The United States has a world class healthcare system. Yet, during the pandemic, America’s largely private healthcare system has seriously struggled. Despite being on the frontline of the fight against COVID-19, many US hospitals are now losing millions of dollars a day as they cancel profitable surgeries to make room for the less-lucrative work of treating coronavirus patients. It seems absurd for healthcare professionals to lose their jobs during the worst public health crisis in a generation, but that is precisely what is happening.

In Europe, healthcare is largely provided free of charge. Of course, we can quibble about what “free” means (the taxpayer ultimately has to foot the bill). Yet there is clearly a difference between the approach taken by most European countries and the healthcare system in the US. Could the ongoing pandemic encourage the US to take a “more European” approach when it comes to healthcare (especially in an election year when healthcare is likely to be an important electoral issue)?

What do our readers think? We had an impassioned comment sent in to us by Muriel, who believes healthcare is as much a basic need as housing, food and water and should be guaranteed unconditionally. Is she right? Should healthcare should be free for everybody, particularly in the wake of the COVID-19 pandemic?

To get a response, we put Muriel’s comment to Francesca Colombo, Head of the Health Division at the Organisation for Economic Co-operation and Development. How would she respond?

Well, Muriel, you’re absolutely right in the sense that every human being on our planet has really the right to enjoy the highest level of attainment of health without really any distinction of gender, of race, of religion, of political belief and so forth. And I think in the context of the COVID-19 crisis this has really shown the importance of ensuring adequate funding of health services.

I would also like to highlight that, in September 2019, there was a universal health coverage declaration by the UN General Assembly that has really positioned universal health coverage as a landmark feature of our societies and economies.

Now, universal health coverage really means that everybody should be able to access healthcare and high quality healthcare without facing financial hardships. It means that individuals should have access to health services without being pushed into poverty or having impoverishing costs because of that.

And this is the fundamental element; there can be some countries where a share of the health spending is funded directly by individuals or through other means, but what is fundamental is that we don’t have impoverishing direct spending by households. And you will also understand that protecting the most vulnerable people, the most vulnerable groups, is particularly important, and I think the COVID-19 crisis has more than ever highlighted the fundamental importance of adequately-funded health systems.

Next up, we had a comment sent in from Hugo, who would disagree; he believes that the quality of healthcare is much higher in the US than most of Europe, and adds that taking care of healthcare is an individual responsibility and “only the lazy ones don’t have healthcare”.

To get a response, we put Hugo’s comment to Lee Ohanian, Professor of economics and director of the Ettinger Family Program in Macroeconomic Research at the University of California, Los Angeles (UCLA). What would he say?

In free societies – such as in the United States and in Europe, Australia, and many other countries – we all highly value that freedom comes with responsibility. We make our own choices, we have the opportunity and responsibility to make our own choices, and we do that wisely, because if we don’t then someone else will do it for us. So, that’s an important point that is in the background of any reasonable discussion about any good or service that we buy.

In terms of Europe, customers are not really incentivised to search for the best healthcare deals. In economics there are, broadly speaking, two ways to ration demand: through price or through waiting. And in Europe there’s a lot of waiting for some types of procedures. Some types of healthcare may not be offered. My understanding is that within the National Health Service [in the UK], operations such as cataracts surgery in some locations are not even offered because it’s termed of limited clinical value.

Now, 96-97% of cataracts surgery are very successful and can mean the difference between good eyesight and blindness. So, this is the longest-running publicly-provided single-payer healthcare service in the world and they are struggling with costs because the NHS, and a lot of Europe, just simply doesn’t obey the principles of economics.

So, yes, Europe can learn some things from the US, the US can learn some things from better principles of economics, and I think both locations can do a lot better in terms of satisfying consumers of healthcare and not wasting so many resources.

Should healthcare be free for everyone? Is healthcare as much a basic need as housing, food and water? Or should healthcare be treated as a marketplace, promoting efficiency and cost saving through competition between providers? Let us know your thoughts and comments in the form below and we’ll take them to policymakers and experts for their reactions!

IMAGE CREDITS: Photo by HH E on Unsplash


81 comments Post a commentcomment

What do YOU think?

  1. avatar
    Христо

    It should be affordable for anyone. Which means not going bankrupt when you go to the hospital like in third world countries like the USA. So the short answer is yes. I believe it’s possible. With a lot of money and a lot of wisdom. Health is not something for trade. It’s a human right.

