It seems as though a debate is slowly beginning to brew in Britain. Healthcare used to be completely untouchable, but each year as the rolling news becomes increasingly dominated with crises in the NHS, people are starting to accept the need for change.
Each year, the same problems arise, no matter if the government is red or blue, and it is because our health system has systematic failures. The problems lie deep in the foundations of the NHS, indeed the entire institution was set up on three flawed premises. First, that as we grew healthier demand would fall. Second, that the demographics of this country would stay relatively unchanged. Third, that it could be publicly funded through the then “stamp”.
These might have seemed reasonable assumptions at the time, but they have been proved wrong time and time again, because however much is spent on the NHS it is simply never enough. Indeed, the UK ranks 19th out of 23 for mortality amenable to healthcare, and 20th out of 24 developed countries for cancer survival.
As a report by the Institute of Economic Affairs shows, if the UK’s breast, prostate, lung and bowel cancer patients were treated in Belgium or Germany instead of by the NHS, more than 14,000 lives would be saved each year. If the UK’s stroke patients were treated in Germany, Israel or Switzerland instead of by the NHS, more than 4,300 lives would be saved each year.
Supporters of the NHS cite a Commonwealth Foundation study which ranks the UK the best of all the healthcare systems it looks at. Yet, looking at the data behind it, under the “health outcome” section – surely the only one that matters for a system that is supposed to help you when you’re ill – the UK is ranked in 10th place out of 11. A report in The Guardian best summed it up: “The only serious black mark against the NHS was its poor record on keeping people alive”.
It is high time in this country that we accepted that radical reform is necessary. It is simply not true that the NHS is the “envy of the world”. No other country in the world has ever chosen to replicate our healthcare system – and looking at the statistics above that is not at all surprising. Who in their right minds would want to replicate a model that not only can’t deal with a flu outbreak but also completely crumbles as soon as winter arrives?
Britain should be bold and progressive by creating a social health insurance system as exists in countries such as Switzerland, the Netherlands, Germany and Israel. Under this system, individuals pay regular contributions –as they currently do for the NHS through taxation – to an insurer, they are then free to seek treatment from a medical provider of their choice and their insurance company subsequently reimburses the provider for the expenses incurred.
Indeed, with a social health insurance system, you don’t need the state to own or subsidise hospitals, or to control policy from the centre; you simply need it to regulate the system to a satisfactory degree.
What distinguishes social insurance from conventional insurance is that under the former, insurers cannot vary premiums in accordance with individual health risks, they cannot reject applicants based on their medical history, they cannot cherry-pick the healthiest in society, and they cannot rule out coverage for pre-existing conditions.
So, this system offers the best of both worlds by combining the key principle of the NHS that most British people admire – that healthcare should be available to all regardless of one’s ability to pay – but also including crucial market mechanisms which drive up standards: competition, individual choice and the freedom to innovate.
Making this distinction between the social health insurance model and the system that exists in the US is key. It will likely come as an unfortunate surprise to the Labour Party that there are alternatives to the socialist foundations of the NHS and the dysfunctional American model.
And like on so many other issues, the left is determined to protect the past at the expense of the future, but those who argue against change should come out and tell us just how many preventable deaths they are willing to tolerate in order to satisfy their ideological obsession with the state owning and operating everything.
Small-c conservatives – largely from the Labour Party – forget that the architects of the NHS were visionary radicals and if they had not sought to abandon the status quo the institution would never have existed. But they should not be so naive as to think that it was built to last forever, indeed we must accept that sometimes even our most cherished institutions have an expiration date.
So instead of clinging onto a failing system from the 1940s, let’s channel the bold instincts of our predecessors and design a system based on that noblest principle of universal healthcare, but one that also incorporates the social insurance features used throughout Europe. Because we can have a world-class healthcare system or we can have the NHS, but we cannot have both.