01/13/2013 02:57 pm ET Updated Mar 15, 2013

The Downside of American Freedoms

Americans love their freedom. They want to be free to do as they wish and free from constraints, especially those imposed by government. In a recent Gallup Poll, those aged 18-34 said that their "individual freedoms" were "the best" or "above average" in America, compared with other modern, industrialized nations. The figure went up to 80 percent for those aged 35-54. They also gave high marks to the "quality of life" (66/65 percent, respectively) and "the opportunity for people to get ahead" (59/52 percent, respectively).

These appreciative views, however, diminished considerably when Americans were asked about their health care and economic systems. Only 20 percent of 18-34 year-olds rated the health care system as "the best" or "better than average" (32 percent of 35-54 year-olds) and just 24 percent (35 percent for 35-54 year-olds) rated the economic system highly.

Given the high cost of health care and the inability of millions of Americans to get health insurance, it is not surprising that Americans rate their system low in comparison with other nations. The outcomes of the American health care system are mixed, at best, as well. Indeed, a recent report from the National Research Council concluded that Americans, when compared with peer nations, "have a longstanding pattern of poorer health that is strikingly consistent and pervasive over the life course." Indeed, Americans fared worse in nine areas, including infant mortality and low birth weight, injuries and homicides, adolescent pregnancy and sexually transmitted diseases, HIV/AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disabilities.

Given persistent high unemployment and underemployment, especially among minority groups, stagnation in wages, and an economy that is still struggling to emerge from the "Great Recession," the low marks for the economic system are also not a big surprise.

What should be surprising is that Americans may not see much of a connection between the items they rated. When you maximize your freedom to choose in health care, this contributes to a system that is less efficient and effective than it might be. You get as much (or as little) health care as you can afford, in a fee-for-service system that offers few incentives to rein in costly medical procedures, regardless of their utility. In the job market, Americans trumpet the "free market," without realizing that such freedom can lead to wild speculation by business and individuals -- producing not just the chance to become wealthy but economic downswings which cause great suffering.

Freedom is not an unalloyed good. While the assumption is that maximizing freedom enables people "the opportunity to get ahead," that assumption needs to be qualified. If we think our health care and economic systems do not compare favorably with those of peer nations, it may well be that the freedom we cherish is paid for in some cases by a poorer quality of life. Freedom to do your own thing does not necessarily lead to freedom from poor health and economic privation.

Often, we look to government to balance individual freedom with societal well-being. This is the purpose of regulation and legislation. Well-executed, government levels the playing field and protects those who would otherwise be disadvantaged by too much freedom in their own hands or the hands of others. But that balancing role has proved especially difficult in recent years, as we distrust government more and seem unable to agree on what it should be allowed to do. Not surprisingly, then, the same Gallup poll found that only 36 percent of Americans aged 18-34 felt that our "system of government" was "the best" or "better than average," compared to other nations (50 percent of 35-54 year-olds felt that way).

The result of individual freedom and incapable government, then, is what the Gallup Poll may be reflecting. We seem to want more freedom and less government, when in fact more freedom may also require more -- and better -- government.

This is not an argument that government is inherently good. Indeed, government can be overbearing, unjust and inefficient. But it is an argument that we need to consider more carefully what government must do so that we can retain the freedom we cherish. If freedom to do what we wish is not leading to better health and economic prosperity, we need to ask why.

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