  2. avatar
    Wasim

    I assume, think about it for sec, if government took care of them, then no need for private insurance companies who their money based on gambling on people health, in good times, and who threat to rise the cost in bad times, if people have to pay directly to government and then government pay Healthcare employees it would be more sufficient and in good times government could invest the surplus in successful projects that might eventually establish sustainable project that pay directly the healthcare worker, and people with time will have to pay nothing or less eventually

  3. avatar
    Wasim

    no need to such question, American themselves admit they have the worst healthcare system that only get worst under trump administration, not saying the European is the best, but it’s far more better than anywhere else
    That however only means it still need development, as it’s getting rusty and costly with time

  4. avatar
    Sara

    ‘Free’ nothing is free. It’s tax financed and leave the EU citizens cash strapped.

    • avatar
      Debating Europe

      Hi Sara, would you prefer the American model also for Europe?

    • avatar
      Renata

      no

    • avatar
      Sara

      I really don’t see why you think this so binary. Look at CH, low taxes, excellent health care.
      But however you look at it, what you are talking about is tax financed and not free.

    • avatar
      Valentina

      American model? Big NO

  5. avatar
    Stef

    Its not free. The question is should it be payed by taxes and managed by government or payed ad hoc and managed privately.

    • avatar
      Debating Europe

      What is your opinion – should it be managed by government or privately?

    • avatar
      Stef

      i think there shpuld be a balance. Do not give all of it to government because most of the times it is inefficient

    • avatar
      Stef

      also stop using misleading lingo like FREE. it is not free

    • avatar
      Felicidad

      Public health without structure without support to doctors and nurses in Spain.

  6. avatar
    Silvia

    Healthcare should be public and accessible to all.

  7. avatar
    Γεώργιος

    Fundamental human right

    • avatar
      Radu

      not a human right at all. Just a regular service you buy on the market.

    • avatar
      Γεώργιος

      You are right.Humans must die if they can’t buy.Vultures law

    • avatar
      Radu

      Then you should make all products on the market human rights.

    • avatar
      Γεώργιος

      Human health is not product mister.Mercy

  8. avatar
    Manuel

    Yes! The health care should be universal and public.

    • avatar
      Radu

      Yes! Just like in Venezuela.

    • avatar
      Stelios

      Just like Cuba that provides support all over the world.

  9. avatar
    Maria

    Portugal Mario Centeno since 2015 is blocking money to health because he wanted to show a low deficit in the UE. This weakned the NHS. He is a Socialist by the way. The private sector was essential in this pandemy because the NHS, was working for Covid-19. If not a crash would be like in Italy.

    • avatar
      Irene

      The private sector was essential?! That’s a joke!

    • avatar
      Maria

      Yes, many of the consultations were held there. A lot of people have insurance because in NHS, everything took a long time with lack of human and material resources. If it’s not the private, the NHS cracks. It’s not joke unfortunately. And you should think instead of parroting.

    • avatar
      Maria

      read what I wrote to D. Pink IRENE And I advise you to think before hitting the head. The misinformation in this Parents is shocking

    • avatar
      Irene

      The private sector cancelled certain deals and left a lot of people unassisted. Did you hear what the Minister of Health said? I didn’t hear any denial. Had private sector assistance those who had money to pay for appointments and surgeries or to pay for some insurance policies. Those who don’t have money, don’t have access to the private sector.

    • avatar
      Maria

      when everyone depends on the public, the cracks system. I’m talking if patients don’t covid who continued to be followed in private. NHS’s practically lockdown strategy allowed the NHS response to Covid-19. Open your eyes

    • avatar
      Irene

      Of course yes! If they had money or insurance.

    • avatar
      Maria

      there are a lot of people with company seuros. And it’s a shame that there are so many poor people in this country who receive so much from the EU.

    • avatar
      Manuel

      I think for my head, reason I defend NHS. Anyone who prefers other models is free, so free that many end up in NHS.

    • avatar
      Maria

      exactly I defend NHS. That’s why I don’t forget the Captivation. If there hadn’t been a practically complete shutdown on NHS treating only Covid-19 and a social lockdown, the same thing would have happened in Italy. But now there’s a big economic problem and the country is paupérrim.

  10. avatar
    Michael

    Healthcare is not free. We pay for it through taxation. Healthcare should be freely available to anyone who needs it, regardless of means, but we must rid ourselves of the childish notion that things financed by the government are “free”, otherwise you end up with a political environment in which no one is worried about how to pay for things, which leads to these institutions becoming unsustainable.

