How to abolish the NHS

The National Health Service enjoys strong support among the public, making it almost impossible to introduce radical reforms, even if the performance of the NHS is relatively poor compared with systems in other developed countries. Over the last thirty years reform efforts have therefore focused on greater private sector involvement within the NHS system and the deployment of some internal market-style mechanisms in an attempt to improve efficiency. In a recent initiative, for example, a private company has been contracted to manage a ‘failing’ NHS hospital.

The problem with such ‘part-privatisations’ is that they typically involve complex contractual arrangements and the creation of numerous ‘interfaces’ between government bureaucrats and the private sector, which may result in increased transaction costs and a reduction in overall efficiency. At the same time, private firms working within the NHS framework remain constrained by a strict regulatory framework on top of rigid contractual commitments. There is therefore little scope for the entrepreneurial discovery and innovation that brings such enormous gains within genuinely free market arrangements.

Moreover, since politicians and officials retain control over funding, the system remains unresponsive to consumer preferences and subject to capture by special interests, particularly producer interests such as the medical and nursing professions and the pharmaceutical industry. Mixed public-private systems therefore risk introducing additional transaction costs while suffocating the potential gains from private sector entrepreneurship. If this results in disappointing outcomes, as is likely, the whole concept of privatisation may be brought into disrepute.

There is therefore a strong case for taking a different approach. Rather than focusing on the gradual introduction of  ‘market reforms’ and public-private partnerships within the NHS system, an alternative strategy would seek to bypass the NHS by liberating the private healthcare sector such that the NHS became less and less relevant as more and more people opted out of state provision to avoid long waiting lists and substandard care. This option has the potential to create a virtuous circle – by reducing burdens on the NHS, taxes could be cut, wealth created, and more people would be able to afford private healthcare, reducing the NHS burden still further and gradually undermining its political base.

But radical regulatory reform is necessary if a dynamic private health sector offering low-cost, high quality and innovative treatment is to emerge. A selection of regulatory changes is suggested below:

  • Perhaps most importantly, the compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality. Ending current restrictive practices is essential to enable private firms to increase productivity in the sector.
  • Restrictions on the types of treatment available ‘over the counter’ should be lifted to enable patients to obtain medication without recourse to registered doctors and regulated pharmacies.
  • Burdensome drug licensing regulations should be rescinded. Instead, the testing of new drugs should be left to private firms and free markets. Reputable companies would have strong economic incentives to ensure the safety of their products, while there would also be far more freedom for experimentation and innovation by new market entrants, with huge potential benefits for patients.
  • Prohibited recreational drugs, such as cannabis and opiates, should be legalised to allow the sick to benefit from their numerous medical applications.
  • Some form of tax rebate could be introduced for patients choosing to opt out of NHS treatment (see, for example, this study from the Adam Smith Institute).
  • Private firms should be free to bring in low-cost medical professionals from abroad and at liberty to determine rates of pay and working conditions through private contract.
  • Legal reforms could enable patients to waive their right to clinical negligence claims.
  • Planning controls and building regulations should be liberalised to enable the rapid development of new private healthcare facilities.

Finally, it should be noted that internet technology has mitigated many of the information asymmetry problems that have previously been cited as a rationale for heavy state regulation of health. A combination of new technology and a dynamic, entrepreneurial private health sector could make the NHS increasingly irrelevant.

The NHS is the most efficient health care service in the world. Several studies have confirmed this. That's why "The National Health Service enjoys strong support among the public" so keep your grubby free market vulture claws out of it. The world is changing and many people are determined to make your type of thinking extinct.
"The NHS is the most efficient health care service in the world." -By what metric, Anonymous? "Several studies have confirmed this." -Which one?
@Anonymous "The NHS is the most efficient health care service in the world". That is an insult to all who have suffered/died at the hands this state-owned, self-interested, bureaucratic monolith. The well off can afford to go private or fly abroad (as more and more are now doing) to get decent health-care whilst the poor are left with this "service". The sooner the market sorts it out the better.

@Anonymous - the problem with international comparisons is that healthcare systems in other countries are afflicted by unwarranted government intervention, regulatory capture by special interests and so on, even when provision is nominally private.

