The Price of Free Healthcare: Reflections on “The Knife's Edge”

“The Knife's Edge” is an autobiography by British cardiac surgeon Stephen Westaby. Similar to his earlier work “Fragile Lives“ , it details numerous cardiac surgeries he performed, but adds personal experiences and insights into the UK's National Health Service (NHS).

The book recounts how a rugby injury damaged part of his brain, altering his personality. He became impulsive, unafraid of risks, indifferent to others' opinions, and less empathetic. While this strained his relationships, it enhanced his surgical career, allowing him to handle operations with greater composure than others. The book notes that many cardiac surgeons and pediatricians share similar traits. Possessing typical levels of empathy would make it difficult to remain composed when confronting cardiac patients, pediatric patients, and their families. This perspective contrasts with common assumptions—some pursue medicine precisely because of strong empathy—yet daily exposure to life-and-death situations severely tests psychological resilience. Without effective coping mechanisms, breakdown becomes a risk. Doctors like Stephen Westaby are more drawn to medicine by a thirst for adventure and achievement. Adrenaline is their elixir; the more difficult and challenging the case, the more compelling it becomes. Those with weaker psychological resilience should avoid medicine altogether, especially surgery—it harms both doctors and patients.

The book frequently criticizes the NHS, primarily for excessive bureaucracy. Laypeople evaluating and managing doctors wastes vast amounts of administrative funding, leading to shortages of essential medical equipment and healthcare personnel. Free healthcare sounds appealing, but nothing is truly free—costs ultimately come from taxpayers and insurance premiums. No country can efficiently manage publicly funded resources, so coverage should be minimized. Yet departments or institutions receiving public funds inevitably seek to expand their use, inevitably leading to shortages. Governments typically respond by increasing money supply or raising taxes, effectively shifting costs onto ordinary citizens—often amounting to redistributing wealth from the poor to the rich. I believe publicly funded healthcare and education remain necessary, but their scope must be strictly controlled. They should not become universal or de facto monopolies, but rather serve as the foundation of healthcare and education markets. This ensures those unable to afford medical or educational expenses receive basic healthcare and educational opportunities. The majority should still choose suitable health insurance or education funds through the market. While this may seem unfair to the poor, fairness does not mean lowering everyone to the lowest common denominator. Most people face long waits for medical care and can only attend average public schools. Society requires differentiation. As long as everyone has the opportunity to prosper, there's no need for uniform living standards.

The healthcare and education sectors differ from other industries in that they cannot fully self-regulate through market competition. These fields, crucial to human life, health, and developmental prospects, require government oversight. This does not mean the government should take over entirely—especially since government-controlled pricing of medical equipment and pharmaceuticals inevitably creates significant opportunities for corruption. The government's role should focus more on formulating policies and strictly penalizing violations.