Individual Responsibility Versus “free” Health Care for All

Wednesday, November 12, 2008

By Eustace Davie

EustaceGovernments can promise free health care but they cannot deliver it, nor can they ensure that the country’s people will be healthy. They cannot deliver “free” health care because there is no such thing – someone has to pay for it. And good health is largely dependent on healthy lifestyles and nutrition – matters that are out of the hands of government.

Good health for all except the most unfortunate is possible for the greater part of people’s lives. Governments, however, are not the primary determinants of their health, or lack of it. Individuals are personally responsible, and if they do become seriously ill or injured, their recovery is dependent on the quality of the health care providers and technology available to them. One of the most important roles of government in the healthcare field is to ensure that infrastructure in its care, such as provision of clean water, sewerage disposal, and garbage disposal, is properly and efficiently dealt with.

Government policies that have the objective of encouraging citizens to be healthier should be based on reality. Promising South Africans that they will all be supplied with health care free of charge would, for instance, be fraudulent. Canada, with a per capita GDP of $35,729 and the UK with $33,535, have incomes that are 3.67 and 3.44 times that of SA’s $9,736 (measured in US dollars on a PPP basis) and those countries are unable to meet their promises of free health care for all. Both these countries, 12th and 16th respectively on the world’s list of highest incomes, ration health care by means of waiting lists or outright denial of treatment, which sometimes leads to the death of patients. In addition to rationing by queuing, they limit the quality of care by denying patients the newest and best medicines for the treatment of their illnesses.

If wealthy country governments are compelled to renege cruelly on their promises, how much more cruel would the “life and death” committees in a SA National Health System (NHS) or National Health Insurance (NHI) system have to be, in deciding who should receive treatment and who should not. Medical schemes, of course, face the same problem of denying treatment to members who have reached the limits of the cover for which they have paid. Some commentators contend that this is equally cruel but it is not.

Medical scheme administrators are compelled to zealously guard the interests of all the members of medical schemes by ensuring that they stick meticulously to the terms of the contracts. If they should habitually pay for treatments that fall outside the contracts, they will end up bankrupting medical schemes and failing in their duty to the scheme members, denying care to even more people; a flagrant dereliction of their duties that would lay them open to claims for compensation.


The difference between NHS and NHI systems and private medical schemes is that the government systems make promises they cannot possibly honour; creating an illusion of total cover that is false. Governments do not enter into contracts with their citizens, leaving them at the mercy of officials who are compelled to use their discretion in deciding who is to be denied treatment, possibly tantamount to giving them a death sentence. Members of private medical schemes are fully aware that there are contractual limits to the cover they are purchasing. Although the exhaustion of the cover provided by a medical scheme will be bitter to accept, it is a reality that is known to scheme members and very different to the dishonouring of the implicit guarantees of so-called “free” government health care systems.

Death by bureaucratic decision, I would argue, when the patient has lived for years in the belief that “free” health care would be provided from cradle to grave, is less humane than death by inability to pay. The reason is that when there is no such promise individuals will take various steps to avoid illness and dangerous circumstances; they will adopt healthier lifestyles, exercise, act prudently, save to cover health-related crises, and insure themselves as best they can against dread diseases or events. Most important of all, they will not live in a “fool’s paradise” believing that they will be taken care of when they have the worst and most terrifying crises of their lives.

SA’s government should at all costs avoid treading down the fraudulent path of “free” health care for all. It should not create the illusion and expectations that are bound up in such a fraud. It should also not bring upon itself the exponential increase in demand that follows on the creation of the illusion, which inevitably results in the crowding out of the really ill by those with recurring minor ailments.

If government wishes to introduce a National Health Insurance system, it should spell out the terms of the contract it is entering into with its citizens and have the contract actuarially evaluated so that it can determine how many people it can cover with its available resources and concentrate those resources on the truly poor. It should not seek to appropriate the voluntary contributions that people are making to medical schemes, in an act of grand statutory theft, as some unethical people are suggesting – the proponents apparently unaware that contributions made at great sacrifice for the care of self and families will disappear like mist in the wind when transformed into extortion.

Health care in South Africa, built on individual responsibility and individual freedom has a much greater chance of creating a happy, healthy and harmonious society than one built on envy and injustice. Young people should be able to look forward to the time when they take individual responsibility for their own and their families’ health care, utilising all the skills of competitive private medical insurance schemes and having at their disposal world-class health care providers competing to offer excellent health care to them and their families. Our young people have no intention of remaining forever poor – government should envisage a society that caters for them.

Author: Eustace Davie is the director of the Health Policy Unit, a division of the Free Market Foundation.