But the original author was making a (superficial) international comparison to support his disdain for the public's view of the NHS, no? "the NHS is relatively poor compared with systems in other developed countries." If we privatised, how do you suppose we would escape the fate of every other country that uses this system and destroy the government intervention and special interests? I think most sensible members of the public who know their history would be united in the view that there is, and can never, such a thing as true free market capitalism of the kind advocated by its Right-Libertarian fanatics. It's a fantasy. The governments and special interests we have now are a creation of capitalism - they grew out of it and are an inescapable part of it. Classic liberals like the much-misquoted Adam Smith believed that healthcare would be best provided by the government, so it is very ironic that the Adam Smith institute is publishing material like the stuff you post above. Perhaps they should change their name?
Here are some studies. These are the first sources that I found, they may not be the best as there are many of them. Lives saved-per-pound spent: http://www.hospitaldr.co.uk/blogs/our-news/nhs-is-one-of-the-most-cost-e... Lives saved per million of the population, http://www.politics.co.uk/news/2011/08/08/surprise-report-nhs-most-effic... And others http://www.bbc.co.uk/news/10375877 I and my family have always received good care from the NHS, and I treasure it. We spend much less on it as a proportion of GDP than other European countries - the outcomes could be even better if we spent as much as Germany or France.
I tried to post my sources but I don't know if links are allowed as my comment hasn't appeared The first report measured lives saved per pound spent. It was publishes as a JRSM Short Report in August last year: "The NHS saves more lives for each pound spent as a proportion of national wealth than any other country apart from Ireland and is one of the most cost-effective health systems in the world, a study finds [....] Using the latest data from the World Health Organisation, the paper shows that while Labour’s investment in the NHS saw health spending rise to a record 9.3% of GDP, this was still less than Germany with 10.7% or the US with 15%. Not only was the UK cheaper, says the paper, it saved more lives. The NHS reduced the number of adult deaths a million of the population by 3,951 a year - far better than the nearest comparable European countries. " Another was a commonwealth fund report in June last year which looked at quality, efficiency, access to care, equity and healthy lives. The Netherlands came first and the UK second overall. The UK was top for efficiency: "When it came to efficiency, the UK and Australia ranked first and second, respectively."
Studies were a JRSM Short Report published in August last year that found the UK saved more lives per pound than any other health service worldwide, and saved more lives per million of the population. The other was a Commonwealth Report in June last year that rated the UK top for efficiency and 2nd overall (first was Netherlands).
Apologies for multiple posts. I assumed I was breaking some kind of rule by linking or quoting long passages.

@Anonymous - Thank you for posting links to articles describing various studies on the efficiency of the NHS. Judging by the articles, I don't think these studies are particularly useful. Numerous factors affect mortality rates, for example. Demographic factors partly explain relatively poor stats in the US. More importantly, these comparisons are tangential to the main arguments of this blog article. The article is, after all, sceptical about systems that attempt to introduce private-sector provision within a straight-jacket of heavy state regulation, and indeed explains that such systems are likely to be marked by inefficiencies resulting from transaction costs etc...

