Why Healthcare isn’t Free, And Why You Don’t Want it to be

The Merriam-Webster dictionary defines the verb “swindle” as the use of deception to take money or property from someone. Nurses and other healthcare providers in the United States have endured decades of attempts to swindle them out of their money and their livelihood by using the deceptive argument that healthcare should be “free”. Often, these arguments are accompanied by admonishments that free healthcare is fair, just, and humane. Is it?

In the classic essay “Healthcare is not a Right” (1993) Leonard Peikoff points out that if one person has a right to anything at the expense of another person, the other person has become rightless. Unfortunately, pointing this out has become a hot button issue in today’s politically divided landscape. We are frequently discouraged from thinking through the unintended consequences of doing things that seem “nice”, or that others tell us will work because they are being done elsewhere. Let’s reflect on what is really happening in “free” healthcare systems.

Some proponents of “free” healthcare argue that it is free because at the point of care, the patient doesn’t pay. This statement is deceptive because it ignores the obvious fact that citizens have paid, and paid dearly, through taxation. In fact, prepayment through taxation is inarguably the most inefficient and costly way to fund a healthcare system, because it requires large numbers of bureaucrats to administer the system, and none of them are providing healthcare services. They serve only to handle the massive amounts of paperwork associated with administering a large bureaucratic system. An additional factor making these systems very expensive is that patients remain ignorant of the actual cost of services, and therefore they are prevented from seeking more affordable alternatives.

Some even argue that healthcare should be a human right, meaning a fundamental right and freedom that belongs to every person. Let’s examine that. If healthcare was a human right, the patient would be entitled to receive care from a healthcare provider without payment. In other words, the patient would be entitled to benefit from the worker’s services without compensation. We used to have this type of economic system in this country and many other countries around the world. In some countries, versions of this system still exist. In the United States, this system was abolished in 1865. That is why we must clearly and vocally recognize that nothing that requires the labor of another can be a human right.

To follow up on this point, we can look at the difference between a human right and an entitlement, otherwise known as a legal right. The founders of our country created constitutional rights. These are things the founders deemed essential for individual liberty. None of them creates a right to the time, labor, or money of another person. For this reason, our rights under the constitution are considered negative rights, giving us only the right to take action in pursuit of a goal. Positive rights are the alternative: these are the entitlements that are created when a government authorizes citizens to access the time, labor, and resources of another.

Many examples of healthcare as a national entitlement exist in the world today. In every case in which citizens have been given entitlements to healthcare, the result has been predictable: a bloated, ever-expanding bureaucracy with lengthy wait times for suffering patients (Fraser Institute, 2024) due to unlimited demands for care, because after all, who doesn’t want to get something for “free”? Citizens of these countries have been persuaded that they cannot live without government assistance. As the writer Harry Browne famously said, “The government is good at one thing. It knows how to break your legs, and then hand you a crutch and say, ‘See if it weren’t for the government, you wouldn’t be able to walk.”

It doesn’t take an economist to realize that calls for “free” healthcare are nonsensical. Are medications and procedures free, or did it require time, training, and resources to develop them? Are hospitals and clinics free, or do they have building, maintenance, power, and facilities costs? Are healthcare providers free, or did they pay for an education and then work hard to earn a living to support their own families? If you agree that none of the above are free, then you are already aware that healthcare cannot be free.

Nurses, physicians, and other healthcare professionals are often told that the United States healthcare system is unfair because there are “two levels of care”, one for those with higher incomes and another for those with fewer resources. Seldom is it pointed out that the same holds true in countries where healthcare has been nationalized (socialized) by the government. Citizens with fewer resources in nationalized “free” healthcare systems have lengthy waits for the limited care available, while those with higher incomes have a choice. Some pay for additional private insurance and skip the lengthy lines of people who cannot pay more (Commonwealth Fund, 2020). Others travel to other countries and pay for more efficient care. Either way, keep in mind that these citizens have paid a high tax rate for care that they are not receiving, and they are paying again to circumvent the system that they are subsidizing.

As nurses, our inherent empathy, care, and concern for others make us vulnerable to appeals, and indeed demands, that we participate in deceptive and misleading schemes such as promoting ostensibly free healthcare for all. We must take care not to buy in to attempts to manipulate us. As Peikoff stated, “You cannot stop a noble plan – not if it really is noble. The only way you can defeat it is to unmask it – to show that it is the very opposite of noble.” As nurses, we should speak up for our patients and ourselves. There is not, and cannot be, such a thing as free healthcare.

Kim Curry

Next installment: what can we do about the high cost of healthcare?

Sources:

Commonwealth Fund (2020). International healthcare system profiles: England. https://www.commonwealthfund.org/international-health-policy-center/countries/england

Fraser Institute (2024). Canada’s median health-care wait time hits 30 weeks—longest ever recorded. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2024

Peikoff, L. (1993). Healthcare is Not a Right. Text available at: https://ari.aynrand.org/issues/government-and-business/individual-rights/health-care-is-not-a-right/