Healthcare as Freedom Infrastructure
- Annika OMelia
- Nov 12
- 8 min read
By Annika O’Melia
Freedom is foundational to the American experience. Our flag flies over the “Land of the Free and the Home of the Brave,” where rugged individuals pursue life, liberty, and happiness. While U.S. policymakers deeply value independence and personal responsibility, collective investment has always been central to American progress. No one is expected to generate their own electricity or pave the road beyond their driveway—we maintain these systems together because they expand individual freedom, productivity, and possibility.
Just as the physical infrastructure of railroads, highways, and electric grids once powered industrial growth—and broadband and the internet ushered in a new era of innovation—the next great frontier is building robust human infrastructure.
Strengthening the health, education, and well-being of our people will accelerate the rise of a people-centered economy—one where creativity and possibility can truly flourish, and where humans have a fighting chance of competing with the robots gunning for our jobs. Communities where residents have the security to spend in their local economy—and where exorbitant personnel costs don’t weigh down city governments—will see small businesses thrive and public budgets deliver in more expansive, imaginative ways.
From Bandages to Bureaucracy
When Francis Scott Key wrote those famous words on freedom and bravery in 1814, American healthcare was unregulated, primitive, and home-based. Most care came from unlicensed providers offering unscientific treatments in exchange for whatever a patient could pay. There was no anesthesia, no understanding of germs, and no formal hospital system. Death from injury, childbirth, or infection was accepted as a tragic part of life. A male born in 1814 could expect to live about 40 years.
By 1931—when The Star-Spangled Banner officially became our national anthem—medicine had transformed. We understood infection, performed complex surgeries, and trained doctors professionally. Hospitals had become places of healing rather than charity wards. Yet the financing of care remained unsolved. Science had advanced, but the means to pay for it had not. As other nations experimented with national insurance models, the American Medical Association, founded in 1847, fought to preserve a private marketplace for healthcare. Life expectancy for a male born in 1930 had risen to 58 years—a dramatic improvement, but one still shadowed by affordability.
Fast-forward to 2025. Advances in medicine now have the ultra-wealthy flirting with the idea that they can defy death through an abundance of healthcare, medication and technology. Research races ahead, costs climb, and yet the moral math of access still puzzles U.S. lawmakers. In the wealthiest nation on Earth, life expectancy lags other industrialized nations. According to a recent report, life expectancy for a male living in the top 1% of counties ranked by median household income is 84.3 years, while a man living in the bottom 50% of counties ranked by median household income lives an average of 77.4 years - a difference of 7 years.
Globally, our sister nations have figured out how to cover their entire populations at lower cost and with better outcomes, while the United States—spending 17 percent of GDP on healthcare—remains paralyzed by political gridlock. The Nordic countries, Japan, and Australia all treat healthcare as essential public infrastructure. We treat it as a commodity—and the results speak for themselves.
Healthcare Spending as a Percentage of GDP by Country
Freedom as Economic Design
Others can debate health policy ; I want to talk about possibility.
From where I stand—as an entrepreneur—healthcare isn’t just a social issue. It’s the architecture of freedom itself.
Beneath all the politics and policy papers, healthcare in America is a question of economic design. It determines who can take risks, who can innovate, and who can afford to fail. In a country that celebrates small business and self-reliance, our system traps too many people in jobs they’ve outgrown simply because leaving means losing coverage. It traps mothers tied to Medicaid, unable to risk higher earnings; it punishes small businesses that can’t match corporate benefits; and it drives workers away from the small businesses most rooted in their communities.. We call that the free market—but it’s anything but free or fair.
Freedom to Compete
“Universal healthcare” is often dismissed as socialist, but I see it as capitalist infrastructure—the foundation that allows free and fair markets to thrive.
Economist Amartya Sen wrote that real freedom isn’t just about choice; it’s about capability—the ability “to do and to be what you have reason to value.” Health is the precondition for every other kind of capability. Without it, all other freedoms—to work, to create, to care, to rest—become theoretical.
That’s why universal healthcare should be viewed as infrastructure. Like roads or power lines, it enables participation in the economy. It allows capitalism to function for everyone, not just the insured.
When only the largest corporations can afford to provide healthcare through large insurance pools, small businesses are disadvantaged. When similar corporations pay wages so low that employees still rely on Medicaid or SNAP to survive, those workers can only afford to buy the goods and services the giants sell—creating a feedback loop that crushes local economies.
Capitalism Without the Panic
A society where everyone has guaranteed healthcare isn’t socialist—it’s stable. It’s capitalism without the panic. Desperation hurts entrepreneurship. Fear makes people cling to what’s known, not create what’s possible. It’s hard to be brave when your financial future hangs in the balance.
When healthcare is tied to employment, fear keeps people in jobs they’ve outgrown. It keeps parents from launching businesses, artists from going full-time, and workers from negotiating better pay. It smothers the very risk-taking capitalism depends on and ensures that only the big boys thrive. Currently, the Magnificent Seven (the largest and most influential tech companies) make up 37% of the S&P 500’s value in October 2025. Budding competitors are already wildly disadvantaged, especially if they have to hold onto their day job so their family doesn’t go bankrupt amidst a medical emergency.
