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difficulty in seeing a doctor is one of the three new obstacles. whenever there is a call for universal free medical care, it will inevitably cause heated debate. the focus must be: everyone knows that universal free medical care is good, but who will pay for it?

some people will say that the state pays and has plenty of money. this is as good as saying nothing. the state's money comes from the people. the state can only redistribute it, but it cannot create money. if the state wants to pay more, it can only collect more money first. no one likes to pay more taxes, and many people and companies really can't afford to pay more taxes.

whether it is free or not, whether you pay for it or not, you need to first look at the bill and then look at your wallet.

according to the statistical communiqué on the development of my country's health care industry in 2022 released on october 12, 2023,

the total national health expenditure in 2022 is preliminarily estimated to be 8.48 trillion yuan, of which government health expenditure is 2.39 trillion yuan, accounting for 28.2%; social health expenditure is 3.80 trillion yuan, accounting for 44.8%; and personal health expenditure is 2.29 trillion yuan, accounting for 27.0%. the per capita total health expenditure is 6,010.0 yuan, and the proportion of total health expenditure to gdp is 7.0%.

social health expenditures should mainly refer to medical insurance expenditures, but also include commercial health insurance expenditures, social medical expenditures, social donations and assistance, administrative and institutional fee income, etc.

personal expenses, of course, come directly out of the patient's pocket.

according to the 2023 medical insurance development statistical bulletin,

by the end of 2023, the number of participants in basic medical insurance will reach 1,333,869,000, with coverage remaining above 95% and quality of participation continuing to improve. the number of participants in employee basic medical insurance will reach 370,938,800, and the number of participants in urban and rural residents' basic medical insurance will reach 962,930,200.

in other words, it can be said that basically all people are covered.

in 2023, the total income and total expenditure of the basic medical insurance fund (including maternity insurance) will be 3,335.516 billion yuan and 2,814.033 billion yuan respectively.

the income of the basic medical insurance fund for employees (including maternity insurance) was 2288.057 billion yuan, of which the income of the pooling fund was 1663.607 billion yuan. the fund expenditure was 1771.780 billion yuan, of which the pooling fund expenditure was 1162.058 billion yuan. the accumulated balance of the pooling fund for basic medical insurance for employees (including maternity insurance) at the end of the year was 2640.589 billion yuan.

the basic medical insurance fund for urban and rural residents had income of 1,047.459 billion yuan and expenditure of 1,042.253 billion yuan.

at present, the income of medical insurance is actually greater than its expenditure. this is a good thing. for the sake of simplicity, let's assume that the income and expenditure of medical insurance are balanced. and assuming that the national health expenditure in 2023 is the same as that in 2022, the government will still contribute 28.2%, and the personal contribution (direct plus indirect through medical insurance) will be 71.8%, about 6 trillion yuan.

in other words, universal free medical care would require an increase of 6 trillion yuan in government spending each year.

in addition, china's defense budget in 2022 is about 1.5 trillion yuan, and public education spending is about 4 trillion yuan:

in 2022, the total investment in education nationwide was 6,132.914 billion yuan, exceeding 6 trillion yuan for the first time, an increase of 5.97% over the previous year. the national fiscal education expenditure was 4,847.291 billion yuan, an increase of 5.75% over the previous year, accounting for 4.01% of gdp, achieving "generally not less than 4%". the national general public budget education expenditure was 3,925.696 billion yuan, an increase of 4.79% over the previous year, accounting for 15.07% of the general public budget expenditure.

in other words, to make up for the expenses of universal free medical care, it is necessary to cut all defense spending and all public education spending on the basis of existing public health spending, and transfer the money to health, not to mention the remaining gap of 500 billion yuan.

some people will say that if officials don't get corrupt, they will have all the money. first, corrupt officials are not recognized by the state, and they will be arrested if they are found corrupt. corrupt officials who are not afraid of being arrested will still be corrupt until they are arrested. from the perspective of the accounts, this does not solve the problem. secondly, no matter how much corrupt officials have embezzled, i believe that it is still not enough to cover the total amount of national defense expenditure and public education expenditure. it is far from enough.

the national medical expenditure is already so high, are the people satisfied? they should be dissatisfied, especially since the resources of the top three hospitals are still scarce. this is an unsolvable problem of limited resources and unlimited demand. your body is your own. if everyone goes to the best hospital, it will be like only going to tsinghua and peking university for the college entrance examination, which will inevitably cause anxiety. there used to be barefoot doctors everywhere, but now there are none. now that people go straight to the top three hospitals for major illnesses or minor disasters, there is indeed no room for barefoot doctors.

from the perspective of saving, closing hospitals and cutting services can save money, but it is not feasible; reducing doctors' income can also save money, but it is also not feasible; reducing the profits of pharmaceutical companies, i believe that the profits of most pharmaceutical companies are still within a reasonable range, not to mention that drug reform is already underway. china's medical system needs reform. excessive medical treatment and insurance fraud must be stopped. perhaps it needs to be like western commercial medical insurance, which can only be reimbursed by insurance companies/institutions for review, rather than being controlled by pharmacies and insurance companies paying according to the bill; tiered diagnosis and treatment should be promoted; hospitals must operate as non-profit organizations, with the goal of balancing income and expenditure, and cannot become a profitable industry; many things need to be done to improve china's existing medical system, but it will not save 6 trillion yuan.

the fiscal budget cannot squeeze out the extra 6 trillion.

universal free medical care seems to be a distant dream. the reason is that we don’t have the money.

yes, there are countries in the world that implement universal free medical care, and canada is one of them. however, i believe that people have seen a lot of complaints about canadian medical care, so i will not repeat them. i must say that canadian doctors are not happy with this, and i have inside information on this. this is when medical expenses account for 40% of alberta's provincial expenses. alberta is a wealthy province in canada, and many other provinces are not as rich as alberta. medical expenses account for a higher proportion, but the service is not necessarily better. by the way, canada is a federal system, and medical care is managed by the provinces, and the federal government only "guides".

cuba also implements universal free medical care, and the quality is pretty good. to be honest, how cuba did it is a mystery. can anyone with the knowledge tell me?

as for other countries, please list how fast, effective and economical universal free medical care they have.

canada has considered mixed public-private healthcare, but it cannot solve the problem of excellent doctors moving to private hospitals. this is just like when public schools and cram schools coexist, school teachers have no time to teach properly, and their minds are all on cram schools. it's the same principle.

universal free medical care is a beautiful ideal and a goal to strive for, but talking about it now is empty talk.