  11. avatar
    Radu

    Here’s a good rule of thumb: is healthcare free in Venezuela & Cuba? Yes, it is. Then it should not be free everywhere else.

    • avatar
      Dobromir

      Is water liquid in Cuba and Venezuela? Yes, it is. Then it should not be liquid anywhere else.
      You are not wrong about healthcare, but your logic is stupid.

    • avatar
      Radu

      “Insanity Is Doing the Same Thing Over and Over Again and Expecting Different Results”.

    • avatar
      Chris

      I hardly think they are great examples for quality of life

  12. avatar
    Paul

    What is healthcare ?
    Clearly everyone would include any life saving actions…or ones that mitigated significant pain…..but cosmetic surgery..unlimited IVF…kidney transplants for alcoholics..extending the life of a 90 yr old for a few months at a cost of 500000 .
    Medical technology makes many things possible…but not all are desirable or affordable

    • avatar
      Chris

      I agree a blank cheque to the nhs is dangerous and WILL be abosed and wasted

  13. avatar
    István

    there is no my health insurance, neither their health insurance.
    THERE IS OUR HEALTH INSURANCE. in case someone have no health insurance, there is no health insurance no one at all.
    not too confusing, isn’t it?

  14. avatar
    Asuman

    I am very happy with the health system of my country turkey and the minister of health.. They took very good measures with the moments of health work, in our hospital
    Clean and medicine was equipment in tool care. Stay home in short, wear mask, pay attention to the distance.

  15. avatar
    Pedro

    It is not free because tax will support but yes, available to everyone with symbolic charge.

  16. avatar
    EU-Reform- Proactive

    Hardly anyone in the EU, their politicians, think tanks, seconded bureaucrats or experts dare to express the uncomfortable truth what reality unapologetically offers or affords vs. what idealism and their supporters demand.

    Anyone thinking living in an ideal world- can justifiably demand such ideals- why not?

    Miraculously, it is free of restriction to endless funding, nor does it ask the origin of the (m)honey flow. Such Father Xmas believes are normally age-restricted. The infamous Nanny!

    The century-old argument between fundamental idealism & realism will never end until the uncomfortable truth awakens the ever slumbering.

    Resets will happen, the semantics between idealism & realism will resurface but will keep us busy for ages!

    If one guarantees such an ideal system- that particular ONE has to prescribe how everyone has to: behave, eat, live, learn, work, sleep, relax, exercise, indulge and abstain from vices, etc. ..endless!

    https://www.spaceandmotion.com/Philosophy-Realism-Idealism.htm

    So far, our social democratic political system- using the fruits of a capitalist free-market approach- is the current proven & workable one since WWII. It’s however becoming overstretched due to many factors.

    If one asked- what is an acceptable, fair & affordable compromise- since Actuarians being aliens- may be actuarial scientists could tell us?

  17. avatar
    Lavinia

    Are you really asking that question in 2020? This shouldn’t even be a topic of debate.

    • avatar
      Debating Europe

      Hi Lavinia, how do you mean that?

    • avatar
      Lavinia

      Why ask if only rich people should have access to healthcare and if the poor should be left to suffer or die? The idea in itself is absurd. Of course healthcare should be free for everyone. What is the purpose of living in society if we don’t take care of each other? This may be a question for the US, not for Europe.

  18. avatar
    Claudia

    Extremely efficient and excellent response from our Public Health system in Portugal to the Covid crisis. The system worked fully, and adapted very quickly to the demands of the escalating crisis back in March, created extra intensive care units in hospitals all over the country, and started testing as much people as possible at also a fast rate. So, yes, universal health care is the mark of a civilized and fully democratic society. It is paid for by everyone taxes and the poorest people who do not pay taxes are also fully covered of course.

    • avatar
      Debating Europe

      Hi Claudia, do you think more European countries should adopt a model like this?

    • avatar
      Claudia

      @Debating Europe I think so, I do

    • avatar
      Valentina

      agree :)
      Public health care for everyone..a lot of things sholud be private,but education,health care and protection (police, army) sholud be public :)

    • avatar
      Jan

      yes

  19. avatar
    Constantina

    Health and education are basic human rights and we must have equal access to it. There’s the principle, and the question now is how do we do it?

    • avatar
      Debating Europe

      Hi Constantina, what steps do you want European governments to take to achieve that?

