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Some form of universal health care coverage currently operates in many Western countries, including Canada, the United Kingdom, and the Netherlands. With the passage of the Affordable Care Act in March 2010, the United States will employ an amalgam of universal health care through state-run health insurance exchanges mandated for implementation by 2014. While the benefits of a universal health care system appear obvious, the potential down side of universal health care merits discussion as well.


Advocates of universal health care believe it should be a right for all citizens. However, since all citizens are not created equal, health wise, universal health care could end up being unfair to health-conscious citizens. Smokers, for example, receive the same treatment under universal health care, even though their conditions are self-induced, as non-smokers. Smoking-related illnesses like emphysema and lung cancer place an enormous drain on the system, and are mostly preventable. A similar argument can be made for those who are overweight or heavy drinkers. In a universal health care system, people do not have to take responsibility for the health consequences of bad lifestyle choices. Everyone gets covered, and everyone shares the cost.


Different countries employ different definitions of "universal." A recent study from the Commonwealth Fund compared the current U.S. system with Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, and found that certain countries cover some costs, but not others, which causes problems for citizens. For example, in Canada, universal health care covers physician care and hospital treatment, but not prescription drugs. A Canadian can go to the doctor for free, learn what prescriptions he needs for free, but must pay for those prescriptions out-of-pocket, or through extended medical coverage to supplement his government plan. For low-income citizens, this often translates as no access to prescriptions at all. The Netherlands plan, by contrast, includes prescription drugs and dental care.


Some countries with universal health care struggle to sustain efficiency. Canada and Australia ranked lowest, according to the Commonwealth Wealth Fund study, in accessibility of physician appointments and wait times for basic medical services, as well as specialist care, tests, and elective surgery. Other efficiency issues noted by the study included Canada’s propensity for misplacing medical records and tests.

Susceptibility to Abuse

Any system invites abuse, and the universal health care system is no exception. Often, citizens of countries with universal health care will “milk” the system. The most common example of this phenomenon occurs when citizens don’t live in their country of origin, don’t pay taxes in their country of origin, yet still return home whenever they need to go to the doctor.


Universal health care budgets usually demand successive levies from year to year – no surprise, since they are funding literally millions of people. For some countries, however, the system is not sustainable, especially in light of the aging population. In Canada, for example, the lionshare of provincial budgets consistently goes to health care. Some provinces spend 40 percent of the total annual budget on health care alone. Funding for other programs like education and infrastructure are continually gobbled up by ballooning health care costs.