The Real Shutdown in Your Doctor’s Office

My mother retired this year after decades of teaching/administering in the public school system. It should’ve been a season of rest—a chance to read, travel, and settle into her new status as Gramma (or abuelita—I will report back on how that’s going at a later date).

Instead, she found herself staring at a new math problem: how to afford health insurance. The premiums for her and my father were so high that her pension takes a massive hit each month to cover them.

We hear a great deal these days about the potential for a government shutdown in Washington. But another shutdown happened long ago—in our healthcare market. Prices no longer signal value. Competition is simply a mirage. Even if Congress reopens tomorrow, the system that decides who gets care and who can afford it remains closed to ordinary Americans.

A big reason Democrats and Republicans can’t reach a deal is healthcare. They’re battling not over whether the system works (it doesn’t) but over who pays for it. Even in conservative strongholds, the politics are shifting: in Georgia’s 14th District, Representative Marjorie Taylor Greene recently backed extending Obamacare subsidies, saying her constituents couldn’t afford to lose them. The shutdown debate isn’t really about spending levels—it’s about a dependency both parties helped build.

From a free-market lens, the Affordable Care Act didn’t reform healthcare—it froze it. What we call a “system” today is a cartel of insurers, hospitals, and agencies bound together by rules that hide prices, distort incentives, and punish innovation.

The System That Pretends to Care

In a real market, prices tell the truth. They guide choices and reveal value. In America’s healthcare market, they tell us nothing. Ask what an MRI costs and you’ll get a shrug—even from your doctor. The numbers are negotiated in secret among hospitals, insurers, and bureaucrats.

Hayek called this the knowledge problem: central planners can’t know what millions of individuals know locally. When retirees like my mom can’t plan their budgets or compare providers, it’s not because they lack discipline, but because the information they need has been buried under bureaucratic complexity.

I see the same logic at school. Every semester, my law school requires proof of insurance or auto-enrolls students in an expensive plan. Most of my classmates are healthy twenty-somethings, but we’re forced to buy coverage we rarely use. The policy is supposed to teach responsibility, but instead teaches obedience.

Insurance once covered catastrophe—your house burns down, your appendix bursts. Now it covers almost everything, from checkups to colds. When someone else pays the bill, you order more. When doctors know insurers will pay, they order more tests. This is what we call moral hazard: people take greater risks when they’re insulated from cost.

The ACA entrenched this issue. By mandating “essential benefits,” expanding subsidies, and penalizing those without coverage, it transformed prudence into paperwork. The result isn’t a healthier nation—it’s a poorer one. In fact, medical bills are now one of the top causes of bankruptcy in America; proof that what we call a safety net often feels more like a trap.

Meanwhile, the system rewards incumbents. Want to open a cash-only clinic? You’ll hit licensing and certificate-of-need laws. Want to offer telemedicine or subscription-based care? Prepare to navigate rules built for billion-dollar hospital chains.

This is cartelization; free markets and competition have been dispensed with long ago. This is not a failure of the market; it is a failure of regulation that prevents a market from forming. Washington subsidizes demand, prices rise, and rising prices are used as proof that “markets fail.” The fix? More subsidies.

On ACA exchanges, families pay higher premiums for shrinking networks. In many rural counties, like my hometown, only one insurer remains—a monopoly disguised as access. Each round of reform redistributes pain without reducing power. And once people depend on government coverage, even its critics must defend it. The subsidy spiral becomes a loyalty test.

The Market That Could Reopen

A genuinely free healthcare system would look nothing like today’s.

• Transparent Prices: Clinics would post actual rates, allowing patients to compare and choose.
• Insurance for Catastrophe: Routine care would be paid directly or through affordable membership models, such as Direct Primary Care.
• Deregulated Entry: Let telehealth and cross-state plans flourish.
• Voluntary Competition: Insurers could experiment with coverage types—no “essential benefits” from Washington.
• Local, Decentralized Solutions: Co-ops and mutual-aid networks could meet needs without federal micromanagement.

And if you listen to podcasts lately, you’ve probably heard the ads. CrowdHealth, Medi-Share, and other “health-sharing” programs pitch themselves as alternatives to traditional insurance. They’re not insurance at all—no guarantee of payment, no bureaucratic middleman, and no government approval. Members voluntarily share one another’s medical bills, often for a fraction of what a policy costs.

This is much like how Amish communities handle healthcare: many belong to church-backed “aid plans” that pool money to pay members’ medical costs. It’s a real-world example of people treating healthcare as a communal responsibility, not a bureaucratic product.

They’re not perfect, but they prove what happens when people are trusted to solve problems instead of waiting for permission. These models aren’t the future—they’re the remnant of what we once had: adults pooling risk and helping one another without Washington’s supervision.

Economics, properly understood, is the study of human action. When people bear the costs of their choices, they act with care and foresight. If those costs are socialized, individual responsibility becomes less apparent. Whether it’s a retired teacher who can’t afford her premiums or a law student forced to buy insurance he doesn’t need, the message is the same: the state knows best.

America’s recurring shutdowns are symptoms of a deeper paralysis. The real shutdown is moral and economic. We’ve stopped trusting markets and ourselves to make responsible choices. And a system that hides prices while demanding obedience isn’t a market. If we ever want healthcare to be affordable and usable, we have to let it be what it’s never been allowed to become: a market. Until we do, we’ll keep calling it “healthcare” while it keeps making us all a little sicker.