Breaking with a decades-old tradition, Mr Milburn became the first Secretary of State to use the "R" word, carefully avoided by his predecessors, but insisted every health care system in the world had to make choices.
He promised to end the "lottery of care" generated by the pick-and-mix system of postcode prescribing and replace it with a fairer, rational system based on a scientific assessment of what worked.
Setting out his plans to the first conference of the National Institute of Clinical Excellence (NICE) in Harrogate, Mr Milburn sought to put clear water between Labour and Tory policies on the NHS by insisting its needs could be met from taxation without resort to charges or private insurance.
His remarks came as doctors' leaders meeting at the British Medical Association yesterday called for a no-holds barred review of funding for the NHS. They joined a growing cacophony of voices, led by the opposition, insisting that the demands on the NHS are increasingly outstripping the Treasury's capacity to fund it.
But Mr Milburn rejected the claim and insisted charges would fall on the elderly and the young, who had most need of the NHS but who could least afford to pay, while private insurance would be affordable only for those least likely to claim on it.
"The NHS is both fairer and more efficient than the privatised alternative. We reject the private option as intrinsically flawed," he said.
The NHS could not provide everything it was theoretically possible to provide, even if the whole of the UK's Gross Domestic Product were spent on it but to call that "rationing" was meaningless, he said. "What is true is that the NHS, just like every other health care system in the world has to set priorities and make choices. The issue is not whether there are choices to be made but how those choices are to be made."Reuse content