[the nuance] series: healthcare
find your lens on messy issues
Welcome back to The Nuance — a series that helps you think more productively about complex topics.
Every big issue exists in gray areas, but our discourse pushes them into black and white – robbing us of informed conversations that might actually move us forward.
This series isn’t about finding the “right” answer. It’s about building capacity to see multiple layers instead of just picking sides. That’s productive thinking in a messy world.
Today’s topic: Healthcare in America
Mainstream discourse frames this as socialized medicine vs. free markets, or universal healthcare vs. individual choice.
The actual challenge: How does a nation build a system where people can get care when they need it without bankrupting themselves or the country?
Most of us want affordable care AND quality treatment. We want coverage for everyone AND the freedom to choose our doctors.
Let’s dive in:
The problem at hand is that “healthcare reform” collapses wildly different challenges into one debate. As always, let’s separate them:
We already spend enough to cover everyone: $14,000 per person annually, double what other wealthy countries spend. But it’s absorbed by drug companies charging 10 times other countries’ prices, administrative bureaucracy that costs five times what peer nations pay, and hospital systems that have consolidated into regional monopolies. Covering everyone means redirecting what we already spend, not finding new money.
Insurance requires healthy people subsidizing sick people: When “choice” means healthy people can opt out, the remaining pool gets sicker, premiums jump, and even more healthy people leave—each wave making coverage less affordable for those who need it. Americans value autonomy and distrust mandates. Both are real: insurance needs shared risk, and people resist forced participation.
Healthcare doesn’t function like normal markets: You can’t shop around during a heart attack. You rarely know what an MRI costs until after you’ve had it. Insurance companies profit by avoiding sick people — exactly opposite of what society needs. Framing this as normal market competition has real limits here.
Every other developed nation figured this out differently: Canada has single-payer with wait times. Germany has mandatory private insurance. Britain has the NHS with chronic underfunding. France has a hybrid system. None is perfect, but all of them cover everyone while spending half what we do.
American pharmaceutical subsidies fund global innovation: US insulin prices are 8-10 times higher than Canada. U.S. consumers effectively subsidize drug development for the world because other countries negotiate prices and pharma makes up revenue here. That’s producing new treatments. It’s also killing Americans who ration medicine. Both are true.
These layers all exist. When they conflict (and they constantly do), we have to prioritize.
The healthcare debate collapses these layers into two sides.
One side:
Healthcare is a human right—Medicare for All or similar universal coverage solves this. Every other developed nation proves it works. The current system leaves 27 million uninsured and bankrupts families. Insurance companies profit from denying care.
Where they’re coming from:
Medical bankruptcy is real. Rationing insulin is real. If you’ve watched someone skip treatment because they couldn’t afford it, or faced six-figure bills after a car accident, the “market solutions” argument feels inhumane.
The other side:
Let markets work—reduce regulations, increase competition, expand Health Savings Accounts. Government-run healthcare means DMV-style inefficiency applied to critical things like chemotherapy. The VA and Medicaid prove government can’t run healthcare well.
Where they’re coming from:
Wait times in Canada are real. Government underfunding in England is real. If you’ve experienced responsive private care, or watched government programs fail, “universal coverage” feels like trading quality for access — and hoping you’re never the one who needs that quality.
Both are pointing at something real, so we oscillate between “single-payer now” and “free markets will fix it” without acknowledging that the current system already IS heavily market-based and is failing.
Let’s talk lenses. Our perspective shapes our approach to this issue. What’s yours?
Quick diagnostic:
If you focus on medical bankruptcy and families avoiding care, you’re prioritizing affordability. The question: how do we ensure cost never prevents someone from getting treatment?
If you focus on wait times and government bureaucracy, you’re prioritizing efficiency.
The question: who can deliver care most responsively — markets or government?
If you point to international data and health outcomes, you’re prioritizing evidence.
The question: what measurably works elsewhere that we’re refusing to try?
If you focus on breakthrough treatments and medical innovation, you’re prioritizing advancement.
The question: how do we maintain R&D without making drugs unaffordable?
Your default lens determines which solutions feel obvious and which feel dangerously naive.
Now watch what happens:
An affordability person says “Medicare for All solves this.”
An efficiency person hears “Let’s make healthcare as responsive as the DMV.”
The affordability person hears “Let people die while markets sort themselves out.”
Add someone prioritizing evidence: “Germany’s system works—mandatory private insurance with heavy regulation.”
Same issue, different lenses.
Our divides ease when we see that we’re using different frameworks to weigh the same tradeoffs.
When you notice healthcare coming up in conversation, pay attention to which part of the problem the other person cares about most. Someone worried about insurance premiums eating their paycheck is starting from a different place than someone focused on government inefficiency. Neither is wrong—they’re just weighing different pieces of an impossible tradeoff.
“I support universal healthcare” or “I believe in free markets.” aren’t positions, they’re sides.
A real position means naming what you’re willing to give up. “I want everyone covered even if my own premiums rise and I lose access to specialists.” “I want pharmaceutical innovation to continue even if that means some drugs stay expensive.” “I trust international evidence even if copying other systems means years of messy transition.”
The only “wrong” position is pretending there’s no tradeoff.
Notice what these have in common—they all acknowledge cost. That’s what turns vague support into an actual position.
With that clarity, you can assess whether specific policies actually advance what you care about. You can spot when your own side is dodging hard questions. You can recognize when someone across the divide is protecting something legitimate, even if you’d weight it differently.
Healthcare moves forward when enough people can articulate not just what they want, but what they’re willing to trade for it.
If not us, who?
j