State of Health: Liberty, Responsibility, and the Road Ahead

Andrew Sterling works for LDI Ltd., an Indianapolis-based family office, where he is primarily responsible for building new investment deal flow and evaluating potential acquisitions and strategic investments to support LDI’s investment goals.  Andrew currently resides in Westfield, IN with his wife and two golden retrievers and in his free time enjoys reading, working out, rooting for IU basketball/football, and playing very mediocre golf.

The Liberty Fund in Carmel provided a fitting backdrop for our MDLF session on the “State of Health.” Surrounded by thoughtful debate and guided by our moderator, Pat Lynch—who is celebrating 25 years of leadership at Liberty Fund (congrats Pat!)—we wrestled with two central questions: Who is responsible for good health? and What is the future of health in the United States?

One of the most striking readings was the Commonwealth Fund’s Mirror, Mirror 2024 report. While the United States spends more on health care than any other developed nation, the US consistently ranks near the bottom in health outcomes, access, and equity. The takeaway is clear—more spending does not automatically translate into better health. Outcomes, incentives, and leadership all matter

The Cato Institute’s “The U.S. Health Care Free Market Myth” points out that while the United States is often labeled a “free market” system, health care in America is deeply shaped by government policy, tax distortions, employer-based coverage incentives, and regulatory barriers. If we are frustrated with system performance, we must be honest about the system’s design. A largely centralized system distorts pricing, reduces competitive incentives, and contributes to higher costs.

The Haven Health Management article on the future of healthcare technology introduced a different tone—one of possibility. Artificial intelligence, predictive analytics, telehealth, and remote patient monitoring are poised to redefine delivery models. However, realizing healthcare technology’s full potential requires tackling cybersecurity risks, ensuring transparency and regulation, supporting workforce readiness, and measuring real-world effectiveness of new tools.  

What made the day powerful was not just the content, but the debate. We wrestled openly with the tension between personal responsibility and systemic responsibility. To what extent is individual health shaped by lifestyle choices versus social determinants or government policy? A “good” health care system cannot ignore personal agency, but neither can it ignore structural incentives.

One question posed in our session—Would we trade a human doctor for AI?—was intentionally provocative. While my initial answer was yes, my fellow classmates persuaded me that technology should augment human judgment, not replace it.

While we tackled several controversial topics (the COVID-19 response, AI, personal responsibility versus social determinants, big pharma, etc.), the dialogue always stayed civil—exactly what a Liberty Fund seminar is designed to foster.

The MDLF core values—personal responsibility, individual liberty, and the importance of private enterprise—were woven throughout the discussion.

Personal responsibility surfaced repeatedly. A society that absolves individuals of agency risks eroding the very behaviors that lead to better outcomes. Liberty means preserving freedom of choice in care decisions, insurance models, and innovation pathways. Private enterprise, meanwhile, remains the most powerful engine for experimentation and advancement—particularly in biotechnology, digital health, and AI-enabled diagnostics.

If the U.S. system underperforms, the solution is not to abandon markets but to align incentives so markets function properly. Transparent pricing, consumer choice, competition across state lines, and outcome-based reimbursement models all move us closer to a system that rewards value rather than volume.

We also benefited from Chelsea Linder, Vice President of Innovation & Entrepreneurship at TechPoint, who presented “Perfecting Your Pitch” in preparation for our April capstone presentations. Her session was a reminder that ideas—no matter how compelling—require clarity, confidence, and precision to gain traction.

What It Means to Be an MDLF Fellow

Two elements make MDLF uniquely meaningful to me.

First, my love for Indiana drove me to move back here from Arizona. There is no other fellowship I know whose sole focus is on moving Indiana forward. This state gave this small-town boy a chance. MDLF’s unwavering commitment to “those on life’s first rung” reflects a compassion for disadvantaged Hoosiers that is inseparable from a belief in upward mobility through private enterprise.

Second, the Fellowship is building an ecosystem of change agents across Indiana. I was deeply influenced by Mitch Daniels’ governorship and his 2008 reelection tagline: Courage, Vision, Results. Being a change agent requires the courage to confront hard truths—like uncomfortable health statistics. It requires casting a compelling vision for reform. And it demands measurable results.

The State of Health conversation made one thing clear: the future will not be shaped by ideology alone, but by leaders willing to pair principle with pragmatism. That is the charge of an MDLF Fellow—to think deeply, act boldly, and keep score along the way.