In the United States, health care is often seen as a private good. The benefit of a private good belongs primarily (or even exclusively) to the individual. But a private good could have some broader benefit as well. A private good is usually seen as being the responsibility of the beneficiary. Put roughly, you should pay for your private good, not the rest of us. There are many things that are clearly private goods.

For example, my running shoes are a private good because they benefit me, and I should be the one to buy them.  In terms of broader benefits, my health 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.  .

Obviously. a public good is supposed to benefit the public and is often 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 directly. For example, public transport does not directly benefit someone who never uses it and only gets around by walking or biking.  There is considerable debate over what goods (if any) should be public. Public versus private health care is a matter of debate in the United States.

Apart from the United States, most wealthy countries have chosen public health care. The United States offers some public health care in the form of Medicare and Medicaid but people need to qualify for both and the Trump administration and Musk are doing what they can to cut into these programs.

Most working people rely on private health care. One reason is the rhetorical narrative that health care is a private goo or at least better as a private good. In terms of being a private good, the idea is that each of us is responsible for our own health care in that 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 good for me, but not for you, hence I should bear the cost.

There are also arguments that private health care is better than public health care. This can be countered by the fact that people go bankrupt due to medical expenses, people cannot afford and hence do not get basic care, and people  turn to GoFundMe to pay their medical bills. It is true that we have the best health care 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 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 are private goods analogous to how health care is a private good in the real America. In this alternative America, citizens need to purchase military, police and legal insurance or face high costs for purchasing 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 who could not pay might be able to qualify for some basic services through government programs such as Militaryaid and Policecare. Those unable to qualify for these programs and unable to afford the services would be on their own. They would need to rely on self-defense, a 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 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 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 be lean and efficient, operating in accord with strict market forces as God intended. Unless, of course, they grew bloated and inefficient.

In this world, the results would be like 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 to have their spouses’ murder   investigation or keeping Canadians off their land. Many people would be victimized, injured or killed because they lacked basic coverage. But defenders of the system would praise it for all it alleged virtues and mock other countries for their public police, military, fire and legal services.

Things like police, military, legal and fire services are seen as public goods because they meet a state’s minimal obligation of protecting its citizens. Such goods require large expenditures, thus requiring collective funding and this can be seen as justifying 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 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 pragmatic 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.