Sovereign Individuals and Broken Healthcare Incentives

Show Notes

Dan and I both cracked open The Sovereign Individual this month, and this episode is us comparing notes from about a quarter of the way in — him a chapter or two ahead of me, both of us a little lost in the same fog. It's a slog of a book, and we said so. I confessed I keep losing the thread somewhere in the pages of knighthood history (a full set of armor cost something like sixty sheep, the horse another twenty — that part I did retain), terrified an important sentence is hiding in there that I'll need by chapter seven. Dan's more forgiving: he found a real lesson in how expensive military technology made early feudal power, how those little fiefdoms were almost individual sovereignties, tiny city-states. We agreed the authors — James Dale Davidson and Lord William Rees-Mogg, with a preface by Peter Thiel — do a surprisingly good job building you from feudalism to the nation-state even when they meander. We're less sold on where they're taking it.

Because the thesis, as far as we can tell this early, is that the information age fragments the nation-state and frees the sovereign individual — no more reliance on fiat currency, no more government control over how online purchases get taxed. And Dan put it bluntly: that is not what happened. There was more tax-skirting before e-commerce, not less, because everything is legible now — legible to machines and therefore to the government. I used to be able to hand a guy five bucks cash and nobody needed to know; you can't buy something on my site in an illegible way anymore. We chewed on whether crypto changes that and landed on no — between volatility and Know Your Customer rules, it's nowhere near as anonymous as the early hype promised. The real utility is mundane and lovely: cheaper international transfers for people wiring small amounts home, beating Western Union's old eighty-dollar fees. Which got us griping about how a bank wire still costs forty-five bucks and dies if you miss a three o'clock cutoff, like a human somewhere still has to eyeball it. The whole ACH machine — the automated clearinghouse — is just a noodly mess of counterparties.

Then healthcare blew up, and we couldn't not talk about it. Luigi Mangione and the UnitedHealthcare CEO assassination. What got me wasn't the act so much as the spread of the reaction — how many people, quietly, seemed to feel the killing was understandable. I told Dan I was surprised how big that camp turned out to be; he wasn't surprised the thing happened at all, only that it hadn't happened sooner. Neither of us thinks murder is okay. But we both think the reaction says something ugly and real about where people's relationship with healthcare has gone. I pointed to a Graeme Wood piece in The Atlantic that called the attitude un-American and, well, ugly — and I think that's fair while still understanding exactly where the anger comes from. Dan had the better frame, as usual: a crowd doesn't throw rocks until one person does, and then the next bottle has a flaming rag in it. Sentiment like that is virulent — easily spread — and once you find two people close to you who feel it, suddenly it feels okay to feel it yourself.

The part neither of us could untangle is the incentive structure underneath all of it. The executive took the fall, but is health insurance even where the rot lives? We kept noticing the roots run deeper — into teaching hospitals tangled up with universities like MD Anderson and the UT system, into hospital price books where a single nitrile glove carries a three-hundred-dollar standard cost just so the insurer can be shown a thirty-percent "discount." I paid eighty-five dollars for two ibuprofen in a hospital room I could've DoorDashed a whole bottle for. What I really want is somebody — like that account that diagrams the Fed's repo plumbing — to map one hospital system's money flow the way they map BNY Mellon: every counterparty, with the blocks locked in by law marked in red, so you'd finally know what you can't fix without Congress. You have to know the source of the thing before you can change it: is it law, is it attitude, or is it just we've always done it this way?

We closed where the book keeps poking us — the word overkill, which Dan realized actually means something. Hunter-gatherers, the authors claim, worked maybe eight to fifteen hours a week because over-hunting wasted food and over-working burned calories the group couldn't spare; an over-kill literally endangered everyone. We've both flattened that word into a throwaway. (We were honest that the hunter-gatherer-leisure claim didn't fully ring true for us — it felt dissonant, like it didn't even serve the authors' own point — but it's a hell of an etymology.) That's the real pleasure of reading something this ambitious alongside a friend: even when you think the crystal ball is mostly fog, the language it knocks loose stays with you. The survival instinct that makes us love a doomsday book is the same one that made overkill a warning instead of a brag.

Go read something, damn it.

— Sean