The modern American health insurance system didn’t emerge because someone designed it thoughtfully, and it shows. It evolved from a series of political, economic, and cultural accidents beginning largely around the period of World War II. As with many political redistribution schemes, once underway, the system has snowballed into the unsustainable trajectory we see today.

My goal in writing this article is to explain how we got here, describe the present situation from the physician’s vantage point, and outline what must change to restore sanity to American healthcare.

About two thousand and three hundred years ago, while walking on the peripatos of the idyllic Lyceum, Aristotle noticed something very interesting. He saw that the interest being paid on lending from the fortunate to the miserable for the fulfilment of their personal needs is unfair, and that the wages paid to slaves are too low. All too obvious, there was no market mechanism.

On Sunday night, Federal Reserve chair Jerome Powell announced that Trump’s Department of Justice had served the Fed with grand jury subpoenas, threatening a criminal indictment of Powell.

The subpoenas concern statements Powell made to the Senate Banking Committee last summer about renovations to the Eccles Building—the Fed’s headquarters in Washington, DC.

President Donald Trump last week stated that he would ask Congress for a $1.5 trillion defense budget in 2027, an enormous $500 billion increase over 2026’s military budget. The proposed spending increase reflects how much the Trump administration has become focused on pushing new wars, and how much the White House loves to spend taxpayer money. 

The long-boiling tensions between the Trump administration and Jerome Powell’s Federal Reserve escalated over the weekend, with a New York Times report and subsequent public statement from Powell over the opening of a federal indictment about alleged false statements regarding Federal Reserve building renovations.

[Editor’s note: 2026 is the 250th anniversary of the Declaration of Independence, and this year we will be featuring many of Murray Rothbard’s work on the American Revolution and its meaning. In this essay, Rothbard touches on many themes we find on his work on American history, such as his contention that the abandonment of the Articles of Confederation by the “founding fathers” was a counterrevolution against the ideals of the Declaration of Independence.] 

Net present value (NPV) is a popular decision-making criteria used by firms to make key, crucial choices about how to allocate resources across an economy. Net present value forecasts temporally discount future cash flows to their present value to check whether a project creates value. If a project has an NPV greater than zero, it creates value. On the other hand, if a project has an NPV less than zero, the project loses value.