Well you wouldn't think they were particularly useful, would you - they're certainly not useful to you. Personally I don't think demographic factors figure largely in the worse mortality rates of European countries. On the contrary. And it is the attitude shown in this article that is fueling many of the abysmal "reforms" being proposed today. You are right of course that this article is actually proposing an alternative method to destroy the NHS from without rather than from within, dressed up in the pretty language of consumer choice. But I don't believe that the NHS would become less and less relevant unless the government continues to drive it into the ground and reverse the improvements that had been made before they came into power. Private health insurance is prohibitively expensive (even in the US) and is inadequate if you have pre-existing health conditions - it is no real alternative. And even if it were to be widely taken up, ultimately this article is in favour of taking health care away from the poorest in society, once the reforms it has proposed have "undermined" the NHS' political base. And that is disgusting. It advocates taking away people's freedom to live without fear - the fear of bankruptcy if they get ill, the fear of losing everything if their insurance won't pay out.
(besides, I was really taking issue with this "The National Health Service enjoys strong support among the public, making it almost impossible to introduce radical reforms, even if the performance of the NHS is relatively poor compared with systems in other developed countries. " so my comment wasn't entirely tangential. I think it is fair to comment on anything I feel is misleading)
@anonymous - this debate is not as black and white as you assume. Of course, there are difficulties within any system due to vested interests taking over and so on. As the author of the ASI paper, I tried to find a way through that would provide individuals with more choice and open the NHS up to competition at the consumer end (I do think it is dangerous to do what the government has done and just open up at the supply end). One tries to develop systems to reduce the power of vested interests and some systems work better than others in that respect. I felt that my suggestion in the ASI paper did that reasonably well as do Richard's suggestions above more directly. I would be interested in a quote from Adam Smith about health care because, given the state of health care at the time, I am not sure that it would be much more valid than an Adam Smith quote about making motor cars. You call us right-wing fanatics but there is really only one other system in the developed world that has followed our pattern in the UK. We have not got the system that Beveridge would have wanted and it was at the extreme end of all the models considered in 1947. And the Dutch system you praise is probably one of the more liberal ones. We all have personal experiences and our famly's recent ones have been dreadful. I won't go into detail on a public forum but it really involved lack of attention to the personal needs of the patient with some serious consequences. One hears this over and over again (and, indeed, there are two or three other incidents with other members of the family, one of which ended up with my late father spending six weeks in a stroke rehab. unit blocking an acute bed - costing a few thousand quid a week - because he lost his place in a queue for 20 minutes of urologist consultant time whilst being transferred between the two places. As it happened, he was not bothered, but it just shows where you get when you run a system without prices! The last experience was the latest in a long line of family experiences. Measured by pure efficiency, the NHS might do quite well (depending on how you define "output"): but in the same way that a Lada production line might have been "efficient" with no regard for product quality. I think we can do better and nearly every country in the world believes it can do better by a different path too.
Let me make a further point. The absence of pre-funding in all systems (and it is possible - in theory - to have a pre-funded nationalised system) will exacerbate the demographic problems because 50% of all health spending is in the 18 months before death.
I would imagine that no other country followed our example because of the vested interests of capitalists and the political classes. It is remarkable that it was allowed to happen here and took extraordinary historical circumstances. That does not mean that it is inferior, and not worth copying. I am sorry to hear of your family's experience and it is obvious that our service is not perfect, but i think there can be many different interpretations of this that don't boil down to "a lack of prices." For one, successive governments have constantly meddled with management, and wasted money on things like aborted IT projects. We also spend less as a country on our healthcare than places like Germany or France. Finally, I think the comparison to the Lada production line is inappropriate. The measure of efficiency is that of lives saved - a product which is the same whoever produces it, and is surely of the highest value.
well we could probably argue back and forth for weeks without making any impression on each other. But, in general, anything that is provided without any involvement of the price mechanism is going to run into trouble. I am surprised that the UK does well on a lives saved measure of efficiency because it does badly, I believe, on a premature deaths measure. But, let's suppose you are right. If you are right, I think that probably bears out the Lada analogy. What about the comfort, care and value of time for those who remain alive? Perhaps that is what other countries get from spending more. The government is bound to interfere in a system that is entirely government funded and run - that is the point of the system (it responds to votes, not pounds). Such large mistakes are in the nature of a government-run system (which is not to say that there are not problems with privately run insurance-based systems such as over-provision). I am not trying to persuade you - as I say, neither of us will persuade the other. But, there are inherent problems with systems run without prices and without choice. Also, it is very often not capitalists who are at the heart of mixed systems - indeed, it was not in the UK (GPs excepted who are obviously large in number and were self employed at the foundation of the NHS: indeed, they still are), it was local authorities, charities and mutual organisations.
You are probably right with your first point! Thank you for your polite reply though, despite my irritable posts; it is helpful for me to try to understand a point of view that is different from mine. I find I lean more and more towards left-libertarianism, so don't find the nature of the relationship between government and health provision ideal, but I do wish to see its structure preserved if the alternative is privatisation.
our monograph on prohibitions might interest you (you can download it from the publications part of the website)
Anonymous - the only truly comprehensive and international comparison of medical systems that I know of is that carried out by the OECD. You can read its summary conclusions about various countries here: www.oecd.org/document/39/0,3746,en_2649_33733_46491431_1_1_1_1,00.html Click on the union Jack to read its summary of the UK, but to save you time I'll quote the relevant bits here: "Efficiency and quality: Below average DEA score" "About average spending per capita" "The quantity and quality of health care services remain lower than the OECD average while compensation levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems" "High relative income level of health professionals" The OECD also produces a separate graph showing how much could be saved, given the current level of services, if various countries were as efficient as the best. The NHS shows one of the biggest potential savings. The Euro Health Consumer Index (which, as the name suggests, compares European countries) also rates the NHS poorly and says that Bismarck-type systems (social insurance) are generally superior to Bereidge-type (government-run) systems.
Thank you for suggesting the OECD report, which I would probably have avoided given that it is perceived by many as having a distinct neoliberal agenda. However, there was no need to save me the time - I was prepared to do more research on it. And while there are some disappointing results for the UK, the overall impression of the NHS really does seem to depend on how you spin it. The Guardian of course picked out different statistics (as well as mentioned the more disappointing ones) - they also included this quote from Mark Pearson, head of health at the OECD :"The UK is one of the best performers in the world. But outcomes are not what you expect because there is a big reform every five years. We calculate that each reform costs two years of improvements in quality. No country reforms its health service as frequently as the UK". And as a proportion of GDP, the report found our health spending to be absolutely average (our spending per capita would then of course be higher we have higher GDP than many of the countries we are compared to).
Your suggested improvement of abolishing the compulsory licensing of medical professionals strikes me as such an obvious non-starter that it would be worth deleting it simply in order to gain more credibility for the others. Most people have a horror story of dealing with an unqualified plumber/electrician/builder etc. - and this proposal would inevitably be described (caricatured?) as allowing anyone to write prescriptions, carry out operations etc.

