Kevin Williamson of National Review Online ponders “free” health care.

Middle- to upper-middle-income Britons do pay higher national income taxes than do their American counterparts, but when state and local taxes are taken into consideration, the math looks different, with middle-income households in New York State, for example, liable in at least some cases to pay higher income taxes than they would in the United Kingdom. (By way of comparison, taxpayers in Denmark typically pay nearly twice the income tax they would in the United States.) Overall, British income taxes are slightly but not radically higher than American taxes.

So, comparable income-tax rates and all that sweet free health care — it looks like the British are getting a great deal, no? But, of course, it is more complicated than that.

The Brits take a great deal of national pride in the NHS, but, for many in the United Kingdom, that pride is not enough to get them to actually rely on the NHS for health care: One in five Britons choose private care funded out-of-pocket rather than the NHS care funded by the taxes they already are paying, according to the BBC, citing delays, lack of available services, and the indignity of having to “fight for treatment” with the NHS bureaucracy. One in four NHS patients say that working with the state-run system has harmed their mental health.

Meanwhile, residential and at-home care for the elderly, a growing concern in aging nations such as the United Kingdom, can be outrageously expensive. Britons with modest assets (say, $35,000 in home equity) might expect to pay around $90,000 a year for retirement care. In some cases, those expenses can run into six figures.

It isn’t just care for the elderly. Mental-health care in the United Kingdom is poor (though not as poor as it is in the United States) and getting poorer as the number of available treatment spots are cut.

That’s typical of the socialist model of providing scarce goods and services: The things that are free you can’t get, and the things you can get aren’t free.