Free healthcare means worse quality

The argument

The claim is that quality and free provision cannot be had together: it is not possible to have a highly efficient, high-quality health system that is free at the point of use. The reason offered is financial rather than ideological. Publicly funded systems cannot generate the funding required to offer the best healthcare solutions available, because their revenue is bounded by what a government can raise and allocate, while the cost of the best available treatment is set by what medicine can now do — and the second rises faster than the first. What follows from that gap is rationing. Countries with healthcare systems that are free to the public end up rationing medical services, not as a failure of administration but as the necessary consequence of finite funds meeting demand that nothing restrains. Where care carries no price at the point of use, nothing there limits how much of it is sought, so the limiting has to happen elsewhere: in waiting times, in eligibility rules, and in decisions about what will be offered at all. The rationing bites hardest at the top of the range. The most expensive treatments are often unavailable to the public if the government determines that the costs of the treatment do not outweigh the potential benefits. That calculation is made for a population rather than for a patient, so a therapy that would help the person in front of the doctor can be refused because its cost per expected benefit is judged too high across everyone who might receive it. The conclusion drawn concerns where the money comes from. The only way to maintain a health system of the highest quality is to have the patient pay at least some of their healthcare costs — which is why, on this argument, healthcare should not be free.

Context

A publicly-funded health system generates less money than a private health system that can make substantial profits from patients. The government is therefore forced to take a utilitarian approach and ration treatments based on a cost-benefit analysis.

Premises

Counter-arguments

There is no guarantee that a health system that requires individuals to pay for their treatment leads to better and more efficient services. Healthcare companies are not required to reinvest their profits in their product. They can, and do, funnel that money to owners and shareholders without using it to improve their product. In a private system, there are also still barriers to the best treatment options. The only difference is these barriers are financial. Under both systems, a poor person without insurance cannot access the best treatment options available. Having more care doesn't mean better care. Private companies have an incentive to have more patients and charge to dispense more drugs, more surgeries, more expensive tests. But doesn't mean the system has better outcomes for it; it simply makes more money for hospitals, surgeons and caretakers.

Rejecting the premises

[Rejecting P1] A free health system will be accessible to all members of the population, thus increasing the overall productivity, generating revenues outside the health system that benefit the whole society. [Rejecting P2] There is no guarantee that a medical company will put any of the revenues into refining the product. [Rejecting P3] It is possible to finance healthcare from other sources of revenue; centralized healthcare doesn't need to be a closed system.