Our Malady

1. America's healthcare system prioritizes profit over health and freedom

We would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care.

Profit-driven healthcare. The American healthcare system is fundamentally structured to prioritize financial gain over patient wellbeing. This manifests in several ways:

• Hospitals prioritize procedures that generate revenue over those that promote long-term health
• Insurance companies have incentives to deny coverage and limit care
• Pharmaceutical companies focus on developing profitable drugs rather than addressing critical health needs

Freedom and health intertwined. This profit-centric approach undermines both individual health and personal freedom. When people are burdened by medical debt or afraid to seek care due to costs, their ability to pursue life, liberty, and happiness is severely constrained.

Systemic change needed. Addressing this issue requires a fundamental reimagining of healthcare as a human right rather than a commodity. This shift would prioritize preventive care, equitable access, and patient outcomes over corporate profits.

2. Health inequality undermines democracy and individual liberty

If health care were available to everyone, we would be not only healthier physically but also healthier mentally. Our lives would be less anxious and lonely because we would not be thinking that our survival depended on our relative economic and social position.

Health as social equalizer. Universal access to quality healthcare has the potential to reduce social and economic disparities, creating a more level playing field for all citizens.

Democratic participation. When people are healthier and less burdened by medical concerns, they are more likely to engage in civic life and participate in democratic processes. Conversely, poor health and medical debt can lead to:

• Reduced political engagement
• Increased vulnerability to misinformation and manipulation
• Erosion of trust in public institutions

Personal autonomy. Good health is a prerequisite for true personal freedom. Without it, individuals are constrained in their choices and abilities to pursue their goals and dreams.

3. The importance of early childhood development for lifelong health

The capacities that people need in order to operate as free adults develop when we are small. The skills that we will apply to become unique human beings are created during the first five years of life, as the brain grows to nearly its full size.

Critical early years. The first five years of life are crucial for brain development and establishing lifelong patterns of health and behavior. During this period:

• 90% of brain development occurs
• Foundational cognitive and emotional skills are formed
• Health habits and attitudes begin to take shape

Long-term impacts. Investments in early childhood health and education yield significant long-term benefits:

• Improved physical and mental health outcomes
• Higher educational attainment and earning potential
• Reduced likelihood of chronic diseases and social problems

Societal responsibility. Ensuring all children have access to quality healthcare, nutrition, and early education is not just a moral imperative but a strategic investment in the future of society as a whole.

4. Doctors should have more authority in healthcare decision-making

Doctors are the people who are trained in both the science and the humanism of care. When we think of medicine, we think of them, rather than of the corporations that hide behind their images on billboards. If we gave doctors the authority they deserve, we would all be healthier and freer.

Physician disempowerment. In the current system, doctors often find themselves constrained by:

• Corporate policies prioritizing profit over patient care
• Excessive administrative burdens
• Pressure to see more patients in less time
• Limited ability to make decisions based on their medical expertise

Patient impact. When doctors lack authority, patient care suffers:

• Less time for meaningful doctor-patient interactions
• Reduced ability to provide personalized care
• Increased likelihood of missed diagnoses or inappropriate treatments

Restoring medical authority. Empowering doctors to make decisions based on their training and expertise, rather than corporate directives, would lead to improved patient outcomes and a more efficient healthcare system overall.

5. Local journalism is crucial for public health and democracy

Journalists saved American lives in early 2020 by forcing an unwilling president to confront, if fitfully and belatedly, the reality of the coronavirus.

Information as public health tool. Local journalism plays a vital role in disseminating accurate health information and holding institutions accountable. The decline of local news has led to:

• Reduced awareness of local health issues and outbreaks
• Less scrutiny of local healthcare providers and public health policies
• Increased vulnerability to misinformation and conspiracy theories

Democratic function. Beyond health, local journalism is essential for maintaining a functioning democracy:

• Informs citizens about local issues and government actions
• Facilitates community engagement and civic participation
• Acts as a watchdog against corruption and abuse of power

Revitalizing local news. Investing in local journalism, potentially through public funding or innovative business models, is crucial for both public health and democratic vitality.

6. The COVID-19 pandemic exposed systemic flaws in U.S. healthcare

Since health is so elemental to existence, confidence about care is an important part of freedom. If everyone can assume that treatment will be available when necessary, they can turn their minds and their resources to other matters, make freer choices, pursue greater happiness.

Preparedness failures. The pandemic revealed critical weaknesses in the U.S. healthcare system:

• Inadequate stockpiles of essential medical supplies
• Fragmented and uncoordinated response efforts
• Disparities in access to care and health outcomes

Systemic inequalities. COVID-19 disproportionately impacted marginalized communities, highlighting longstanding health disparities based on race, income, and geography.

Lessons for reform. The pandemic underscored the need for:

• A robust public health infrastructure
• Universal access to healthcare
• Better coordination between federal, state, and local health authorities
• Increased investment in medical research and pandemic preparedness

7. Universal healthcare is both economically efficient and morally necessary

The idea that commercial medicine is efficient, even in simple economic terms, is grotesque. It is ludicrous to claim that our present system is cost effective. We pay far more for health care than do people in comparable countries, and we get far less.

Economic inefficiency. The current U.S. healthcare system is remarkably inefficient:

• Higher per capita spending than other developed nations
• Worse health outcomes on many metrics
• Significant administrative overhead and waste

Moral imperative. Beyond economics, universal healthcare is a moral necessity:

• Ensures equal access to a fundamental human right
• Reduces financial stress and improves quality of life
• Promotes social cohesion and reduces inequality

Feasible alternatives. Many other developed nations have successfully implemented universal healthcare systems that provide better care at lower costs. The U.S. can learn from these models to create a more equitable and efficient system.

8. Restoring truth and factuality is essential for public health

We cannot be free without health, and we cannot be healthy without knowledge. We cannot generate this knowledge by ourselves as individuals: we need a general belief in the value of truth, professionals whose job is to produce facts, and robust institutions that support them.

Trust in science. Public health relies on a shared understanding of scientific facts and trust in medical expertise. The erosion of this trust has led to:

• Vaccine hesitancy and the resurgence of preventable diseases
• Resistance to public health measures during the pandemic
• Proliferation of pseudoscientific health claims and treatments

Combating misinformation. Addressing the spread of health misinformation requires:

• Improved science education and media literacy
• Support for independent journalism and fact-checking organizations
• Greater transparency from health institutions and government agencies

Informed citizenry. A well-informed public is essential for both individual health decisions and collective action on public health issues. Restoring faith in factual information is crucial for creating a healthier, more resilient society.

Last updated: January 25, 2025