“If you think health care is expensive now, wait until you see what it costs when it’s free.” — P.J. O’Rourke
The Democratic Socialists of America (DSA) have a plan for America. It’s full of bold ideas like “ending capitalism,” providing universal free housing, abolishing the police and prisons, and of course guaranteeing universal free health care.
“Guarantee universal healthcare, the DSA platform demands, “at no cost to individuals.”
Alarmingly, this is also the health care plan of the Democratic Party — or rather, of a surprisingly large number of Democratic nominees for Congress this year.
Progressives, socialists, and now Democrats are calling the abolition of all private health insurance (and all existing government health insurance, including Medicare) and replacing it all with a single new cradle-to-grave entitlement: “Medicare for All.”
This would be a top-down, one-size-fits-all, government-run health care system. Supporters tout it as guaranteeing “health care is a right, not a privilege” and ensuring no one ever faces a premium, deductible, or co-pay again. They claim it would actually cost less than the current system, with better results.
Who’s going to tell them.
It’s not like this idea has not been tried before. It has been tried, in lots of places. And it doesn’t work. And it’s definitely not free.
To take just the most famous example, since 1948 Britain’s vaunted National Health Service (NHS) has promised “free at the point of use” medical care for the whole population.
What admirers of the NHS never mention is Britons pay for this “free” health care by standing in line. A recent article in The Atlantic — “How Britain Became as Poor as Mississippi” — describes the reality:
“The National Health Service, the celebrated pillar of the British cradle-to-grave welfare state, has a backlog of 6 million patients — almost a tenth of the population — waiting for treatment.”
The article continues:
“Many Brits can neither obtain an appointment with a publicly funded dentist nor afford a private one; in a 2023 survey, one in 10 reported doing DIY dental work, in extreme cases extracting their own teeth or gluing broken crowns back together.”
DIY dental work. Let that sink in.
Does this surprise anyone? Economists have a saying: “A free good will be used to excess.” Make a product free, and it disappears from the shelves. People find themselves on a waiting list or standing in line.
Free stuff is inevitably rationed stuff.
And monopoly service is inevitably low-quality. Monopolies deliver poor service because they don’t have to please their customers.
The Atlantic article notes that, due to scandalously high numbers of preventable tragedies involving newborns, the “[t]he health service now has to spend more money settling maternity-malpractice claims than it does on actually providing maternity care.”
Governments have to manage scarce resources. Which helps explain the not-infrequent reports of the NHS denying treatment to severely ill infants and the (merely) elderly for budgetary reasons.
So, while the American version of this scheme might be “free at the point of use” for some Americans, it would be a broken promise for most. And, for a vulnerable minority, it would be life-threatening.
And then there’s the budgetary cost. The Congressional Budget Office estimates that, over its first decade, “Medicare for All” would cost taxpayers in the vicinity of $30 trillion (not a typo).
Which puts us in mind of Milton Friedman’s famous book, There’s No Such Thing As a Free Lunch. The title sums it up. It’s economically and mathematically impossible to “guarantee universal healthcare at no cost to individuals.”
Perhaps we should mail a copy of Friedman’s book to every candidate running on “Medicare for All” this year — along with a good pair of pliers.
Better Idea: A Triple Shield
Happily, there’s an alternative: Shift choice and control to patients.
Our current system is broken. It costs too much and imposes too much hassle and waste. Prices are opaque. Paperwork and insurance claim-denials drive us all crazy.
But the cause is not a failure of the free market. The cause is our lack of a free market. Our system is basically a government-regulated market that concentrates power in the hands of a few big public bureaucracies and a few big health care corporations. And they all behave like monopolies. “Medicare for All” would just reduce the number of monopolies to one.
The remedy for what ails our broken health system is not more monopoly. It’s more competition.
The real problem is that patients do not control their own health care dollars and decisions. If they did, things would be different, and better. We’d have a truly competitive marketplace with:
- transparent prices
- anytime access to our favorite doctors, and
- affordable insurance that’s there when we need it.
It’s not hard to get there. We just have to guarantee every American access to three basic protections:
- A Good, Affordable Health insurance Policy: One that protects you from large, unexpected expenses but doesn’t cover things you don’t need, and stays with you from job to job.
- A Direct Primary Care Subscription: This is an affordable option by which you subscribe to your favorite doctors for a low fee, with no extra or hidden charges and no insurance-company meddling. DPC doctors offer round-the-clock access and same-day or next-day appointments. And they spend four times as much time with their patients as traditional, insurance-based doctors do.
- A Tax-Free Health Savings Account: An HSA is a powerful financial tool — a medical wallet — that gives you direct access to the drugs, devices, and procedures you want, when you want them, without having to ask anyone’s permission. For low-income Americans, we could fund these accounts using a portion of the money we currently spend on Medicaid and Obamacare. Alas, right now, no more than one in five Americans has access to this tool. Everyone should.
Together, these three tools can form a “triple shield” enabling their owners to enjoy better health with true peace of mind:
- No one is forced to go without necessary care.
- Providers compete for our business.
- Prices are low and transparent.
- Innovation delivers ever-greater abundance.
- Wait-times are short.
Health care will be more like shopping online and less like taking a number at the Department of Motor Vehicles. Hospitals will be more like hotels.
And we certainly won’t have to pull our own teeth.
The Bottom Line
Health care monopolies like “Medicare for All” and Britain’s National Health Service can never work because they ignore the laws of human nature and fail to respect human freedom and dignity.
Freedom is the only approach that can work because it’s the only approach that can deliver affordable, high-quality health care to everyone, with true peace of mind.
If you agree, forward this article to your local congressional candidates and tell them:
“Medicare for All? No, thanks. Give us freedom instead.”
To learn more about AFP’s Personal Option plan to give every American reliable, hassle-free health care you can afford, visit personaloption.com.
Dean Clancy is a Senior Health Care Policy Fellow at Americans for Prosperity.
