In the United States, health care is mostly seen as a private good. A private good has two main aspects. The first, and most obvious, is that the good is private—the benefit is seen as being primarily (or even exclusively) to the individual. Put roughly, it is a good for you, but not for me (or the rest of us). Second, the good is thus typically seen as being the responsibility of the beneficiary. Put roughly, you should pay for that good, not me (or the rest of us). Of course, a private good might have some broader benefit. There are many things that are clearly private goods. For example, my running shoes are a clear private good—they benefit me, and I should be the one to buy them. In terms of a possible broader benefit, my being healthy means that I do not miss work, and this benefits my employer and students. But this is not enough to make them a public good. There are also clear public goods.
Obviously enough, a public good is supposed to benefit the many and is typically seen as being the responsibility of society. Put roughly, it is a good for us and we should pay for it collectively. A public good need not benefit everyone—almost every good is not of interest or use to at least some people. For example, public transport is not of benefit to a person who never uses it and gets around on their bike or by walking. There is, as one would expect, considerable debate over what goods (if any) should be public. Public versus private health care is certainly a matter that generates considerable controversy.
With the main exception of the United States, most wealthy countries have chosen public health care. The United States does, of course, offer some public health care in the form of Medicare and Medicaid—but people need to qualify for both. Most people who are working rely on private health care. One reason for this is that a narrative has been crafted to cast health care as a private good—or at least better as a private good than a public good. In terms of being a private good, the general idea is that each of us is responsible for our own health care—we must earn the money to pay for insurance and treatment. With the exceptions of Medicare and Medicaid, we are on our own. The idea is that my health is a good for me, but not for you—hence I should bear the cost.
There are also the arguments that the current private health care is better than public health care. This can be countered by pointing to the number of people who go bankrupt due to medical expenses, who cannot afford and hence do not get basic care, and those who turn to GoFundMe and similar sites to pay their medical bills. It is, I must admit, true that we do have the best health care that money can buy—if you have the money to buy it. I will set aside this debate to focus on the main issue: whether health care is best seen as a public or private good. One way to approach this matter is to consider paradigm cases of public goods.
Consider, if you will, an alternative America in which defense, police, fire and the legal system were regarded as private goods analogous to how health care is seen as a private good. In this alternative America, citizens would need to purchase military, police and legal insurance or face high costs for purchasing basic military, police, fire and legal services. In the case of military and police coverage, a citizen would be provided with various degrees of military protection for their person and property. Without such coverage, a citizen would need to pay high costs to secure such services as defense against foreign enemies and police investigations into crimes committed against them. Those lacking the ability to pay might be able to qualify for some basic services via such government programs as Militaryaid and Policecare. Those unable to qualify for such programs and unable to afford the services would be on their own—they would need to rely on self-defense, a good garden hose and vigilante justice to address threats and crimes against them. This would be fair and just—after all, having the military protect me does not benefit you, nor does having the police investigate the theft of my truck benefit you. Only having the military protect you benefits you. Only having the police investigate the theft of your truck benefits you. So, by the logic of health care as a private good, police and military services are also private goods. The same would also apply to aspects of the legal system. Being able to defend my property or other rights in a legal system does not benefit you, it just benefits me.
There would be, of course, certain police, military and legal activities that would occur because they would be a good for these institutions and the state. The police would certainly enforce laws that generated revenue for them and the state; but if the law served only your private good, then you would need to pay for its enforcement. Such institutions would naturally be lean and efficient, operating in accord with strict market forces as God intended.
In this world, the results would be analogous to health care in the real world. People would be locked into jobs to keep their police, military, fire and legal benefits. People in need would turn to GoFundMe to pay for such things as the murder investigation of their spouse or keeping Canadian invaders off their land. Many people would be victimized, injured or killed because they lacked basic coverage. But such is the way of private goods.
In general, such things as police, military, legal and fire services are seen as public goods because they are regarded as meeting the state’s minimal obligation of protecting its citizens. There is also the fact that such goods require large expenditures to operate, thus requiring collective funding—which warrants providing a collective good. The same can be applied to health care—just as the state should protect its citizens from ISIS, fire and crime, it should also protect its citizens from COVID-19 and cancer. After all, you are dead whether you are killed by an ISIS bomb, a criminal’s bullet or COVID-19.
Police, military and other such services are also seen as public goods because they do (mostly) benefit everyone—even though the specific applications obviously benefit specific people. The same also applies to much of health care. For example, infectious illnesses spread and containing them is a public good. As another example, sick and injured people contribute less to the economy, so treating them benefits the public by getting them back into serving their core functions in capitalism: working and spending. As such, health care should be seen as analogous to the public goods of the military, police, fire, and legal system. There are, of course, obvious exceptions in which medical procedures are entirely private goods (like face lifts) but these exceptions do not disprove the general principle.