The hidden cost of “free” services.
Walk into a government clinic in Lagos on a Monday morning, and you’ll see the real price of “free” healthcare. Even early in the day, the benches are already full. Mothers clutch sick children, elderly men sit on the floor, and everyone waits, sometimes for hours, just to be seen. When a nurse finally calls a name, there’s often a quiet expectation for a “token,” a polite word for a bribe, to move the process along. And if you do make it to the doctor? The medicine is often out of stock. You leave with a prescription in hand and another bill to pay at a private pharmacy.
This isn’t a glitch in the system. It is the system. For millions around the world, “free” state services come with a hidden surcharge that doesn’t appear on a receipt. The poor end up paying not just in cash, but in time, in dignity, and in opportunities lost.
For people living on the margins, time is money in the most literal sense. A woman who sells oranges on the roadside might earn $5 on a good day, but if she spends that day waiting at a public hospital, she loses not just her income but her customers. A teenager who queues for hours at a broken municipal tap before school sacrifices more than her morning; she loses the chance to study, to learn, to dream beyond that line. These are invisible costs, what economists call “opportunity costs”—but for the poor, they are crushingly real.
There’s also a humiliation tax. In many public clinics and schools, the poor are treated not as clients but as inconveniences. Patients are scolded for “bothering” nurses. Parents are told that there are no seats for their children unless they slip some cash to the right official. The wealthy are insulated from this. They pay for private schools and private clinics, skipping both the lines and the indignities.
And here’s the bitter irony: the “free” service is often barely worth what it costs. Public schools in Mumbai are notorious for missing teachers, broken toilets, and overcrowded classrooms where 70 children share a single chalkboard. In many clinics, the doctor shows up only a few days a week, if at all. The pharmacy is not stocked. A “free” education doesn’t mean much if a child leaves unable to read. A “free” hospital visit is pointless if you leave without any medicine.
This is why, across the developing world, the poorest households are making what looks like an odd choice: they’re paying for private services they technically could get for free. In Kenya, low-cost private schools charge just a few dollars a month, and parents, many of them living below the poverty line, find a way to pay. In Nigeria, families scrape together cash for small private clinics because they would rather hand over a modest fee and be seen within an hour than spend an entire day waiting for a government doctor who might never arrive.
These aren’t luxuries; they’re acts of survival. When a mother spends $5 for her child to attend a private school, she isn’t rejecting a free option. She’s rejecting the hidden costs of that free option: wasted time, endless frustration, and a future sacrificed.
The wealthy don’t face these trade-offs because they can opt out entirely. When state schools fail, they hire tutors. When public hospitals crumble, they go private. Only the poor are trapped in the monopoly of “free” provision. And monopolies, by nature, breed complacency. When the state is the only provider, there’s little incentive to improve. What choice do people have? They can complain, but they still have to line up.
That’s the quiet injustice of “free” services. They promise fairness but deliver entrapment, locking the most vulnerable into systems nobody else would tolerate. If we care about equity, the answer isn’t to pour more money into those systems—it’s to give people real choices. That might mean vouchers that follow students rather than schools. It might mean subsidies that allow families to choose between public and private clinics. It might mean supporting the entrepreneurs who run low-cost schools and hospitals in underserved neighborhoods.
What it shouldn’t mean is forcing people to endure empty classrooms, endless lines, and quiet humiliation simply because “it’s free.”
The phrase “free public service” is seductive. It suggests generosity, fairness, and shared goods. But for the poor, “free” often means something entirely different: hours lost, dignity stripped, and opportunities shut off. Ask any parent in a Nairobi slum or a Lagos shantytown, and they’ll tell you—they don’t want more free things. They want things that work. They want the freedom to choose. They want the dignity of being treated like a customer, not a burden.
Until we face that uncomfortable truth, the poorest will keep paying the highest price for “free.”
