Americans have long rhapsodized over our nation’s defining characteristics: freedom and equality. Yet these two ideas are actually contradictory when it comes to the design of health care policy. In this podcast, Powers discusses how creating a health system that promotes equality impedes on individual freedoms. She also highlights the problems with allowing too much freedom of choice in health care. New developments, from genetic testing to amazing drug treatments, are exacerbating the ability to create a system that balances equality and freedom. Powers offers up an alternative and also outlines which of these important considerations – freedom or equality – should be prioritized in the American health care system.
Key Citations

* Kamala Harris and the elimination of private insurance: CNN
* Prioritizing private pay patients at the Mayo Clinic: Modern Healthcare

Transcript
PDF Version for Download
Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on iTunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.
As the 2020 presidential election approaches, we will be hearing some familiar terms on the campaign trail. We’ll hear politicians mention one of my favorites, the American Dream. I’m partial to this one, because my book that proposes an overhaul of the health care system is called Health Care: Meet the American Dream. But we’ll also hear a lot about freedom and a lot about equality – two values intrinsic to the American spirit.
In this podcast, I will talk about freedom and equality in the health care system. What does it mean to have freedom in health care? To have equality in health care?
This is critical to discuss because I believe that freedom and equality cannot co-exist in our health care system. Yet we, as Americans, support both freedom and equality. We’re going to have trouble figuring out a way forward for health care if we don’t start considering this rarely discussed contradiction. Which is more important? Do we really understand the ramifications of striving for either freedom or equality in health care?
So let’s get into it.
We Americans love, and better yet, expect, freedom of choice. When the Affordable Care Act was designed, there was hope that buyers on the health insurance exchanges would have choices. The exchanges were called marketplaces for a reason. People were expected to shop for their insurance, and the marketplaces were supposed to make it easy to compare prices.
We’ve subsequently learned that shopping just on price for health insurance doesn’t allow consumers to make informed choices because the products vary considerably by coverage and access. One plan may offer the same pricing as another, but your doctor may not be included in one of them. So the products aren’t equal, even if the pricing implies that they are.
In fact, our love of choice is creating a conflict with regard to support for a single payer system. Take Democratic presidential candidate Kamala Harris’s view.