Point missed: This is not about $5 being returned as $4 -- you are separating the real value of government services from cash transfer payments. That $4 may include $1 of cash payments (eg you are retired), $1 to national defence and police, $1 to the local hospital, $1 to cleaner air.
Absolute user-pays health results in users making choices about their health based on their economic situation. Some people, who should go to the doctor choose to save their money. This violates basic liberal principles because such action is interfers with the rights of others to have a healthy environment. The fundamental objective of the state is the defence of its citizens.
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