Contradiction? Who cares!

People can profess a belief while at the same time saying things that directly contradict it. Here's a vivid example of this fact: a recent press interview with the former Polish secretary of public health. Given who the interviewee was, the interview topic was of course public healthcare system in Poland, so to give the proper context I'll say a few words about how this system works. The system is funded through payroll taxes; a certain fixed percentage of earned income is withheld and then deposited into the budget of a central government agency called National Health Fund (Narodowy Fundusz Zdrowia). This agency employs all the doctors working in the public sector, manages all public hospitals and clinics, and provides funding for all publicly available medical services; consumers of public healthcare are not required to pay any out of pocket fees.

Dr. Balicki is currently managing one of the largest public hospitals in Warsaw (and in Poland, for that matter). He uses an example from the day to day affairs of his hospital to illustrate problems with Polish public healthcare. Balicki says his hospital performs 700 cataract removal surgeries a year. That's how many the National Health Fund is able to pay for. However, the demand is much higher: each year, 1600 patients sign up for this surgery. Balicki says his hospital actually has the resources to perform 1600 cataract removals without much problem, but it can't because the law forbids public hospitals to accept any money on behalf of the patients, so those 900 patients a year who cannot have their surgery paid for by the Fund have to get in an ever growing line.

A few moments later, Dr. Balicki briefly talks about the idea of creating a "basket of government-guaranteed free medical services." As of now, the law "guarantees" every citizen that the state will provide any available medical service free of charge. Of course, no government in the world can afford to keep such a promise; hence the need to ration public healthcare in Poland. The idea of a basket of free goods is basically to assess how many and which medical services the government is actually able to pay for, and guarantee those. The rest would have to be paid for via the private sector, either by insurance premiums or fee-for-service payments. Balicki is opposed to the idea, and his argument is that "the government cannot restrict access to medical services by providing some of them for free while charging for others."

Think about this for a moment. If the government says it only has money to provide certain explicitly enumerated medical services for free and that other services will have to be paid for by someone else, that's restricting access to healthcare. But if the government guarantees to provide all services for free even though it cannot afford to do so and is forced to ration them (just as it happens in Balicki's own hospital with cataract surgeries), that is somehow different than restricting access to care. It seems that, to Balicki, "restricting access" means not "causing a situation where some people who want certain services have to go without" but "explicitly charging fees for services." But wait; in the very same interview, Balicki himself gave an example of a situation where 900 people a year can't access a service, even though surely some of them would be willing and able to pay for it. In other words, a situation where explicitly charging a fee for a service would actually increase access to it.

The human brain is an amazing device. It's capable of holding so many blatantly contradictory beliefs...