When healthcare is guaranteed, people can take chances. They can move, invent, create, and fail—without losing access to the doctor, therapist, or medication that keeps them alive. That’s the kind of capitalism worth defending: one built on confidence, not coercion.
A Market That Isn’t a Market
We call it a healthcare “market,” but it doesn’t behave like one.
Government subsidies keep prices high instead of driving them down—just as college tuition soared alongside federal loans (See the Bennett Hypothesis). Whenever there is an artificial influx of new spending power into a sector, the costs will rise. The government is, ironically, subsidizing higher healthcare costs for everyone—especially after cost-control measures like the individual mandate and “Cadillac Tax” were stripped from Obamacare after passage. According to the Kaiser Family Foundation, insurance premiums on the ACA are set to rise 26% in 2026 (https://www.kff.org/quick-take/aca-insurers-are-raising-premiums-by-an-estimated-26-but-most-enrollees-could-see-sharper-increases-in-what-they-pay/). That’s not competition; that’s collapse.
Family coverage for employers cost roughly $27,000 in 2025 with employees paying $6,850 of the total cost. For my small business, family insurance quotes I received this month priced family plans at nearly $30,000 per year or 53% of the median household income of $57,000 in my primary business location zip code. The math for families is not mathing.
Employers with more than 50 employees are required to offer health insurance. My business employs or contracts with roughly 20 people, so I’m not legally obligated to provide coverage. Still, I constantly weigh the benefits of doing so—I don’t want to lose a valued team member who needs affordable healthcare and is forced to seek employment elsewhere to get it. Unmarried parents, who may not have the benefit of spousal insurance, are often most impacted in this scenario.
The average monthly income for my staff, who have the freedom to set their own hours and have no production mandates outside of grossing more than $1,000/month for the business, is $6,750/month and ranges from a new mother working a few hours a week to net $750/month to a clinician working a full-time schedule and making over $17,000 a month. For the average earner, a family plan would cost $2500/month or 37% of their paycheck.
As a small business, my insurance pool of employees is too small to offer affordable coverage. The marketplace looks at the cost of the lowest individual plan offered, which would cost the employee $500/month, which is 7% of monthly income, which makes the plan “affordable.” If I offer "affordable insurance, my employees and their children would no longer qualify for marketplace coverage, which is more affordable for families.
Other countries spend half as much and get better results. Australia’s universal public system guarantees coverage for everyone while allowing private insurers to compete on extras. It’s humane, efficient, and sustainable—a model that would liberate American small businesses, parents on leave and those seeking meaningful work. Not to mention non-profits and city governments that are saddled with sharp yearly increases in health insurance costs. A public foundation with a private layer of “choice” promotes innovation without denying essentials.
Freedom to Build
Universal healthcare isn’t just a moral imperative—it’s an economic development strategy. It lowers risk, frees creativity, and keeps people healthy enough to build things. It’s the infrastructure of a dynamic capitalism, where entrepreneurs don’t have to marry a paycheck to keep their children alive.
My Story
When my husband and I were newly married, every job decision revolved around one question: Which of us can get health insurance? It turned out I had an easier time finding full-time work with great benefits. Though I’m the one with the entrepreneurial spirit, I took the stable employment and he worked in the gig economy.
When I helped facilitate a merger at work and lost my job—pregnant with twins and soon to be mother of four children under five—Medicaid literally saved our lives. I developed HELLP syndrome, a life-threatening pregnancy complication. Without a medical safety net, it’s no exaggeration to say I might not have survived childbirth.
My husband had just started a new job that came with benefits. That stability—access to healthcare—gave me the freedom to become an entrepreneur. It allowed me to take the risk of starting my own business, which now generates over $2 million in annual revenue, contributes to local property taxes through ownership of two buildings, and has created more than 20 jobs here in my hometown.
Today, I lead a team of employees and independent contractors. I try to model freedom and autonomy—the kind of leadership that trusts people to design their own lives. But the one obstacle I still can’t solve is health insurance for my amazing team and structuring something that doesn’t inadvertently make healthcare more expensive.
Whether as a student, an employee, unemployed, or running my own company, the riddle of health insurance has been central to every phase of my American life. The only time it didn’t factor into my decisions was when my husband and I lived in Canada for two years—and experienced the simplicity of universal healthcare. It was glorious. Even as immigrants, we received full healthcare, as the Canadian government recognized we were contributing to the economy by renting, attending school, working, paying taxes, and spending in the local economy.
A More Capable America
A publicly funded universal system with private options layered on top—like Australia’s—would finally give small business owners, contractors, and creators the same foundation as corporate employees. It would make healthcare a right, not a variable in a business plan. It would free up the capabilities of artists, scholars, researchers, young parents, caregivers, and more.
That’s not anti-capitalist. That’s capitalism with room to breathe.
Because real freedom isn’t just the right to start a business; it’s the ability to build one without gambling your family’s health to do it.
That’s the kind of economy worth fighting for—a capable America where everyone has the freedom to do and to be what they have reason to value.
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