    • avatar
      Constantina

      In the Netherlands where I live, we have mandatory private health insurance with the basics covered and by your own choice you can set a risk limit paying less or more each month according to your choice. The biggest risk you can take is about 1000 euros per year. Meaning that no matter what, even if I pay the cheapest insurance I can only pay 1000 euros in health services maximum. The population is 100% covered because in the case of low/no income, the government pays for you. I think it works well. There are definitely some flows in it but it could be a good example. It is socially fair, you pay only if you have the income, and the whole population is covered for the basics and for expenses more than 1000 euros.

    • avatar
      Ilina

      is this not evident? Why do you ask this question if these are basic human rights and the current COVID-19 pandemic is doing away with these basic human rights and not only temporary?

  20. avatar
    Catherine Benning

    Should healthcare be free for everyone?

    As long as everyone gets it in their country of origin. Paid for by their own taxation system that can be used by those whose health systems they can all use when travelling around. And that it is the equivalent to all others at the top of the spectrum of good health systems. And covers us all for every eventuality. After all, human rights are for everyone no matter which part of the planet they are in or originate from. No matter their race, gender, intellect, etc.. No matter their ability to supply it. Yes/No?

  21. avatar
    Thomas

    Understand that this is a complicated issue. Unfortunately, much of the discourse is tainted with emotion and therefore logically insolvent. Healthcare, particularly preventive and catastrophic care, should be AVAILABLE (graduated payment schedule) to everyone but the belief that it is or should be free is childish. Equally silly is the talk of rights. The word is all to often juxtaposed with FAIR, which is where a pig get a blue ribbon but a legitimate legal or moral construct. Much like with the NHS the German system if fraught with delays, rationing and inequities. Insurance isn’t for every day things, that is why we don’t have grocery insurance and why car insurance doesn’t cover fuel costs. The moral imperative with anything “free” is over consumption and health care is no different.

    • avatar
      Catherine Benning

      @Thomas

      Where we have health care free at time of use, it is never considered unpaid for. It is paid through taxation. Which is much lower than the private robbers who are looking for a generous profit from their investment each year. And not through fanciful notions of pretending ‘private’ health care is going to look after you when you need it.. They fail to pay up. And they fail to offer ongoing cover once the profits from you will no longer be expected. That is not health care. That is eternal waste.

      One more time.

      https://www.youtube.com/watch?v=0pnEMBgEG24

      How it began with a huge struggle.

      https://www.youtube.com/watch?v=-ywP8wjfOx4

      And from an American point of view.

      https://www.youtube.com/watch?v=FvYaTTpmVUk

      And remember, you can buy a private health system if you want to pay for it. It does not give you a better service. In fact, private health care is not for emergency situations. That is dealt with through NHS A&E.

      The reason a great deal of pressure is presently on the NHS is because of immigration and illegals being allowed to use the system without paying for it. And that is in the millions who come here for just that. They are not required to buy their own private health care before seeking treatment. Which is a lunacy the government of the UK has consistently refused to address. Mostly, because they are consistently lobbied by pharmacies all over the world to enable them to rob the individuals the way they do in the USA. America hates the British exposure of the reality of social medicine. They wish they could destroy our system the way they did in Cuba.

  22. avatar
    Thomas

    Catherine,

    Thank you for the well thought out response.

    To be clear the current state of US Healthcare traces it’s roots to the same point in time as the NHS. Skilled labor during WWII was hard to come by so Companies offered Third Party coverage as an incentive to attract workers. Thus began the unintended and astronomical escalation of healthcare costs in the US. As I referenced earlier, consumers who are insulated from the true cost of their actions will invariably spend and consume more.

    The second causal factor actually resides in the AMAs push for government take over of healthcare in the US believing that it would ultimately profit it’s membership. Many people either ignore or are unaware of the fact that the US system is already partially socialized. Medicare and Medicaid are both wholly government administered programs and to date the results have been equally as unimpressive as those of the NHS.

    After an extensive study of the British system of socialized medicine, formulated what he called “the theory of bureaucratic displacement.” He observed that in “a bureaucratic system . . . increase in expenditure will be matched by fall in production. . . . Such systems will act rather like ‘black holes,’ in the economic universe, simultaneously sucking in resources, and shrinking in terms of ‘emitted production.’”

    His findings for the NHS were exactly the same as the impacts on care delivered/available under Medicare and Medicaid. The data indicates a drastic decline in output over a half century. From 1946 to 1996, the number of beds per 1,000 population fell by more than 60 percent; the fraction of beds occupied, by more than 20 percent. In sharp contrast, input skyrocketed. Hospital personnel per occupied bed multiplied ninefold, and cost per patient day, adjusted for inflation, an astounding fortyfold, from $30 in 1946 to $1,200 in 1996. A mild rise in input was turned into a meteoric rise; a mild fall in output, into a rapid decline.

