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September 2017 Brief: Volume 24, Number 27

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What Do You Give Up to Get “Free” Healthcare?


by Amy K. Frantz



Whether you support or oppose Obamacare, few would dispute that at least some changes are needed. Many conservatives would like to repeal and replace it with a more free-market-oriented system. Many liberals, such as Senator Bernie Sanders, would like to move to a single-payer or completely government-run healthcare system.


“Free” healthcare for all sounds great, right? But before we jump on board, we should take a look at those healthcare entities that are currently government run to see how we might fare under such a system.


One of the most well-known government-run healthcare systems is Great Britain’s National Health Service (NHS). The most recent internationally known patient of the NHS was Charlie Gard.[1] Charlie was born with a rare genetic disease, mitochondrial DNA depletion syndrome. The London hospital caring for Charlie determined that no further treatment would help him and that his life support should be turned off. His parents wanted to take him to the United States to try an experimental treatment at Columbia University. But the London hospital said no, and the British courts backed the hospital’s decision. Even if the courts had decided in favor of the parents, the doctors at Columbia University determined it would have been too late for the experimental treatment to help by the time the case made it all the way through the Court of Appeals, the British Supreme Court, and the European Court of Human Rights. The final wishes of Charlie’s parents — to allow Charlie to die at home so they could spend a few more days with their son before his life support was removed — were also denied by the British system.


Whether you believe Charlie Gard’s parents should have been able to take their son to another hospital in another country for experimental treatment or you believe ending Charlie’s life was in his best interest, you cannot deny that the decision on what to do for Charlie Gard was made entirely by the British healthcare system, with little to no input from his parents. That is what happens when your “free” healthcare is provided by the government. The government is paying the bills, so the government is also making your healthcare decisions.


Sweden is another country with a largely government-run healthcare system. It’s also a country presidential candidate Bernie Sanders often held up, along with other Scandinavian countries, as a model for the United States to follow. Zach Maher, a freelance writer and former staff member of the New York Review of Books, wrote about his niece’s experience with the Swedish healthcare system:


Six months ago, my two-year-old niece broke her leg. The physician who treated the girl told my brother-in-law that his daughter would be given a full-body CT scan. The doctor insisted that the procedure was mandatory, but not for any medical reason. Rather, the Swedish social-services administration requires such scans to look for evidence of child abuse. While the doctor did note that the broken leg was the result of an accident, he told my brother-in-law the matter was “out of [his] hands.”[2]


The family refused to submit the child to the scan, citing the medical risks of exposing the two-year-old to anesthesia and radiation. Instead of understanding their concerns, the Swedish government bureaucracy investigated the parents as suspected child abusers, inspecting their home, interviewing them multiple times, and interviewing their friends and neighbors. Ultimately, Swedish social services found no grounds to continue the investigation, but not without first scaring the parents into believing their children might be removed from their home, simply for trying to protect their daughter from medically unnecessary tests. This incident also highlights the fact that the doctor had no discretion to determine whether he felt the parents should be suspected of abusing their child. In fact, the doctor had declared it was an accident. But an injury to a child, no matter the cause, requires the healthcare system in Sweden to default to the belief that the parents are guilty of child abuse until proven innocent.


Finally, we should look at the government-run healthcare system that already exists here in the United States: the Veterans Affairs medical system. The VA’s inefficiencies and long wait times for appointments have been well documented in the last few years. In 2014, the Veterans Choice and Accountability Act was adopted to try to improve the system, providing an additional $16 billion, including $2.5 billion to hire more doctors, nurses, and other staff. But an investigation by National Public Radio (NPR) found:


The VA has about the same number of new hires as the VA would have been projected to hire without the additional $2.5 billion; the new hires weren’t sent to VA hospitals with the longest wait times; and the VA medical centers that got new hires were not more likely to see improved wait times.[3]


Another obstacle to reforming the VA is the difficulty in removing those in charge of the deficient system. The VA Medical Center in Washington, D.C., was plagued with problems while under the direction of Director Brian Hawkins.


[Inspector General Michael Missal] found that 18 of 25 sterile storage areas for supplies at the D.C. facility were dirty. The hospital had no effective inventory system, so doctors and nurses had to routinely cancel or delay procedures for lack of supplies; they used recalled or expired products on patients. The facility had run up 194 official reports of safety incidents involving patients since 2014 — and those were merely the incidents reported. Vendors removed equipment because the hospital failed to pay its bills.[4]


Mr. Hawkins was reassigned in April of this year, then fired in July. However, he appealed to the Merit Systems Protection Board, claiming he was wrongly dismissed. The Board determined he must continue to be employed by the VA while he fights his dismissal. Is this a good use of tax dollars, while many veterans are unable to get timely healthcare? Congress did adopt legislation earlier this summer to attempt to make it easier to fire bad employees at the VA, but it will still be an uphill battle.


“Free” healthcare may sound enticing. But remember that with “free” government-run healthcare, the government is paying the bills, so the government is also making healthcare decisions for you and your family. The government may be making decisions for your doctor as well, in some cases. And finally, the one government-run healthcare system we do have now in the United States — the VA — is certainly not one that should be replicated for all in its current state.


[1] Robert Mendick, “Charlie Gard: The tragic case of a too short life,” The Telegraph, July 28, 2017, <> accessed on August 24, 2017.
[2] Zach Maher, “What Swedes Give Up for ‘Free’ Money,” The Wall Street Journal, August 14, 2017, <> accessed on August 22, 2017.
[3] Steve Walsh, Patricia Murphy, Stephan Bisaha, and Quil Lawrence, “VA Hospitals Still Struggling with Adding Staff Despite Billions from Choice Act,” National Public Radio, January 31, 2017, <> accessed on August 22, 2017.
[4] Editorial Board, “Can the VA Fire Anyone?,” The Wall Street Journal, August 14, 2017, <> accessed on August 22, 2017.


Amy K. Frantz is Vice President of Public Interest Institute, Muscatine, Iowa.
Contact her at


Permission to reprint or copy in whole or part is granted, provided a version of this credit line is used:"Reprinted by permission from INSTITUTE BRIEF, a publication of Public Interest Institute." The views expressed in this publication are those of the author and not necessarily those of Public Interest Institute. They are brought to you in the interest of a better-informed citizenry.




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