Wanless couldn’t find any alternative funding model to the UK’s that would deliver a given quality of health care at a lower cost to the economy. Other systems seemed likely to prove more costly than the UK’s, which came out as relatively efficient and equitable. “It delivers strong cost control and prioritisation and minimises economic distortions and disincentives, ” he wrote. A key advantage was its fairness, “providing maximum separation between an individual’s financial contributions and their use of health care.”5
Previous considerations of alternative funding models have come to the same conclusions. In 1960, a government working party on NHS finance chaired by Frank Figgures was sceptical about alternatives to general taxation. Its arguments “proved apposite and convincing on the many future occasions when alternative methods of funding the NHS were considered,” writes NHS historian Charles Webster.1
One of these future occasions was the Royal Commission on the NHS in 1979. It declared itself unconvinced that the claimed advantages of insurance or charges outweighed “their undoubted disadvantages in terms of equity and administrative costs.”20
In 2000, The NHS Plan
contained a section on why tax funding was best.21
Yet the hunt for a better funding model is never called off, with each new foray unfolding along similar lines. It begins with the NHS being judged as seriously underperforming. The real reason for this, whether admitted by the government of the day or not, is because not enough money is being spent on it. Early in the hunt comes sightings of the “bottomless pit” of insatiable healthcare demands, quickly followed by assertions that substantial increases in healthcare spending are “unsustainable.” When asked for their advice, economists tell politicians that a tax based system provides governments and patients with the best deal. As a sideshow to the main event are the hucksters, peddling their own funding models, hoping that some of the billions spent on the NHS might end up in their pockets, or those of their backers.
But this doesn’t look like happening any time soon. The NHS remains a centrally funded system, free at the point of delivery, with the exception of minimal patient charges. The package of services that the NHS has elected to provide looks unlikely to seriously stress the current tax based funding model. Arguably, taxation could be used to raise even more money for the NHS.
But whether the package of services the NHS has elected to provide is enough is the big question. Governments have been deliberately vague about what that package includes, which has served them well in the past. But the failure to be explicit about this means that sensible discussion on the funding of services that are outside this package is postponed indefinitely. Consumer action is making this position unsustainable for much longer.