Universal healthcare is not free healthcare: There is no such thing as free healthcare

I typically scroll through Facebook to see if there are postings or reels of interest. If universal healthcare is the topic, I usually respond, in part to market my book and link my UHC Facebook page, and in part to write a correction if I believe the information is inaccurate.

Today I saw a posting that really riled me. It was a world map showing countries with UHC, and of course the U.S. was one of the few countries in the world without some form of universal coverage.

What irritated me was that the map indicated that some of the countries offered free healthcare.  I quickly dashed off a reply in all caps: THERE IS NO SUCH THING AS FREE HEALTHCARE.

What miffs me about the term “free healthcare” is that Republicans and Fox News use it to infer that universal healthcare is socialism, or worse, communism. Republicans believe that healthcare is a commodity. Purchasing health insurance is a personal responsibility, and if you can’t afford it, that’s not my problem, it’s not the government’s problem, it’s your problem. For example, if you get your health insurance through your employer, that is because you earn it through your work. However, under UHC, someone who doesn’t work, such as someone on disability, would get the same health insurance. From the conservative perspective, you work hard and the other person is a freeloader. That’s not fair.

As I noted in another column, framing that taxes are a burden sticks even though it is inaccurate as taxes pay for many beneficial activities such as public schools, police and fire departments, roads, clean drinking water, public lands, and disaster relief. Similarly, framing UHC negatively works even though it is not free, and it is beneficial in several ways such as making healthcare available to those who are sick and need treatment. So, if you are talking to someone about universal healthcare, and they whip out the “I don’t want to pay for someone else’s healthcare,” argument, here are three ways to counter that assertion.

First, about half of all Americans have tax-supported healthcare, and as a result we are already paying for the healthcare of others. This includes city and county employees and their families such as teachers, firefighters, and sanitation workers. It includes state employees and their families such as the state police, department of transportation workers, and safety inspectors. It includes approximately 2.7 million federal civil servants and their families, even after Trump and Musk took a chainsaw to federal agencies. Local, state, and the federal government provide health insurance through private providers, nonetheless, the money to pay for this insurance comes from your and my taxes.

Taxes are also the source of revenue for a number of federal health insurance programs such as the over 1.3 million active-duty military personnel and their families who are covered under the TRICARE program, as well as several more million covered under TRICARE programs for retired military. It includes military veterans eligible to receive health and mental health services through the Veterans Administration. It includes about 63 million seniors on Medicare, about 1 in 5 U.S. residents. Despite cuts to the program by Trump and the Republicans, it still includes 88 million Americans on Medicaid; nearly one in four Americans! Finally, it includes about 7.2 children enrolled in the Children’s Health Insurance Program (CHIP).

All this is through direct taxation. Many Americans in the private sector also have part of their health insurance paid for from taxation due to their companies having contracts with local, state and federal governments. For example, the University of Virginia has multiple sources of income, including about 12% that comes from state funding as well as federal research grants. And let’s not forget that SpaceX depends in large part on federal contracts for launching satellites. That’s right, Elon Musk is on the federal dole. Consequently, if we are going to fund universal healthcare through some form of tax, as we are likely to do, then we’re more than halfway there.

Second, if you have health insurance through a private insurance company (e.g., Anthem, United Health Care, Cigna) such as one provided through your employer, you are paying for someone else’s insurance. Many people misunderstand how insurance works. They believe that when they pay for health insurance it goes into a personal account that only they can use. However, your insurance payments go into a financial pool and are paid out to members as they need it. Based on current rates, if health insurance was a private account, you could be paying into it for years, even decades, and it could be wiped out by just one adverse event, such as a heart attack needing bypass surgery. So, the argument that people shouldn’t pay for another person’s health care is contrary to how private health insurance actually works.

Finally, there are several ways to fund UHC. For example, under U.S. Sen. Bernie Sanders’ Medicare-for-all approach, much of it would be paid for by taxing the top 10% of wage earners. So, while not entirely “free,” the wealthiest would underwrite the cost of healthcare for the majority of Americans. I don’t believe that is politically feasible.

The plan I present in The Case for Universal Health Care takes a different approach. I believe in creating multiple sources of income to ensure that the program is sustainable for future generations and can adjust to a fluctuating economy. For example, most of the money would come from a health care tax on goods and services. The money taken out of your pay to cover health insurance would come back to you as additional salary to offset the new tax. The more you spend, the more you contribute to the program. In this way, the wealthiest Americans contribute at a higher rate. Nonetheless, everyone has “skin in the game” and there are no freeloaders. And I describe several other ways to generate revenue, so that the tax is not burdensome.

Unless you are 8 years old and wake up on Christmas morning to find the toys you wanted under the Christmas tree, nothing is free, including universal healthcare. My approach ensures that everyone pays into the system through a sales tax, so there are no freeloaders. Finally, about half of all Americans have their health insurance paid for through taxes, so we are well along the way toward UHC.