@Anonymous - The removal of compulsory licensing is one of the most important reforms needed to break the stranglehold of producer interests. It does not mean that professional associations would cease to exist. Rather, consumers would be free to choose whether to use a 'registered' professional or not. Indeed there could be competing professional associations with different standards. The brand names and reputations of private healthcare providers would also provide incentives for high quality care, along with various feedback mechanisms. It is not clear that expensively-trained doctors are needed for every diagnosis or to perform simple medical procedures...

Anonymous - I think that you're more likely to have avoided the OECD report because contradicts your assertions about NHS efficiency. The OECD is an inter-governmental body , not some 'neoliberal' campaigning organisation. Nobody else performs more rigorous international comparisons. If Mark Pearson really said what you claim, then it rather argues against a government-run NHS, since governments change and therefore different politicians and going to want to make the changes they prefer. That's an argument against a government-run medical service. In any case, just about all western countries are amongst the best performers in the world when it comes to medical services - that's because they're some of the richest countries in the world. Even if they're only spending the OECD average (as a percentage of GDP), this is way above average in cash terms. The Euro Health Consumer Index also rates the NHS poorly within Europe, incidentally.
I actually hadn't read the OECD report at all, so it was nothing to do with the content. I merely meant that I have read some rather dubious things about them, so view them with suspicion. But the report does indeed seem rigorous enough. Mark Pearson did indeed say what I "claim" - the article is actually the first search result on Google if you search for OECD NHS: http://www.guardian.co.uk/politics/2011/nov/23/health-bill-nhs-oecd-report. I don't believe that it does argue against a government -run NHS, however. The constant meddling is not necessarily a feature of government-run services, but the dire state of democracy and politics in this country since Thatcher. I can only hope that the current crisis of capitalism will eventually change public opinion and force a change (not much evidence of this yet in the UK but there are stirrings in the US where the economic situation is - at the moment - worse. Unfortunately we have highly effective propaganda to overcome). I would like the infrastructure of the NHS to be in public hands when this change happens. Of course, I would like to see more democracy in general and de-centralised power.
"That's an argument against a government-run medical service" ....that's an incredibly creative interpretation, ha ha!
It's a very reasonable interpretation to all but the irredeemably naive. If you don't want politicians to control your medical service, then don't advocate one run by - and answerable only to - government. Make it answerable only to users and make the funding follow user preference. That way, providers will only re-organise when there is need to be more efficient or provide a better service.
"The OECD is an inter-governmental body" - and unfortunately most governments are rather neo-liberal at the moment
That's a creative interpretation to coin a phrase. Most governments more or less completely control the health and education sectors (notwithstanding this debate), spend between 40% and 50% of national income and regulate the economy in more detailed ways than ever before.
Anonymous - The idea that most governments are 'neo-liberal' is your fantasy. How come public spending is so high if this is the case?
I would say that it's a very questionable interpretation to all but the irredeemably fanatical. I did not say what you suggested above - I would like the medical service to be run by public representatives, and I am free to question the nature of that representation. I do not think private profit should have any place in the running of health care, and find that idea much more problematic than the changeability of political control. I'd be interested how you would differentiate the system you propose from the disastrous American one. Regardless, privatisation of other services in this country has also had very bad results (although perhaps everything would be different if we all lived in that magical free market fairy land that could never actually exist)...
Interesting - long distance coaches, telecomms, energy, rail - which of those would you renationalise? I am actually old enough to remember what those services were like before. Problem with comparisons with the US model are that 50% of it is completely financed by the state and that is before one thinks of other interventions. You are a left libertarian but, in addition to the state spending 50% of national income, it would run health (which it does already), presumably education (ditto) and presumably telecomms, energy, rail, water, coaches, road freight, airports, airlines (and all the other disastrously privatised services). How much liberty would there actually be? A system without profit is a system that decides to throw away any information about what people actually want and has to be replaced by a system based on what "elected representatives" think people want. Yes, there imperfections in the market, of course, but if you throw away the price system you throw away rational information on how much alternatives cost and how much poeple value those alternatives.
Obviously I am not keen on the state, but until there are popular social alternatives I wish to keep the NHS as the lesser of evils, because I think the majority of people want to know that they will be cared for if they are ill, without conditions. I was going to write a longer post, but there is no point - I feel like I need to go and wash my brain out. Goodbye!
Anonymous - So you want a medical service run by 'public representatives' and you don't want any private profit to be involved. Doesn't make any sense to me, but that's your choice. What I don't understand is that you want to force your preference on others. I have no objection to private profit and and perfectly happy to use any willing provide that I feel offers the best choice for me. Why do you want to stop me? This is what I don't understand - just because you want to restrict your choice (fair enough) why do you want to restrict mine? Why can't we both have our way? The current problem is that government confiscates our money through taxes and then will only fund the medical services that it provides itself, regardless of whether patients would prefer to use another provider. What sense is there in this? Incidentally, before the NHS there were many not-for-profit providers. Most hospitals were charitable institutions, in fact. I'd be happy to return to this situation - you could restrict yourself to just using not-for-profit institutions and I wouldn't. The we'd both be happy, surely?
There is no point entering any further discussion with you, it's the same old tired thing. For any poor soul who stumbles on this discussion: http://world.std.com/~mhuben/libindex.html
(a bit America-centric but quite useful if you want to understand these loonies)