    I would submit that contrary to your assertion, “America hates the British exposure of the reality of social medicine.” that the US is ignorantly stumbling towards it. This forum is unfortunately not for the failings educational systems.

    I would refer you to the Mayo Model as the optimal way to deliver care on a micro economic scale.

  23. avatar
    Thomas

    Oops, sorry. The he I was referring to was Dr. Max Gammon and his “Theory of bureaucratic displacement.”

  24. avatar
    Anthie

    No need to even ask. Yes. Health care should be accessible to all. People who have private insurance, good for them; the state can simply reward them with minor tax exemptions (1-2%). But if you do not have an insurance, yes. The state should pay for your health care and support you. Receiving medical care is a human right, not a luxury.

  25. avatar
    ROBERT COX

    Fundamentally “yes”. But perhaps the pervading Eiuropean system of mutual funding with state back-up for the worst off citizen-patients is the best

  26. avatar
    Richard Lewis

    Health care in the US “world class” – yes if you have pots of money or mortgage your house or you are fortunate enough that your employer provides top insurance!

    Prof Ohanian should do his/her homework. Cataract operations ARE available on the NHS. Options for lenses may be limited. And by the way, why is it that Americans always compare their system with he NHS? There are different models in Europe.

  27. avatar
    Catherine Benning

    Should healthcare be free for everyone?

    Here is an example of why the western hemisphere need for healthcare, free at the point of use, is necessary. This man flew from Switzerland to the UK to get healthcare, as here in Britain it is free at the point of use.

    https://www.dailymail.co.uk/news/article-8399991/Oblivious-Swiss-tourist-says-ILL-prepares-busy-Tube.html#reader-comments

    He got on the plane sick. Away from the very best healthcare you can find in Europe, Switzerland. Now why did he do that? Our healthcare is not as good as the Swiss, so we are told. But, it is free to the world here. Where did this guy come from? Was he Swiss? I doubt it, as a Swiss would be unlikely to leave their country for healthcare here. Unless they were seriously sick in the head.

    If there was universal healthcare throughout the Western world, free at the point of use, he would not have felt the need to take a flight whilst he was ill and therefore be a threat to us all by spreading his disease. It would have been contained in the first place he noted his malady. Akin to New Zealand, we should shut our borders to save the lives of ‘our’ people. Our lives matter. They did it for years in the UK with dogs and Rabies. Now we have a vaccine for dogs who travel. We are Rabies free. Just as New Zealand is Covid 19 free.

    Why have we become so under developed in our common sense?

  28. avatar
    Michał

    There is no free health care as such. There are costs which need to be covered anyway. In my view the state budget should cover together with investors investments in the equipment needed and infrastructure. Private or semi-private insurance companies should cover costs of service provided with little share paid by individuals.

  29. avatar
    Pedro

    Healthcare is a Human Right. Therefore, it’s the right of every human being to have it. Since there are human beings with very few money, healthcare should be for free.

    • avatar
      Edmond

      on the other hand..if you dissregard the safety of others you should be desqualified

  30. avatar
    Ingrida

    Can unemployed and ignored by the job centers due to their selection criterias have a right to free healthcare? Sad, sad world Or… unemploed must take a loan to cover costs of “free” healthcare

  31. avatar
    Edgar

    I think being free (at the cost of taxes, free for care acts) doesnt mean to have no competition or dont have high quality standards. Should never be for profit, the center should be the care for the patients. However health professionals should be paid properly for their services and have conditions to do their work properly. Health should be more centered in primary care reducing unnecessary costs and having a more cost-effective healthcare for all.

  32. avatar
    Γεώργιος

    Ιt is fundamental citizens right

  33. avatar
    Ilina

    What does this mean « free »?Taxes are paid by the same persons who need support and assistance from the state they live in. Is that for free? Those who support the social system they are inevitably part of, due to their birth or other status, cannot require any support in return?

  34. avatar
    Teresa

    It should indeed as well as education.

  35. avatar
    Ana

    Of course. Otherwise poorer people don’t have access and private services suck you dry. Besides, private health services are worse than public sector in my country. Yes they are more comfortable, but if your health problem is severe, you end up in the public, because they can’t help you. It’s not being free that leads to lower quality services, it’s defunding. No private health service can respond properly to a problem like COVID-19, and we will have more like that in the future, so we better wise up.

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