The Guardian today had an article by Andrew Lansley, the current Health Secretary, arguing that the NHS will collapse without reforms. Let’s imagine that he’s correct. The problem I have then is what this implies. We spend 8.4% of GDP on healthcare. In the US it is closer to 19%, while in Germany, France, Switzerland, and many other European countries it is around 11%. We aim to provide universal coverage, free at the point of use, for the entire population. We also try to do so by spending at least 20% less than many other comparable countries. It is therefore quite possible that it is no longer possible for the NHS to continue providing this, given their level of funding.
If Andrew Lansley is indeed correct, what is the solution? He is claiming (as is David Cameron, Nick Clegg and Shirley Williams) that they can continue to provide universal coverage, free at the point of use, as long as the NHS is reformed in the manner proposed. Given the huge opposition and the involvement of the private sector (who will quite rightly need to make a profit) this seems highly unlikely. What seems much more likely is that the publicly funded NHS will provide a basic level of healthcare to everyone, but to get world-class healthcare some form of privately funded insurance-type scheme will be introduced. Overall our healthcare spending will rise to an amount similar to that spent in other European countries with 80% (covering basic healthcare) provided through public spending and the other 20% coming from private contributions. This 20%, however, would amount to about £20 billion, or about £300 per person per year. Given that more than half of all households have annual incomes of £25000 or less, this is probably an amount that many families couldn’t afford. This will almost certainly mean that a large fraction of the population will have to make do with basic healthcare, while the wealthiest top up the system to maintain a good standard of healthcare for themselves.
Basically, Andrew Lansley either thinks that he is so clever that he can reform the NHS (with much opposition) in such a way as to provide world-class healthcare for the entire population (free at the point of use) for 20% (or more) less than most similar countries, or he knows what is going to happen and is quite happy to reform the system so that the wealthy maintain their healthcare while a large fraction of the population have a reduced level of healthcare, or he’s an idiot. The latter two would be my guess.