Who Needs Permission to Heal You?

You are on a routine doctor’s visit. Two people are in the room; you and the clinician.

Now count the parties who aren’t there but are making decisions on your behalf: the insurer who decides what your visit is worth, the billing coder who defines your body for payment purposes, the regulator who told the insurer what it may cover, and the compliance organization that sets the rules for what may be documented.

I know that room well. For a number of years as a healthcare administrator, I sat in the executive suites of hospitals, medical centers, and health clinics where those invisible parties were managed.

I left healthcare administration for the final time in 2009 and have been a writer and journalist ever since. The machinery I walked away from has only grown more elaborate. So, when I picked up Julio González’s The Case for Free Market Healthcare (2020), I read it as someone who has seen the crowded room from the inside.

The Surgeon Who Got a Live Demonstration

Dr. González is an orthopedic surgeon and attorney from Venice, Florida, a former Florida state representative, and the son of parents who fled Cuba’s communist regime. Within weeks of the book’s release in 2020, the pandemic had canceled his speaking tour, and a state ban on elective surgery reportedly cut his medical practice’s business by roughly 70 percent.

In the book, he argues that government should get out of medicine. Shortly after its release, a pandemic restriction order promptly empties his operating room. Few authors receive such a swift, personal demonstration of their own thesis.

[A note on method in the spirit of full transparency]. The Case for Free Market Healthcare is a small-press title with few public excerpts. So for this article I draw on the framework González has developed consistently across his legislative record, articles, and commentary over the past fifteen years. While the book is the fullest expression of that framework, what follows is a conversation with his ideas, not a chapter-by-chapter summary.

The Core Argument: Decisions Belong Near the Patient

His thesis is simple. Medical decisions belong in the exam room, between patient and physician, as far away from central authority as possible. In his words, “the best approach to health care legislation is to minimize government’s regulatory sphere of influence and to leave the decision-making as close to the patient as possible.”

His evidence is lived rather than theoretical. He describes Cuban hospitals where surgeons must barter or steal basic equipment, and Venezuelan patients who bring their own food and supplies to the ward. “We have seen this all before,” he writes. That’s the testimony of someone whose family knows what it costs when the state nationalizes medicine along with everything else.

He also worries about more than government. Fewer than half of American physicians now work in physician-owned practices, with hospitals and private equity absorbing the rest. Each layer of ownership adds administrators whose primary interest is the bottom line.

I can confirm that from the other side of the desk. Every layer I helped manage, however well-intentioned, put one more step between the person who needed care and the person who could give it. We weren’t villains, but bean financial counters.

What Self-Governing Readers Should Take From Him

The third party is the problem. Nearly 90 percent of American health spending now flows through a third-party payer, compared with about 67 percent in 1970. When someone else pays, someone else decides. The patient stops being a customer and becomes a claimant.

French economist Frédéric Bastiat observed this pattern in the nineteenth century: “The state is the great fictitious entity by which everybody seeks to live at the expense of everybody else.” Swap “insurance pool” for “state” and you have a decent description of American medical billing. Everyone spends everyone else’s money, and no one’s price tells the truth.

Build, don’t petition. González co-founded the United States Medical Association as an alternative to the AMA, which he considers increasingly radicalized. Whatever you think of his politics, he chose exit over protest: he built a counter-institution. Agorists have long argued that power fears this kind of move most. González put the idea into practice.

Where We Push Past the Book

González’s remedy is federalism, moving healthcare policy to the states. For a constitutional conservative, that’s the endpoint. For those of us who take self-government seriously, it’s a halfway marker

A state certificate-of-need board that blocks a new clinic is no friendlier to the patient than a federal agency doing the same thing. Decentralized coercion is easier to escape, and that’s real progress, but it isn’t consent. If proximity is the principle, it doesn’t stop at a state capital. It runs on to the clinic, the cooperative, the congregation, and finally the individual.

American economist Murray Rothbard defined the state as the organization that “attempts to maintain a monopoly of the use of force and violence in a given territorial area.” A smaller territory is still a monopoly. Thoreau’s line “That government is best which governs least” is usually quoted as a destination, but he carried it further: that government is best which governs not at all. González stops at the first half of that sentence.

The Guild in the Mirror

Here’s the blind spot in most physician-led free-market arguments, and it’s the profession’s own history.

