The Myth of Free and Universal Healthcare – Religion & Liberty Online

For many people around the world, sound health is of the upmost importance. It’s what lets us live up to our potential at work and at home, while its absence takes a serious toll on our quality of life.

In recent years, American and European healthcare systems have often been contrasted on both sides of the Atlantic. Europe is associated with “free” and universal care, while the American system is portrayed as its market-driven opposite. Americans have begun to believe in the myth of free European care; Europeans recoil at reports of American medical bills. Both are caricatures. No modern system is purely market based, and none provides unlimited care at no cost.

At one extreme stood the Soviet model, which promised universal access but assigned patients a doctor by address and reserved better care for privileged groups. Even its supposedly free treatment generated informal payments—gifts and envelopes pressed into doctors’ hands. Today no country follows it in pure form; in Belarus, the closest survivor of the old Soviet Union, state hospitals run their own cash desks for scans and consultations.

At the other end lies the United States, which is not purely market-based either, though it leads the world in developing new drugs and treatments. Most European and some Asian countries occupy the space in between, combining compulsory contributions, taxation, and public provision in different proportions.

Poland belongs to this continental model, but reached it through two decades of transition from the Soviet one—and inherited the weaknesses of both. Its experience offers a useful test of what “free” and universal healthcare means in actual practice.

Poland formally operates a contribution-based system built around a single nationwide payer. Employees, pensioners, and most people on civil-law contracts pay a mandatory 9% of a base salary tied closely to income. The self-employed pay 9%, too, but never on less than the minimum wage—about $1,270 in 2026—while companies and certain forms of self-employment can cap what they owe.

In practice, therefore, most employees who earn more also pay more. And 9% is not necessarily a permanent ceiling: The head of a multinational pharmaceutical company has called for it to rise to 13%, even tying his firm’s future investment in Poland to how much the state spends on health.

Health status, risk of illness, and how often one uses the system have no bearing on the amount paid. Contributors’ families are covered too—children in education up to 26, non-working spouses—along with the registered unemployed, pregnant women, and, from 2022 until March 2026, Ukrainian citizens. Contributions are topped up by state budget subsidies and by local governments, which fund the hospitals they own.

Nominal public health outlays rose almost threefold between 2014 and 2024: from PLN 72.9 billion (approximately USD 19.2 billion at today’s exchange rate) to PLN 210.6 billion (approximately USD 55.6 billion). However, the budget does not balance, and in 2026 alone the funding shortfall will amount to approximately $4.2 billion. Healthcare contributions are not enough, and next year the state budget is due to add another $9.2 billion.

The average wait for a health service reached 4.2 months in 2024, the longest since measurements began in 2012, when it was 2.4 months. To see some specialists, the delay exceeds a year: 13.9 months for an appointment with an angiologist, 12.1 for an endocrinologist. When hospitals treat more patients than their contract allows, the National Health Fund pays between 30% and 100% of the agreed price, at its own discretion, and from July 2026 it will settle those bills only once a year, leaving hospitals to finance the care themselves in the meantime.

In 2024, nearly two-thirds of Poles used private care at least once, most often because the public system was simply out of reach, not by preference. Four in five paid out of pocket; a growing minority rely on employer plans or private insurance, now covering 5.39 million people.

Much of the increase in National Health Fund expenses has gone to cover rising wages. The government sets statutory minimum salaries for doctors and nurses, pegged to the national average wage, but they apply only to staff on employment contracts, not to independent contractors.

Lately, though, the problem has not been minimum pay but its opposite. Reports of extraordinary earnings and apparent abuse of the remuneration system have shocked the Polish public, all of it centered on doctors who contract with hospitals as independent businesses rather than working as employees, an arrangement known in Poland as “B2B.” On paper this makes each doctor a private contractor, in practice many work much as staff would, only outside the working-time limits and other protections of labor law; they also make lower pension and health contributions. The irony is that those reduced contributions help fund the very system that pays them.

The most prominent case of billing abuse involved a resident doctor in his late 20s who reported medical-practice income of nearly PLN 1.6 million in 2025—some $420,000, an extraordinary sum by Polish standards. At Warsaw’s publicly owned Southern Hospital alone, he was officially recorded as having worked 3,976 hours, an average of 331 hours per month, while simultaneously providing services at several other hospitals. Still in specialist training, he nevertheless ran the hospital’s emergency department as its “coordinator,” a position not formally defined in the regulations.

The young doctor is a member of Civic Coalition (KO), the party that governs Warsaw and leads the ruling coalition in the Polish parliament, and sat on one of the city’s district councils. He was also reportedly attending council sessions and appearing in the media during his contracted working hours.

Public outrage intensified after reports alleged that politicians associated with Civic Coalition and members of their families had been admitted to the emergency department outside the regular queue and allowed to wait in a separate room described as a VIP lounge.

