When I think about July, I think about Independence Day. That wonderful day filled with grilled burgers and outdoor play and ice cream and fireworks! My adopted community of Fort Collins is a bit nanny-state on the fireworks, but puts on a good show at City Park only a few blocks from our home. And when I think about Independence Day, I think about the Founding Fathers – as do many I suppose.
This spring I found a new podcast that I spent some time with, Revolutions with Mike Duncan. Mike spends an entire series covering a historic revolution, one weekly episode at a time. This spring I gave a listen to his first three series, respectively covering the British Civil War (Cromwell and whatnot), the American Revolution (featuring the aforementioned Founding Fathers), and the French Revolution (which was a complete madhouse!). Each of these conflicts were at the center over the notion of liberty. Being “for liberty” is obviously a very popular rallying cry – what with all the revolutions over it, the very notion of Freedom Fighters, and of course the famous line from Patrick Henry that I lifted this months’ title from – “Give Me Liberty or Give Me Death!”
So, what is liberty, really?
On Miriam Webster even, the definition of liberty is a bit complicated:
The quality or state of being free:
a: the power to do as one pleases
b: freedom from physical restraint
c: freedom from arbitrary or despotic (see DESPOT sense 1) control
d: the positive enjoyment of various social, political, or economic rights and privileges
e: the power of choice
Another definition holds forth: the state of being free within society from oppressive restrictions imposed by authority on one’s way of life, behavior, or political views
For me, I would set forth a definition of liberty more akin to: Freedom to pursue one’s own intentions and pursuits without imposition of authority, so long as those freedoms do not harm another or interrupt their ability to do the same. For me, liberty also includes a responsibility over our actions and behavior.
Ok, so…I think I’ve got a handle on what liberty is, but what’s it got to do with health?
You guys know I’m a big fan of unintended consequences, right – I mean, I’m usually not a fan of them, but I like to write about the phenomena and throw rocks at policymakers and stuff. So, let’s talk about our health system in this country, a system that…knock on wood…I’ve had only minimal engagement over recent years. Being railroaded into a sleep study and then popped onto a CPAP system for my mild sleep apnea instead of encouraged to exercise just a little bit and maybe lose 10 pounds was the last straw for me, and I decided to take charge of my own health the best I could.
For some, the American health system has always been pretty great, with well funded machines and technologies paid for by expensive insurance plans from many thousands of corporate enterprises, and funneled through what are now only a few major health insurance companies. Millions of Americans have exceptional health insurance coverage, and can get almost any treatment they are perceived to need, with an office visit only days away – and they barely have to pay anything for it.
Oops – there’s an unintended consequence in our midst! This detachment of the cost of service from the payment of services has contributed to the rising costs of health care overall – who cares what it costs, I’ll take it. And the doctors, God bless them, are scared to be sued in our litigious society, so they’re happy to throw ALL the tests at a patient – oops, another unintended consequence, escalating costs of care.
But, so long as we’ve got all these employer health plans paying big money, it’s all good in the hood, right? Well, not really – you see, there are many who can’t afford a health plan, small business owners and those who work without health benefits, young kids who are healthy and don’t see the need, and we have a bunch of people they call “uninsurable” mucking up the system. So these folks, when they have a health emergency, have no insurance – but that’s ok, they can just use the emergency room where our health system vows to basically “do what they can”. It’s kind of a bummer though, because these emergency rooms cost like 20x as much per hour to operate than a walk-in clinic. No one can make a business out of seeing the uninsured…oops, another unintended consequence wreaking havoc!
And then, the Obamacare plan takes effect some years back – and then kinda blows up, or is dismantled, or whatever. It was a mess from the start, a patchwork system that tried to make everybody happy and instead has mostly made nobody happy. Initially, the IRS could zap you on your taxes if you don’t have health insurance – the one-two punch against economic success! So, now here we are with ever-escalating health costs and a hybrid broken system that has high costs and marginal health outcomes when compared to our western nation peers. It’s great at prescribing pills and putting people on C-PAP machines, but not that great at creating good health, really. But people are starting to catch on, and a doctor recently told me something along the lines of “Want to live a long, healthy life?, do whatever you must with diet and exercise to stay off pills!”
My dad always says, “tax what you want less of, and subsidize what you want more of”, misquoting Reagan, it appears, but I’m inclined to agree with him.
So, how can we apply that to health? What do we want less of? – I guess, unhealthy people, right?, and also we want less rising health care costs. Well, I think paying out of your own pocket for health care is kind of the closest thing to a tax, and is pretty well an aligned-with-liberty thing. And, when you pay for it out of your own pocket, then you pay attention to the price…maybe we can sprinkle some price transparency in – you know, so I can drive to Greeley and save half if I want to?
So then, subsidize what you want more of…what do we want more of? Well, healthy people, duh, and we also want access to quality health care. I’d say not paying medical bills is a pretty straightforward subsidy for the healthy, but how do we ensure access to quality health care. I guess, have a government subsidy to operate a health care facility, maybe with special incentives for rural areas and whatnot? Maybe it gets bigger the better your health outcomes are for your operation – and you must see everyone who lives in your zip code. Maybe we don’t even need health insurance companies at all – maybe the physical care facilities can have their own insurance policies – tight operations and strong reserves, and the ability to finance people on their procedures. Maybe insurance policies could be established for catastrophic only – like if your house burns down, not like if you have to have your sprinkler system blown out in the fall…
“It sounds like you’re saying we could dump many insurance companies and a lot of the big paperwork and reimbursements and wrong insurance codes and streamline the whole thing, and run health care facilities more like a series of independent businesses akin to an auto-repair business? And that these businesses would manage risk and revenues and expenses and seek profit? And would liberty be enhanced?, and would we be taxing the things we want less of?, and would we be subsidizing what we want more of?”
Yes, I guess so, in my dreams. Probably though, the entrenched interests, and lobbying power, and all the red tape already in place would keep such a dream from being realized. And probably there are gaps in my logic, and liberty and commerce can’t make the kind of transformational change to our health system that I imagine. And maybe doctors would rather just have a job for a faceless organization and trust the administrators to put in all the right codes and make decisions fraught with conflict of interest in regards to monetization of patient care…and people can just trust insurance companies to do the right thing…haha.
But as for me and my house, I’ll just do my best not to participate in a broken system.
Give Me Liberty AND Give Me Health.
– Curt Bear
Founder LoCo Think Tank