@Anonymous - I thought you were sympathetic to 'left-libertarianism', in which case I don't really understand your last two comments. Moreover, there is little that a left libertarian would object to in the original blog post.

The bizarre thing about the debate above is that the left libertarian's repose is to deny the very liberty that libertarianism is supposed to deliver. The IEA's piece is a litany of free living propositions; the convulsions against them are statist and anti-libertarian. More to the point it is entirely clear that the term neo-liberal is used in the pejorative sense - even though, by its very nature, neo-liberalism is the coupling together of public and private sector aims in the style of European social democracy. Anonymous doesn't seem to realise that neo-liberalism is the philosophy of the mainstream left; it is not classical liberalism.
As an aside, I note the difficulty of getting politicians to even discuss the question logically. However populist and agreeable to them as soundbites, it is regrettable that not only the PM, but also Lord Tebbitt have asserted their own convictions about the NHS an an irreplaceable institution because of their personal experiences of it, directly encouraging the false implication that, had the NHS not existed, there would have been some kind of awful healthcare void where treatment would have been absent. It might have been better!
My God man, are you mad?! There's a strong incentive to ensure drugs are safe, there's also a strong incentive to get people hooked on heroin! I don't doubt you have good intentions but you are clearly dangerous. I mean it when I say, for the good of mankind, go and sit quietly in a corner somewhere and try not to touch anything important!
If the NHS is so wonderful, why do most doctors have private health insurance? Explain that and stay fashionable.
" ... The National Health Service enjoys strong support among the public, making it almost impossible to introduce radical reforms, ... " So, the title of this article should really be, "How to override the democratic wish of the people in order to improve our profits" That is precisely why the public wish to have healthcare exactly where it is, so that patient care comes before profit.
Andrew Wilson: " ...in order to improve our profits". How do you know that Richard Wellings has any financial interest in this (other than as a taxpayer, of course)? Why do you assume that any desire to reform or abolish the NHS must be driven by a motive other than a wish to improve medical care and derive better value? And, frankly, it is not as if vested interests in the current NHS do not profit very nicely from it. We have easily the best paid and least productive medical staff in Europe, according to the OECD.
I have never read so much unadulterated rubbish from a think tank in the one article and that's saying something. Abolishing licensing of doctors - just how much time do you think the average Joe Bloggs has to check if a doctor is from a 'reputable brand' and how exactly do you visualise they would go about it? And how do they do that if they're in an acute situation? If they've just been knocked down or their appendix has burst, do you think they're going to look up a hospital on Google while they're on the trolley getting wheeled into the operating room? Don't be ridiculous. And as for drug licensing; well, sadly NICE has been divested of that function which now means that every snake oil salesman can push his/her particular brand on a trust without having to go through checks and without a national regulator to ensure that drug prices don't go through the roof. Judging by America's example we can expect to see drugs go up to five times the price we're used to paying on brands here. Our NHS ain't perfect, but we get a hell of a lot more bang for our buck than most countries and that is because it isn't privately run. What is proposed here is just going to break the NHS into a whole lot of competing franchises of varying quality and no redress if something goes wrong. Think of the recent scandal on breast implants if you want to know what lies ahead.
HJ: " ... How do you know that Richard Wellings has any financial interest in this ... " I don't, but he goes on to talk about improving profits. My point was that the majority of people who vote don't want a privatised medical service in this country and no-one gets to override that. " ... We have easily the best paid and least productive medical staff in Europe ... " Efficiency? By what measure? Are yo measuring how much time, say, a nurse is actually just sitting, talking to a patient?
