (because we model the behavior of those around us). So which is better? Equality or freedom in health care?

The answer is freedom.

Our country sprang from an undeniable claim to freedom, not equality. Each of us is unique and our health care needs and wants are different. We must structure a system that provides us with the individual options that work for us, not a watered-down version that wholly works for no one. Decentralizing the payment system, promoting wellness and placing more accountability for outcomes on the individual gives us the freedom to be as healthy as we can be.

To hear more about this idea, please listen to my podcast, “The Contradiction of Freedom and Equality in Health Care,” part of my show The Powers Report Podcast.

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