In a scene from Michael Moore's 2007 documentary about the failures of the United States healthcare system, Sicko, the late British parliamentarian Tony Benn reads from a pamphlet distributed to the people of the U.K. shortly before the introduction of the National Health Service in 1948:
"Everyone, rich or poor, man, woman or child, can use it or any part of it... There is no insurance qualifications, but it is not a charity. You are paying for it mainly as taxpayers, and it will relieve your money worries in times of illness."
Benn's voice raises with a particular since of pride when he reads the phrase about the NHS not being a charity. It is not hard to understand why. Benn was a lifelong socialist and for him one of the most important parts of the NHS was likely that it is not charity provided by the wealthy for the poor, but rather exist because the working class funds it as a means to ensure access to these essential health services for themselves and their children.
This concept is an important one, but it is far too often forgotten when discussing not only national health systems, but other public programs designed to make services like education and disability compensation available to everyone. This essential point is not just ignored by those on the right who want to brand any effort to alleviate poverty or provide a means for equal access to education a handout, but also by many on the left who often chose to refer to proposals like tuition-less college education "free."
For example, Bernie Sander's, whose campaign has done so much to reawaken the fight to make college affordable, refers to the need "to make tuition free at public colleges and universities," as the second policy proposal on the issues page of his website. Sander's is right. The need to make college affordable for everyone will not only free young people from devastating debt, but also increase the availability of education to those who cannot afford it.
But a tuition-free education is not a free education and a single-payer or nationalized health system with no co-pays or premiums is not free health care. Just like the NHS in the UK, such systems would be paid for by everyone for the benefit of everyone. All the systems are likely much cheaper systems than the ones we currently use because the remove the profits made by health insurance companies and student loan financers, but they are not free.
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When the term free is used it unfortunately plays right in the hands of demagogues who would like to portray the benefits of such free services as poor or lazy or worse use language that appeals to racist sentiments. They too will often label these programs as not being free, but instead of arguing that it is all citizens paying for the services, they will say it is the John Galt creators of the world being stolen from to help the masses.
Indeed, we have seen this play out in the portrayal of Sander’s campaign. One popular meme from the right shows smiling Sanders supporters with the text “What do you expect of people who grew up being told that every child’s a winner who deserves a trophy?” The implication being that millennials who support Sander’s proposals are only doing so due to an ingrained sense of entitlement. Using the expression “free healthcare” or “free education” feeds in to this narrative.
In the United Kingdom, both Labour and Conservative politicians use the expression "free at the point of service" to refer to the NHS. What this means is that when a single mom in London takes her child to the pediatrician or a Scottish pensioner goes to receive his cancer screening, they will not have to pay for the services when they are provided, because they already have been paid for.
In the same way if senator Sander's was elected and his plan for higher education passed through Congress a janitor from Boston would be able to attend night classes or a teen with parents making minimum wage would be able to study mechanical engineering without paying tuition not because the education is free or because they are leaching off of the wealthy, but rather because they and their families have paid in the system and providing them with their education will make it possible for them to pay into it in the future. We should use language that reflects these important facts.