Free healthcare leaves the healthiest footing the bill

The argument

The objection here is about who pays rather than about whether care should be available. Under a publicly funded health system, everyone's taxes go towards paying for everyone's healthcare needs. Contributions are collected according to income and care is drawn according to need, and the two have no connection to each other. That is the design rather than a flaw in it, but proponents of this position regard one of its consequences as decisive. Because healthcare use is heavily concentrated among the unhealthiest while tax is paid by everyone, the healthiest people in society end up paying for the services used by the unhealthiest. What sharpens the objection is that a substantial share of health costs follows from choices people make. The person who exercises regularly, eats healthily, and doesn't smoke bears a real cost in doing so: the time, the discipline, and the pleasures foregone. Having borne that cost, they are then required to pay again, through taxation, for the health services of someone who declined to bear it and became ill as a result. The first person is charged twice and the second not at all. Proponents consider this grossly unfair, and the unfairness is not incidental to the system but produced by it. There is a related point about incentives embedded in the same structure. If the financial consequences of a lifestyle fall on the public rather than on the person who chose it, the system removes one of the reasons a person might otherwise have had to choose differently, and the healthy are left subsidising that removal. Because free healthcare leaves the healthiest footing the bill, proponents of this position argue, healthcare should not be free.

Context

If you receive a product or service, you should be the one to pay for it. You wouldn’t go and get a massage and expect someone else to pay for it. Why should you expect someone else to pay for your healthcare costs?

Premises

Counter-arguments

The healthiest segments of society still pay for the healthcare costs of the unhealthiest under a system where the individual is responsible for the costs. Health insurance companies price their plans so that the premiums paid by the healthiest people subsidize the medical bills of the unhealthiest people. Even those that don’t have health insurance are still passing their financial responsibilities onto everyone else. When they can’t pay for their treatment, they rack up debt. If this debt goes unpaid and the hospital has to foot the bill, the hospital increases the prices for the services it offers. The health insurers pay these prices and set their premium prices to absorb them. The public pay for their health insurance premiums. Regardless of the system, the healthiest members of society are always going to subsidize the health costs of the unhealthiest demographics. This may as well be done in a way that does not saddle the least fortunate with large amounts of debt.

Rejecting the premises

[Rejecting P1] Society promotes mechanisms to responsibly provide for the basic needs of those who cannot fully provide for themselves, be it family ties, private insurance, charity or welfare. [Rejecting P2] Under every health system model, the healthiest pay for the unhealthiest.

Framing

It is a bad thing that the healthiest and more productive are paying for the needs of the less healthy and less productive, even if they could become less healthy themselves in the future.