Jeffrey Tucker’s recent article, “Small Steps Toward Medical Freedom,” The Epoch Times (Jan. 6, 2026) has several provocative “urgent priorities for U.S. medical-insurance reform”. Writes Tucker:
I’m going to present three urgent priorities for U.S. medical-insurance reform, plus two additional points that would be nice to have. My goal is to be as simple and clear as possible in hopes that even politicians can understand. If you can help get the word out, thank you. Sadly, this whole system has become so convoluted and the discussion so confused that certain obvious points need to be stated this way.
1. Permit a full range of catastrophic plans with premiums tied to individual risk and assessed by actuaries. Most people do not need more than catastrophic insurance. The co-pay system of endless streams of inexpensive visits, followed by high-deductible and very expensive specialty care, is simply not working. No one even understands how the pricing of this system works, so people both overuse it and underemploy it.
… Making a change to allow maximum freedom for catastrophic care would instantly drop premiums. By how much? I asked a number of AI engines to speculate. The typical answer came back at $100-$200 per month. That sounds reasonable to me. …
2. Permit anyone to have a health savings account (HSA)—not just the insured—with very high ceilings on contributions or no limit at all.
This crucial change will backstop the above change. This will allow Americans to save specifically for medical expenses and do so completely tax free. When the money is not being used, it can be invested in financial markets either safely or in risky portfolios, same as any other savings account. …
3. Untangle insurance from employment on a voluntary basis, so no more employer mandate and plenty of off-ramps for employees. Right now, businesses with over 50 employees have no choice but to provide insurance of some sort to employees. Those who do not are subject to outrageous penalties.
… This is the bare minimum required of any plan. It should be clean and simple.
There are two more points we should add.
4. All special liability exemptions for medical products and services must be ended. That includes vaccines on the childhood schedule. No business should ever be entitled to do any business without bearing consequences for harming others. No system of markets and freedom can possibly work this way. No more indemnifications for special interests. Period.
5. Allow and encourage performance-based payment systems vs. fee for service. Doctors, therapists, and hospitals should be allowed to price their systems this way, actually selling health results rather than selling drugs, diagnostics, and surgeries. This should apply to every form of medical services. For the first time, we would see incentives flip toward actually promoting health, which would mean pushing education and better living.
I could add another 30 or so points but the above would at least get the fundamentals correct. Doctors, patients, and insurers could take it from there, as a vast range of options would spring up everywhere.
This is not a systematic or comprehensive proposal for reform but does point is in the direction of the source of our real problems which must be taken into account in any attempt at reform. For more comprehensive proposals for healthcare reform from a libertarian or free market perspective, see Scott W. Atlas, “Transformational Healthcare Reform,” in Blueprint for America, George P. Schultz, ed. (Hoover Institution Press, 2016) and Michael F. Cannon, Recovery: A Guide to Reforming the U.S. Health Sector (Cato, 2023) and related Cato podcast episode, “Recovery: A Guide to Reforming the U.S. Health Sector” (Oct. 16, 2023).
Note that none of these proposals mentions one obvious cause of outrageous healthcare cost: pharmaceutical patents; nor the obvious solution: abolishing patents, or at least pharmaceutical patents. In the case of the Atlas and Cannon proposals, the failure to even mention patents is probably because Objectivists (Atlas has been associated with the Objectivist Atlas Society) 1 and Cato (used to be against IP but no longer, apparently) 2 are not really opposed to patent law. Tucker, by contrast, is opposed to patents 3 but perhaps did not mention abolition of pharma patents because of skepticism about the role of pharmaceuticals in healthcare. 4
But even Robert F. Kennedy, Jr., hardly a libertarian, recognizes the corrupting influence of patents. From his book The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health (Skyhorse Publishing, 2021)
From the moment of my reluctant entrance into the vaccine debate in 2005, I was astonished to realize that the pervasive web of deep financial entanglements between Pharma and the government health agencies had put regulatory capture on steroids. The CDC, for example, owns 57 vaccine patents and spends $4.9 of its $12.0 billion-dollar annual budget (as of 2019) buying and distributing vaccines. NIH owns hundreds of vaccine patents and often profits from the sale of products it supposedly regulates. High level officials, including Dr. Fauci, receive yearly emoluments of up to $150,000 in royalty payments on products that they help develop and then usher through the approval process. The FDA receives 45 percent of its budget from the pharmaceutical industry, through what are euphemistically called “user fees.”
Or as he writes in Chapter 7:
The 1980 Bayh–Dole Act allowed NIAID—and Dr. Fauci personally—to file patents on the hundreds of new drugs that his agency-funded PIs [principal investigators] were incubating, and then to license those drugs to pharmaceutical companies and collect royalties on their sales.
As for my own suggestions for reform, which are also focused (mainly on the role of patents and in healthcare) and not comprehensive, see:
- Kinsella, “Patents, Pharma, Government: The Unholy Alliance,” Brownstone Institute (April 2024)
- ——, “Decouple Trade and IP Protection,” Brownstone Institute (Dec. 4, 2024)
- ——, “Patents and Pharmaceuticals“
- ——, “FDA and Patent Reform: A Modest Proposal” (May 5, 2023)
- “Are Patents Needed to Make Up for FDA Kneecapping?” (July 2, 2011)
As for Tucker’s assorted points, a couple comments.
First, as for the proposal for promoting the use of catastrophic insurance, as far as I understand, this would not be feasible so long as insurance companies are prevented from denying coverage based on pre-existing conditions. As long as insurance companies are legally prohibited from turning someone down based on a pre-existing condition, then people will not even buy catastrophic insurance ahead of time; they will just wait until they get sick and then buy “insurance.” This would obviously make it impossible to be profitable or operate as actual insurance. 5 So any proposal to promote catastrophic insurance would have to repeal the ban on pre-existing conditions. But this is a non-starter, as even Republicans won’t touch that rail.
Second, as for this proposal: “Untangle insurance from employment on a voluntary basis, so no more employer mandate and plenty of off-ramps for employees.” I’m afraid this might mean tax increases, in effect, then employer-provided healthcare benefits would be treated as part of the employee’s taxable wage.
- The Atlas Society Asks Scott Atlas (Sep. 22, 2021). [↩]
- Cato on Drug Reimportation; Cato Tugs Stray Back Onto the Reservation; and Other Posts. [↩]
- Jeffrey A. Tucker on Intellectual Property. [↩]
- See, e.g., this tweet. [↩]
- On the distinction between case and class probability, see Mises, Human Action, ch. VI §3 and §4; and Hoppe, “The Limits of Numerical Probability: Frank H. Knight and Ludwig von Mises and the Frequency of Interpretation,” “The Yield from Money Held” Reconsidered,” and “On Certainty and Uncertainty, Or: How Rational Can Our Expectations Be?“, all in The Great Fiction. [↩]
