One of the silliest debates in the last ten years has been that surrounding healthcare. Progressives screech about the need for broader Medicare coverage, and conservatives extol the virtues of “free market reforms” to bring down medical costs. In both cases, they miss the mark by fixating on the delivery of insurance rather than an elimination of health issues in the first place.

For the purposes of this post, let us consider conservative arguments. They will typically join libertarians in advocating a rollback on insurance regulation and hospital restrictions, along with less government intervention in the economy. Many will note that in 2013, government spending was already 48 percent of the total for healthcare, and yet costs do not seem to be coming down. They might even point to the historical example of Nelson Rockefeller, who tried to expand government coverage of people under Medicaid, but had to abandon the program after it became too expensive.

These are all valid concerns, yet we run up against several problems. To begin with, as long as hospitals find it difficult to deny care to those who cannot pay, fellow travelers will end up footing the bill. Private insurance already acts like a placeholder of sorts for the government in these situations, but they simply amp up premiums on others to support the weaker links. Further complicating matters on the insurance side is the McCarran-Ferguson Act of 1945, which granted sweetheart exemptions to the insurance industry from federal antitrust laws, making it harder to prevent price gouging.

At least for the purer conservatives and libertarians, antitrust restrictions are a troubling question, appearing to some as a needless restriction on liberty. Others term them “anticompetitive,” and claim such legislation was only implemented to benefit industry actors who were losing market share. The front is thus not unified, although the House did vote overwhelmingly to approve a repeal of McGarran-Ferguson in 2010, only to see it die in the Senate.

The bigger issue being left out of the free market argument is the effect which lifestyle has on personal health. It’s easy enough to note that people must take responsibility for their own diet and exercise regimen, but this view fails to acknowledge contributing health factors sourced in other areas. If we fail to properly regulate food production, for example, we might well have hog waste getting into the water supply, if not the ham itself. The consequences have been algal blooms and massive fish casualties, yet who knows how many humans might already be affected.

Permitting high levels of added sugar in cereals or snacks is another problem. Sure, people are responsible for their own actions, but children will be capricious over what they want. In some cases, those kids might have been raised consuming junk, and not know any different. The mere availability of unhealthy foods might also result in them being consumed because of convenience, particularly if there is no existing market for healthier alternative in close proximity.

Sensible regulation is an obvious solution, with the EU providing baselines, but conservatives and libertarians will often come out against any further government control – while also demanding free market healthcare. Clearly this poses a problem. If people are eating garbage products because “it’s good for the economy,” then they will likely drive up costs after developing conditions like heart disease, diabetes, and cancer. Unless care is entirely individualized, with people “only paying for what they need,” and those unable to pay getting denied service, even private sector insurance will end up subsidizing them through risk pools and higher premiums. In other words, everyone gets charged more.

Thus we are left with a conundrum. Either we must overhaul food production and environmental protections to prevent disease in the first place, or make everyone pay out of pocket for their needs alone. As long as insurance plays a leading role however, the latter idea remains a wistful thought.