on the Legitimacy of ‘Free’ Health Care

Disclaimer: Opinions reflected here are my own, and not representative of any other person or entity. This post isn’t even about a specific country. It’s entirely hypothetical. Any resemblance to actual places or policies is completely coincidental and should be ignored.

No person in need should be refused health care because they are unable to afford it.

If someone is sick they should get be able to access the treatment and investigations they need without going bankrupt. This is what the World Health Organization considers ‘Health for All‘.



But health systems need to be sustainable. Governments shouldn’t promise health care gratis and then serve up a substandard product. Free service with unacceptable wait times, drug shortages and costly basic interventions is impractical and unfair to the population receiving it. It’s free health care in name only, a political tactic, and frankly demeaning to the patients who must navigate these inaccessible territories.

Being able to get medical help without having to pay through the nose is great! I see a doctor at my local clinic for free, get a prescription which I fill at the nearest government pharmacy for free. If I need blood work, an x-ray or ultrasound, those are all free too. If I need to be hospitalised, I don’t need to worry about a bill, and I can rest assured that the hospital has all the resources required to treat me according to international standards.

But what if there are not enough doctors in the clinic, or not enough space in the hospital? What if there isn’t enough medicine in the pharmacy, what if the machines for blood testing or x-ray or ultrasound aren’t working? What if the hospital is overwhelmed by demand and its resources are inadequate for a population this size?  What happens then?

I don’t have the answers but I’m sure the solution is more complicated than just throwing more money at the problem. Sustainability and capacity building are nuanced and necessary concepts that demand to be addressed. Failing to take them into consideration results in a quagmire of dissatisfaction and deteriorating quality.

If high quality, patient-centered health for all is the goal, then the steps to get there must reflect this realignment of values. Any health system that decides to serve users at no charge must remember that it exists to serve, and not to inconvenience or ignore its customers.