After the scandal broke, the doctor returned roughly half a million zlotys by correcting previously issued invoices. Warsaw prosecutors have since opened two investigations connected with the hospital: one into fraud exceeding half a million zlotys, the other into abuse of authority by a public official. As of late July 2026, no charges had been brought against anyone, and the doctor had not been questioned.

This was no isolated case: At the Białystok Oncology Center, the coordinator of its urology unit received nearly PLN 3 million—approximately $790,000—under his contract in 2024. In Braniewo, a county hospital in the north, a surgeon billed 11,577 hours over the course of 2024—in a year that contains 8,784—by invoicing several posts for the same stretches of time, on some days claiming as many as 72 hours of work. He collected roughly $475,000, and the county estimates the hospital’s losses over three years at about $1 million. Another group of doctors earned astronomical sums through a company they had established, reaching, in extreme cases, approximately $6,900 per hour.

There are yet more doctors with “record-breaking” earnings: According to the president of Poland’s Agency for Health Technology Assessment and Tariff System, once earnings from different facilities are combined, between 5% and 10% of doctors—most of them working under B2B contracts—may earn more than PLN 100,000, or approximately USD 26,000, per month. This is equivalent to more than 11 times the average monthly wage in Poland.

Hospital directors attribute the very high rates and billing methods that are disadvantageous to their facilities to the small number of specialists on the market. The problem, however, is that the number of specialists is controlled by … the government and the doctors themselves. It is the ministry that sets the limits on specialty training for doctors, and some sources also mention the phenomenon of an oligopoly among senior staff. “There is a suspicion that the difficulty in gaining access to specialization is due to a lobby that is deliberately blocking the entry of new specialists into the market,” said Joanna Wicha, a left-wing member of parliament.

Poland is also facing a wave of hospital and ward closures across the country, but especially in rural areas. This process is driven by the facilities’ massive debts and the declining number of patients and personnel in certain regions.

Needless to say, there is nothing market-based about a system with a single compulsory payer. Sadly, however, the term “market” is used in public debate to describe the current situation. Hospital managers describe the contracts they sign with doctors as “market terms agreement.”

This context fuels resentment and frustration among Poles. Paradoxically, the people who contribute the largest share of their income to the healthcare system—employees who cannot optimize the amount of their contributions—face the greatest difficulties in accessing it.

This frustration is an opportunity for populist ideas to grow. The Ministry of Health has presented a draft bill that sets the maximum monthly salary for doctors at around $20,000, equal to 16 times the national minimum wage or, for B2B contracts, $64 per hour (1/20 of minimum wage), and imposes a limit of no more than two full-time jobs per doctor, as well as maximum hourly rates and the ability to monitor working hours for B2B contracts. Yet the bill still allows doctors to bill for so-called on-call standby or management consulting and opens the door for higher wages for doctors with special skills

Yet the limits set forth in the bill will not apply to the private sector, which raises concerns that the best doctors may move entirely to private clinics.

Poland’s constitution invokes the principle of subsidiarity in its preamble: the idea, promoted among others by John Paul II, that problems should be solved at the lowest level capable of solving them. It’s hard to see what in that principle justifies a centralized, compulsory state monopoly on medical care.

In such a context, many Poles do not want privatization. In a 2025 survey, 47% opposed it, against 28% in favor and a quarter undecided. They fear social inequality and unaffordable insurance, and 3 in 10 fear that private providers would neglect less profitable services. But the hybrid system they are defending already produces precisely these outcomes. It’s the public system that closes maternity wards in small towns because they do not pay. It’s the public system in which politically connected patients waited in a separate room while others queued.

And it’s the public system in which no one bears direct consequences. A private manager cannot let a facility accumulate debt indefinitely; shareholders would not permit it, if only because they cannot count on being bailed out. Public hospitals can, however, because the debt will eventually be written off with public money. The losses are not avoided—they are deferred, and then paid by those least able to bear them: a weak middle class and the groups with no access to anything else.

Market systems are routinely charged with greed. Yet nothing in the Polish case suggests that a public monopoly is immune to it. A surgeon billing 72 hours in a single day, doctors charging $6,900 an hour, a resident invoicing 331 hours a month—none of this happened in a private clinic competing for patients. In a market-based system, the patient is treated as a customer: an equal party to the contract who has the right to demand quality in exchange for the money he pays, not the object of care dispensed at someone else’s grace. Transparent financial flows and voluntary participation arguably come closer to the ideals of social justice, subsidiarity, and human dignity than one in which participation in a politically vulnerable monopoly fund is compulsory, while executives of private corporations openly lobby for higher mandatory contributions, and ordinary citizens, who have been paying mandatory contributions for years, are left waiting for months for necessary treatment or specialist consultations.

In Poland, and in much of Europe, patients pay for care several times over: in health contributions, in national and local taxes, and often again in private insurance or straight from their pockets. What they get in return is an unsustainable system offering politicized care, long waits, treatment rationed by contract limits, and the closure of hospitals and wards. Americans who long for a single-payer system in a country of 342 million should take note.