A healthy dose of realism

Kenneth Tuson argues for an NHS where responsibility for funding care is returned to the individual

A HEALTH service funded by the state through an increased burden of taxation and which removes from the individual the responsibility for his own and his family's health care will be financially untenable in the 21st century. The idea that each individual can expect comprehensive health care provided by the state is no longer a practical proposition.

Our neglect of our individual responsibility for our welfare leads to an abuse of the provision of services. We are the only developed country where waiting-lists are accepted as normal. It is not a coincidence that we are also the only developed country where funding for health care is not based on an insurance scheme.

None of us would argue against the premise that in a civilised society government has a role in seeing a comprehensive basic standard of health care is available to all. That does not mean that government of necessity must provide that service, neither does it follow that it must provide all the finances for all the services that each individual might demand.

The founders of the NHS after the Second World War were inspired by the ideals of Beveridge, who envisaged a safety net so that nobody should fall beneath a basic level of income and care. It was never his vision that a totally comprehensive health package be provided by government.

An ageing population, increasing public awareness, and the innovations of modern medicine have led to demand for health care, the cost of which has risen at a far greater rate than the ability of the State to provide that funding.

How can we return the responsibility for assessing health-care needs to the individual and the family? The answer is to agree that some funding will have to be transferred to the individual.

I suggest the present system of funding a National Health Service through taxation be replaced by a new system based on compulsory health insurance and the establishment of an independent National Health Insurance Corporation - and a new system of control, with minimal involvement by central government.

The cost of health care should be visible to those who provide it, those who receive it and those who pay for it. And to this end, each patient could take out compulsory health insurance cover. The patient is presented with a bill and is clearly aware of his costs. What proportion of his costs should be recoverable from his insurer is a matter of debate.

Within the insurance premium charge, there must be an excess to cover caring for the chronic sick and the under-privileged minority. .

Finally, the health insurance fund should be separate from general taxation. The current National Insurance contribution would be separated into two component parts, the NHS contribution, which would be suitably increased, being shown as an independent sum. It would be expected, and I can already hear you giggling at this, that income tax be reduced by the appropriate amount.

q The author is a consultant orthopaedic surgeon and vice-president of the Hospital Consultants and Specialists Association. The text is an edited version of his speech at the Bupa Health Debate last week.