Historian David Beito documented how fraternal lodges in the early twentieth century contracted with doctors to care for members for a dollar or two a year. This “lodge practice” covered more than half a million people by the 1910s, and Black fraternal orders went on to build their own hospitals, like the Taborian Hospital in Mound Bayou, Mississippi.

https://youtube.com/shorts/yZnk06EuVEY?is=YtD_lOGAAAnM2V9H

The problem is, organized medicine destroyed it. Medical societies branded it the “lodge practice evil,” boycotted participating doctors, denied them hospital privileges, and pushed to revoke licenses. They then turned to the state to raise entry requirements and restrict supply.

That history cuts both ways for González. It justifies his distrust of the American Medical Association (AMA), but it also shows that the state’s grip on medicine was often invited by physicians themselves.

A truly free market in healthcare threatens licensing monopolies, scope-of-practice protections, and corporate-practice-of-medicine prohibitions as much as it threatens Washington. Those prohibitions are state rules protecting physician ownership from competition.

I watched the guild at work from the administrative side, in credentialing committees and privileging fights. Much of what we called “quality” was also, quietly, “who gets to compete.” Both things can be true, which is exactly why the arrangement is so hard to see from inside.

The Planner Hiding in the Free-Marketer

In his 2009 book Healthcare Reform: The Truth, González proposed “health index scores,” with government and insurance funding for curative treatment ending once a patient hit a certain score. He has said he meant to expose the cruelty of prolonged, futile treatment, and that concern is humane. I’ve stood in those hallways, and he’s right about the cruelty.

But the mechanism is a planner’s tool. A centrally defined score decides who gets care, and whoever designs it becomes the third party he otherwise opposes. The self-governing answer is that end-of-life decisions belong to the patient, the family, and the healer, funded by resources the patient controls.

But What About the Poor?

Every work on free-market healthcare has to face this question, and critics like economist Kenneth Arrow pressed it decades ago: emergencies and catastrophic illness make comparison shopping impossible.

Conservative reformers tend to answer with block grants or state safety nets. We have a better answer, and it’s the lodge again. Mutual aid, built on reciprocity, served immigrants, laborers, and Black Americans whom the formal system ignored.

Its descendants live on today in direct primary care memberships like the one run by Dr. Lindsey Cassidy in Denver, cash-price surgery centers like the Surgery Center of Oklahoma, and healthcare-sharing ministries like Liberty Health Share.

González’s argument gets stronger placed in that lineage. Free-market healthcare is most persuasive when it’s also a story of people caring for each other without having to ask government for permission.

The Taoist Kitchen

The Tao Te Ching says that governing a large state is like cooking a small fish. Stir too much, and it falls apart. American medicine has been stirred by every hand in the kitchen: federal agencies, state boards, insurers, hospital systems, private equity, professional guilds. The patient is the fish.

González’s instinct is to remove the biggest spoon. Mine, after a career spent holding several of those spoons, is to ask why so many are in the pan at all. Lao Tzu puts it bluntly in chapter 57: “The more laws and restrictions there are, the poorer people become.”

Wu wei (effortless action) in medicine wouldn’t mean chaos. It would mean a system that grows from relationships instead of mandates. A person seeks help, a healer offers it, and both agree on terms. Everything else exists to support that encounter, and too often it replaces it.

The Taoist also keeps a certain humility about the reformer’s role. I don’t trust my own former profession to design the replacement any more than I trusted it to design the original. What I trust is the encounter itself, and the ordinary human capacity to find one another and work out terms.

The Verdict

The Case for Free Market Healthcare is a conservative physician’s case for restoring the doctor-patient relationship to the center of medicine. Its strengths are moral clarity, testimony from the Cuban diaspora, and a practitioner’s direct view of how bureaucracy degrades care. And its author did something rare among policy writers: he built an alternative institution.

For self-governing readers, it’s a useful ally and an incomplete map. It names the intruder in the exam room correctly but stops short of calling every government-centric actor out, especially the state-backed professional structures physicians helped build. For this reason, I would encourage you to read it alongside Beito’s From Mutual Aid to the Welfare State to have a more complete picture.

The final irony is the most instructive. In spring 2020, a state order closed a free-market surgeon’s operating room weeks after his book reached readers. González concluded that government should be smaller and closer to home. We can take one more step. The power to decide whether you may be healed belongs to you.