Medicine

Should all healthcare be free?

Free healthcare provides a sense of safety to the residents of a country. People can access life-saving care that they require without the need to pay for their treatment after recovery. However, allowing all patients to access all healthcare is somewhat unviable and, therefore, a balance between health equity and health efficiency must be found.

Since its introduction in 1948, the National Health Service (NHS) has provided healthcare to the British public. Whilst this service is not technically without cost, as the money spent on the service derives from the general public’s taxes, it is free at the point of delivery. Now, over half of the countries all over the world offer some form of free, universal healthcare.[1] Those that do not are often third world countries, with one glaring exception: America. Healthcare in America has always been paid for directly by the patient, either through insurance premiums or upfront payments.[2] America has barely even considered changing this system, and so we are left to ask: which is superior? Does paying for healthcare provide a greater service or should all healthcare be free?

There are, of course, many benefits to privatised healthcare, both to the patient and the practitioner. Private health insurance typically allows a patient to access the care that they require with greater medical resources, reduced waiting times, and a more extensive variety of services available. For example, treatment for rare neurological diseases such as Tarlov Cyst Disease, or even a simple surgery, such as removing a benign tumour, are only offered with private healthcare – although this comes at a costly price. Private healthcare allows the user to take greater control in their medical treatments, as well as their recovery; patients can choose the hospital and doctor to which they are admitted. As well as this, doctors working in the private sector are almost always paid more than those working under the government. They can also negotiate working hours more freely and are likely to receive greater annual leave. It is clear, therefore, that providing a health service for which patients pay for their treatments does have its advantages and could offer a greater experience for both patient and doctor.

However, whilst it can be argued that having to pay for healthcare would allow people to access more modern, up-to-date treatment, vulnerable people in society, such as those who are economically disadvantaged, would not have equal access to the healthcare they need and so are more likely to suffer from untreated illness. What is perhaps more important than health efficiency is that everyone can access some form of healthcare when needed. Within America, one of the few countries that have not implemented universal healthcare, inequalities in health have grown substantially larger because the poorest percentile of the population cannot afford treatment when needed. First published in the Journal of the American Medical Association in 2014, it was first found that the life expectancy of the wealthiest five percent of Americans was 12 years longer than the poorest five per cent. In contrast, within the UK, the disparity in life expectancy was only 5 years.[3] With a free health service in place all over the world, these inequalities would assuredly decline over time. The poorest of the population would be able to access the care that they need, have life-changing surgery, and be prescribed the medicine they require – without having to worry about a large immediate impact to their finances. Surely, therefore, a free health service would create a fairer, egalitarian society.

When running a free-at-point-of-delivery health service, it is vital to consider what healthcare truly is. Mirriam Webster defines it as the ‘efforts made to maintain or restore physical, mental, or emotional well-being’ [4], so this could be extended beyond the practice itself. Arguably, a hospital car park, concourse and cafe assist in maintaining well-being, aiding both the patient and their families in ensuring that they have as pleasant a stay as possible. So, if all healthcare were to be free, would the government have to provide free parking, food, and entertainment to the millions that visit hospitals every year? This, however, is not a viable approach. Instead of making all healthcare and associated facilities free, what seems more realistic is to make all healthcare provided by a medical practitioner free of charge. This would extend to pharmacists, psychologists, doctors and GPs, physical therapists and even those that help with a patient’s recovery.

Despite the perceived benefits of a free healthcare system, this can be regarded as unattainable, especially when considering the diverse health needs of millions of people. When the NHS was first implemented as a completely free health service, it was found to be unfeasible. The initial budget of £108 million was overspent, more than doubling, leaving total expenditure at £248 million. This seems small in comparison to the recent £1.5 billion budget; however, when taking into account inflation, this would roughly be £10 billion in one year.[5] Simply, the evidence above shows the prospect of free health care as financially unviable. Whilst it is possible to offer most of the population free care for basic medical needs, it is simply not possible to offer all treatments without cost. Currently, patients within the NHS are required to make a payment towards eye care, and this itself does not seem extortionate, especially as routine appointments are once every two years. So, to provide effective healthcare to everyone, it appears vital to balance health efficiency with health equity. By asking patients to pay for some treatments, everyone can access affordable care when it is most required. Thus, the government can continue to provide care to the most vulnerable without worrying about the sustainability of their approach.

Alternatively, some people believe health systems should emphasise personal responsibility and that people should be encouraged to maintain a healthy way of life. One approach that could be implemented is increasing the cost of healthcare for individuals with preventable illnesses, forcing them to become more responsible for their health and simultaneously reducing the likelihood of future sickness. For example, smokers could potentially be charged for healthcare that is related to the act of smoking or people suffering from obesity would be charged for the diseases that are associated. On the other hand, many actions that result in poor health, such as an unhealthy diet, are far more frequent amongst poor people. Therefore, such a method could detrimentally affect underprivileged communities, and potentially increase inequalities in health. Rather, a preferable action is to tax items that are responsible for these illnesses, such as tobacco, cigarettes, and drinks with high sugar content. Subsequently, more money could be directed towards the NHS, who could then use this to treat illnesses that transpire.

I believe that healthcare should be provided free at the point of use for many treatments. By implementing a health service for which people should pay, you are essentially deeming a wealthy person’s life more important than their poorer counterparts. It is inhumane to deny a person life-saving medical care, and this is essentially what a private health system would ensure. Undoubtedly, it is not feasible to implement a completely free health service by providing all treatment free of charge; however, some form of treatment for most illnesses should be accessible by all residents of a country.

References

[1] En.wikipedia.org. 2020. Health Care. [online] Available at: <https://en.wikipedia.org/wiki/Health_care> [Accessed 30 April 2020].

[2] AMADEO, K., 2020. Why America Is The Only Rich Country Without Universal Health Care. [online] The Balance. Available at: <https://www.thebalance.com/universal-health-care-4156211> [Accessed 30 April 2020].

[3] I, V., 2020. The American Health-Care System Increases Income Inequality. [online] The Atlantic. Available at: <https://www.theatlantic.com/politics/archive/2018/01/health-care-income-inequality-premiums- deductibles-costs/550997/> [Accessed 30 April 2020].

[4] Merriam-webster.com. 2020. Definition Of HEALTH CARE. [online] Available at: <https://www.merriam-webster.com/dictionary/health%20care> [Accessed 30 April 2020].

[5] Nicholson, D., 2014. The World Needs Free Healthcare For All, Says Ex-NHS Boss. [online] the Guardian. Available at: <https://www.theguardian.com/global-development-professionals-network/2014/dec/12/the-wor ld-needs-free-healthcare-for-all-says-ex-nhs-boss> [Accessed 30 April 2020].

About the Author

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An aspiring medic, Amelia spends her free time researching breakthroughs in medicine and current problems that are associated with the medical industries. She takes a particular interest in medical ethics, and considers how a patient can benefit from treatment the most.

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