Julie: "Our NHS ain't perfect, but we get a hell of a lot more bang for our buck than most countries and that is because it isn't privately run." The OECD analysis makes it very clear that we get much LESS bang for our buck than most countries. If you have contrary evidence, please provide it. As for medical licensure, I suggest that you Google Milton Friedman on this subject - he very effectively destroys the case for medical licensure detailing how it leads to lower quality and lower provision. You rely for your safety and health every day on individuals and companies that are not compulsorily licensed.
Andrew Wilson - In fact, Richard Wellings doesn't mention profits anywhere in this article, but even if he had, then in a competitive environment, providers can only increase profits by becoming more efficient - and isn't that what we're after? In the NHS, medics currently profit very nicely out of a lack of competition. Never forget that the BMA, to name just one organisation, is a trade union run exclusively to advance the private interest of its members. I suggest that you read the OECD analysis if you want to understand what they mean by efficiency. However, essentially they are looking at medical outcomes versus inputs. Summaries of their findings are here: http://www.oecd.org/document/39/0,3746,en_21571361_44315115_46491431_1_1...
Richard handily ignores the fact that 50 million people in the U.S cannot afford healthcare insurance, and they have a financially less efficient service than the NHS. The Free market experiment has failed, and it was an experiment. Government regulation is necessary or else we get Enron or the Lehman brothers. I suspect most people who want to hand the NHS int private hands are hoping to financially benefit form it. The word liberalised bother me too. Liberalised from what? From the people and into the clutches of unaccountable private firms who are in it for the money. This is nothing to do with efficiency or wanting a great healthcare system and everything to do with greed and selfish motives.
HJ. Efficiency is not the same as good patient care. Sometimes the right treatment is not only about the medication given, but about time spent with the patient. It's not efficient economically but for the patient the outcome is much better than if the time hadn't been spent. The best medical outcomes are from evidence-based treatments and not economic studies. Doctors, and nurses in particular, are run off their feet, not because they are inefficient, they are incredibly efficient with their time, but because there is too much to do and not enough trained medical staff to do it. We could easily cover the costs that the NHS requires if the large corporations paid there taxes they are due, rather than deciding how much they will pay over lunch with the inland revenue. That alone would recover billions, never mind the the amount the banks owe us as a nation. We cannot have a situation where the patients' main concern is about the cost, at a time that is emotionally stressful, rather than helping the treatment through diet/exercise etc... If you want to see how privatised healthcare works you need only look to America. People, who cannot afford health insurance because their jobs don't pay them enough, or whose jobs don't cover them, dont get the medication they need and, in many cases, can only lie down and wait for death. What else can they do? That is not a situation we ever want in this country and anyone who tries to introduce it will meet huge resistance. That is why articles like these are suggesting underhand ways of introducing private medicine, because people know that it is not wanted.

The US has not adopted any of the reforms advocated in this blog post. Its healthcare system cannot be described as 'free-market'. Indeed, it exhibits the exactly the problems of heavily-regulated mixed systems that are explicitly described and criticised in the above piece. The UK certainly should not seek to emulate the US system.

Andrew Robinson. Three points - First, 45 million people do not have medical insurance in the US but it would be mistaken to conclude that they are all US citizens or because none of them can afford it, or that they have no medical cover. Second, there is definitely not anything even remotely close to a free market in medical care in the US - very far from it. Do not confuse largely private provision with a free market. Third, why do you assume that the only alternative to the NHS is the US 'system' - there are many other medical 'systems' in the world deemed by the OECD to be much better and more efficient than those in either the UK or the US. I have no connection with any medical provider whatsover and I would like to see the end of the NHS as I do not believe that it serves this country well. What 'greed and selfish motives' do you accuse me of, or do you just throw these accusations because your argument is so thin?