The western world recently celebrated the 25th anniversary of the collapse of the Soviet Union, the communist dream turned oppressive totalitarian regime that denied my Jewish parents admission to medical school, the remnants of which plague my Ukrainian relatives to this day. Such a historical reminder comes at a turning point in our own country, with the Republican American Health Care Act (or some future revision of it) on its way to become the new law of the land.
President Obama’s healthcare legacy, which has taken center-stage among the political debates of the past decade, aimed to enhance efficiency through consolidation into Health Maintenance Organizations and Accountable Care Organizations. This, among other things, led to the creation of monopolistic health networks and the demise of private practice. In the past months, we have been inundated with the shortcomings of the Republican proposal, which unsuccessfully attempts to toe the line between maintaining entitlements and subsidies while balancing the budget and deregulating healthcare. The future of American medicine, for practitioners and patients, hangs in the balance. As the debate becomes bogged down with logistics and finances, and deception of the American public through fear-mongering and smoke-and-mirror promises runs rampant, both sides of the political aisle have stopped short of questioning the recent distortion of healthcare’s place in society. Restoring medicine as an economic transaction rather than a right would allow physicians to better serve the individual and preserve the deep rooted American freedom that makes our lives worth living in the first place.
Health legislators have historically put emphasis on population health metrics, such as life expectancy and obesity rates, as indicators of the quality of healthcare in our country. Many were outraged when in 2015, for the first time in decades, US life expectancies dropped. Although potentially indicative of underlying problems, life expectancy statistics are not the be-all and end-all of a nation’s prosperity. By that logic one would rather live in totalitarian Cuba (79.2) than the US (78.8), or in theocratic Iran (75.5) rather than serene Fiji (69.9). America has long been attractive to those fleeing oppression, like my parents, not for its life expectancy or even comforts, but for its commitment to the preservation of human freedom and economic opportunity. The core principles of American democracy clash with much of current health policy: in declaring themselves independent of an imposing British empire, our founders cemented the fundamental expectation that democratic government must ensure that its citizens’ rights are not alienated. They did not, however, guarantee positive rights, which, in other words, mean a “freedom from [sickness, loss, failure],” rather than a “freedom to [live life as one sees fit].” When applied to healthcare, this approach dictates that the government’s sole purpose is to protect citizens from deviation from the norm: to insure against insults (such as prohibiting a factory from polluting a town’s waterways), rather than to provide interventions. To believe all people are entitled to artificially maintained physical well-being, the core principle of universal healthcare, would be to make the physician into a serf, treating patients into a servitude rather than a service, and the government into a despotic Tsar.
A keen reader may point out that public education could similarly be considered a government overreach. But based on the principles of economics, government intervention in public education corrects a market failure in a way that public healthcare spending cannot rival. Public education has positive externalities: the value imparted to society exceeds the value to any individual member, and it would thus be under-provided by a free market. Meanwhile, over 50% of healthcare spending goes towards only 5% of the US population who, due to largely preventable chronic illnesses, cost society billions of dollar more than they contribute. It would be draconian to blame those with biopsychosocial predispositions for their suffering. However, it is likewise unethical for health legislators to force everyone to foot the bill (as would be the case under universal healthcare) for a few individuals’ hazardous lifestyle choices (such as smoking, drinking or obesity), which recent research points to as the single greatest determinant of health outcomes. While education – ideally – teaches children life skills that are valuable to society as a whole, government-sponsored healthcare “equity” teaches irresponsible adults that they will be provided for regardless of their poor choices.
The only viable, long-term approach to lower costs and improve health quality would be to stop incentivizing individuals from making poor choices by charging those who do more for their coverage. Despite concerns raised by progressive critics, such practices would be no more discriminatory than car insurances adding a surcharge for risky driving, and those suffering from genetic conditions or unpreventable cancers would not be punished any more than handicapped drivers are. Unshackling the free market from current regulations (which mandate everything from basic universal coverage to equal premium pricing) would allow insurers to provide plans tailored to individual healthcare needs and priced according to individual life choices. Unfortunately, this approach stands at odds with the core tenets of much of the health legislation from both political parties today, which aims to help politicians win votes by distributing the burden of poor health rather than removing the incentive, by doling out benefits today at our children’s expense tomorrow. While our legislators attempt to appease political interests and costly patients, free-market advocates stand firm, championing the harsh reality we need to bring costs down and serve individuals more efficiently.
Government-run healthcare is inherently a redistribution scheme between those who make good choices and those who do not. But it was never meant to be so. Health insurance was first adopted by employers to keep their employees healthy and productive, which, in turn, reduced turnover and bred efficiency through the free market. Such private-sector healthcare, the first of its kind in the world, has produced some of the greatest innovations of the 20th century. From the anesthesia and antibiotics which enabled the first surgeries, to the vaccines that let parents sleep at night; from the million-dollar heart-stents, to the targeted cancer therapies that took lifetimes to develop, our commitment to improving lives (and, of course, the profits that followed) have produced the strongest specialist care in the world. However, as insurance was expanded to everyone, and as innovations yielded superbly expensive treatments and longer lifespans, consumers were shielded from the costs of their services. Immune to the price, patients kept running up the tab for insurers, including the largest of them all: the federal government. As the debt balloons to over 20 trillion dollars and our government remains gridlocked, placing the future of American healthcare in jeopardy, we must remember the long-forgotten triumphs of individualism and entrepreneurship that have brought us this far.
My parents and relatives, all survivors of the failed Soviet Union, can attest to the dangers of placing a “greater public good” above individual freedom. The USSR believed it could maintain an enormous level of production without any means of rewarding individuals for their contributions, which led to stagnations in all sectors, massive corruption, and a booming black market for those who could afford it. The same fate awaits the American healthcare system if we do not heed its warnings. 25 years later, my parents (who were in Moscow at the time) still struggle to comprehend how the mighty Soviet Union could implode literally overnight. If we do not reign in our healthcare costs and government overreach today, there may not be a healthcare system left to debate tomorrow.
Over the past decades, the free market has provided consistent and superb specialist care – for the rich and poor – because physicians and hospitals knew their reputations and profits were on the line. Government-managed medicine, under the guise of helping those most in need, does quite the opposite: it creates a two-tier system, arguably similar to that of Germany today. Physicians, unmotivated to perform their under-compensated public sector obligations, seek to provide superior private care on the side to those who can afford it. Patients have no option to switch insurances or hospitals because such freestanding entities have long been abolished, and with them, any hope of free-market accountability or efficiency. Abandoning the unique principles our revolutionary nation was founded upon runs the risk of betraying those very same people — the poor, weak, and sick — we seek to protect.
* Adam A. Barsouk is a student of medicine and health policy at Sidney Kimmel Medical College. Adam values the freedom that America has provided his family, and as a cancer researcher at the University of Pittsburgh and an aspiring physician, hopes to share this commitment by liberating the infirm of the chains of disease and suffering.
The views expressed here belong to the author and do not necessarily reflect our views and opinions.
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