The way people talk, you’d think that there are only two options for a health care system in a civilized society:
1) public health care, as found in, say, Britain, run by the government; health care is basically free;
2) private health care using insurance companies and privately run hospitals, as found in the united states.
People who criticize the US model say that it is heartless, because poor people can’t get treatment.
They say “health care is a right.”
They say “a caring society looks after everyone, not just those who can afford it.”
They say “nobody should die of preventable illnesses.”
…and I agree with all that.
The thing is, why is health care so special? By which I mean, there are many necessities of life, and in industrialised societies, they get taken care of. We don’t just need medicine. we all need food, water, shelter, warmth, and clothes. Yet imagine the absurdity of suggesting that we have “universal food coverage.” Imagine the government wanting to nationalize the supermarket chains and local restaurants. It isn’t logical.
What we have, instead, is a market solution, with a range of privately owned food outlets offering different types of products. For the people who can’t afford to use the market, we have welfare.
That’s how it should be with health, too. A market solution, with welfare solutions for the needy. For food supply there are different kinds of welfare systems, such as vouchers, cash payments, or free access (such as in a soup kitchen). There are different kinds of welfare solutions for health too, and of course there should be vigorous debate about which ones are best. There is also the issue of boundary encroachment: deciding who is or is not eligible for welfare. This can be a messy issue and there are probably no perfect answers, but it’s all part of managing real-world policies with competing imperatives.
One thing’s for sure. A glance around Britain or in the hospitals of New South Wales should be enough to convince anyone that universal coverage ain’t all it’s cracked up to be.