The National Health Service

 Over the years, evidence of systemic health service failings has been followed by panicked government pledges of reform. There have been targets, productivity league tables, efficiency savings (aka cuts), reorganisations, decentralisation, recentralisation and more targets. Vast amounts of extra money have been pumped into the system, rising from 3 per cent of GDP in 1960 to 9.3 per cent in 2022...

The glaringly obvious fact [is] that the NHS simply isn't fit for purpose. Yet this is not permitted to be part of the national debate because the NHS is the most sacred of cows.

That's because its foundational ethic is to be a universal service free at the point of use. The system that is presented as the only alternative is private healthcare as practised in the US, which discriminates against the poor and produces at best only middling health outcomes. The limitations of this debate are baffling because there's a third way that's never considered: European social insurance systems.

Patients Waiting to See the Doctor, with Figures Representing  Their Fears
Rosemary Carson (b.1962)
Photo Credit: Wellcome Collection [CC BY]

Their fundamental characteristic is that people pay compulsory contributions to healthcare providers, with additional contributions by employers and employees. Unlike private insurers, social insurers must accept everyone regardless of age or health status, and contributions are pooled to cover all. So this system meets the principal concern that everyone should be treated free at the point of use.

The details vary from country to country. In France, one large insurer covers virtually the whole population. In the Netherlands and Germany, people choose between a number of insurance systems...

The downside of social health insurance schemes is their high transaction and management costs. Typically, however, they engender higher public satisfaction than either state-run or private systems...

Above all, the system is accountable to the public. Health staff aren't looking upwards to a chain of command subject to the interfering incompetence of politicians...

Moving to a social insurance system would be a daunting and massive change that would take time. But the excuses for dismissing this as not even worthy of consideration have now worn demonstrably thin and are unsustainable.

(Melanie Phillips, The Times, 2024)

A really interesting article which raises some very important and salient points about the national health system. If only there could be cross party co-operation on health and education then things might be a little different.