Tom is a forty-three-year-old self-employed painter and father of two.

He’s currently in remission from lung cancer, having been first diagnosed five years ago. At the time of his diagnosis, he did not have health insurance. Thankfully, for him, American law had finally made it illegal for health insurance companies to discriminate against individuals with preexisting conditions.

Tom had to be offered insurance at community rates. And, this was a good thing for him. His medical expenses exceeded $100,000 annually for his first two years of treatment. No one deserves to go without care for a serious medical condition.

***

Jenny is a married mother of two.

She is employed by a local small business where she worked for the last 12 years. Her daughter has an uncommon, but treatable, blood disorder that requires occasional laboratory testing and infrequent blood transfusions.

Jenny’s employer provided the health insurance of both Jenny and her daughter for the last decade. It has been a part of Jenny’s benefits plan.

Unfortunately for Jenny, over the last few years, the cost to her employer to provide this plan has risen dramatically. The small business she works for has had no choice but to pass down many of these rising costs to her.

Jenny now pays her employer a markedly higher monthly premium for her family to be included on her plan. Her medical deductible is 10 times what it was just six years ago. And her coverage is far worse.

Forced to cut costs even further last year, her employer only offered insurance options with smaller networks of physicians. Jenny is currently driving 90 minutes for her daughter to receive the specialist care she requires. Five years ago, she drove four miles down the street.

Thankfully, Jenny has still found a way to make ends meet despite these obstacles. But, next year is looking to be even worse regarding the cost and quality of her insurance.

***

Health care is once again a major focus of political conversation, so it’s important we understand a few things.

Our President-elect has said he will work to repeal President Obama’s health care law, but at this point, the details are not clear. Will his replacement product be better than what it’s replacing?

It may ultimately depend on your point-of-view. It usually does. The only real certainty here is that there will be tradeoffs. And, the best solution might end up being the hardest one to wrap your mind around. I’ll explain.

The President-elect intends to keep what he calls one of the “strongest assets” of the existing health care legislation — the requirement for all health insurance companies to provide comparable cost products to people regardless of pre-existing conditions.

On the surface, opposing this idea would seem to be preposterous. You’d surely be standing on the wrong side of morality — against the schemes of the do-gooders. If you are sick, you must be covered. That is the only thing that could be just.

If only it were so simple.

Thankfully, Tom has health insurance in this environment, but it comes with an often overlooked tradeoff. Jenny and her daughter are worse off.

Tom was given “insurance” for a condition he already had. He was allowed to buy homeowners insurance after his house burned down. So, he pays a lower-than-expected premium for his predictably expensive care. And somebody somewhere must pick up his slack. In recent years, that’s fallen to people like Jenny. Is this just?

Maybe for Tom, but what about for Jenny?

What if I told you that for every Tom who has been helped by this legislation, 50 Jennys have been made worse off? What if this number is really one to 1000? Is there any point at which the existing scenario ceases to be so just?

What if I now give you a critical piece of information I failed to disclose in the beginning? Tom smoked cigarettes for the first thirty years of his life, and this contributed to him developing his lung condition. Would your view of morality suddenly become less concrete?

Researchers now claim four out of 10 cancers are preventable by healthy lifestyle choices alone. Does this affect your perception here?

You see, the humanitarian in us — and I’m guilty too — frequently believes compelling people to fit inside our moral viewpoint will lead to greater good. Often this is not true.

The irony is governing systems geared toward forcing altruistic behaviors on all people have benefited the poor far less than those designed to get the most out of the human tendency toward self-interest.

What our President-elect is really after — what WE are really after— is high-quality, low-cost health care. That’s the goal. Nothing else.

We can’t achieve this heading in our current direction.

Political processes are just known to respond to those with the most resources. Those with the finances to organize, engage, and lobby the system. In health care, such processes have only served to further protect existing revenue streams — even when they are flowing with less quality and higher cost.

We need innovation.

But, you can’t regulate that to happen. You can’t wish it to be.

To get innovation — to better our system — you will have to give up a few things that you want to hold dear. You may have to accept an imperfect reality, because if not, where will it stop? Today, they will interfere with the health insurance market. Tomorrow, they will say it’s just for every 25-year-old to have the right to buy life insurance at the same rate.

Every industry they touch will become more unaffordable to the poor. And, we will just scratch our head wondering why. We will keep drawing our own blood in search of where it’s going. We will keep crippling the very system that made us great.

The choices I speak of can be tough to make. The right decisions may be challenging and unpopular, even political suicide for some. But, in the end, whatever we do, there will always be some Tom who is helped at the expense of a Jenny. Just the names and the details will change.

The real solution, of course — as difficult as this may be on the surface — is to focus less on what is arbitrarily just and more on what has proven to be successful at driving quality and lowering cost — innovation and free exchange. Allow outliers to exist. Don’t regulate them away toward a below-average mean. Relax mandates. Let variability in health insurance plans flourish and allow people to determine the best ones. You will gain not just improved health insurance options, but imagine the potential for other innovative schemes — like the option of purchasing insurance for pre-existing conditions of your choice. It will bring us closer to our goal than anything we’ve tried before.

I’d even encourage you to find a charitable way yourself to smooth out some of the imperfections that will arise along this pathway.

But ultimately, there will just be less of them to deal with.

Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com.

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