If politicians are serious about the NHS’s future, they need to have an honest conversation about healthcare reform. It is an imperfect system, but as Nigel Lawson said, the UK treats the NHS like a religion. The King’s Fund’s survey found 53 per cent of respondents support our healthcare system. Yet the NHS is one of the worst healthcare providers for outcomes. The Commonwealth Fund Study finds the British healthcare system comes second to last in the category for health outcomes. As Kristian Niemietz wrote in his book ‘Universal Healthcare Without The NHS’, survival rates for breast cancer in the UK are 81.1 per cent, the lowest rate among high-income countries. The UK is 5 percentage points below South Korea in this category. Although the NHS has made rapid progress in cutting waiting times since the 2000s, they are still worse than those in Switzerland, Holland, Belgium, Luxembourg, Austria, Denmark and Finland. The NHS lags behind other developed countries for healthcare spending. This is because it suppresses voluntary spending, which allows patients to boost their healthcare packages if they need access to other services.
When an NHS debate is initiated in this country, it is dishonest. No serious reform can be implemented without media pundits comparing it to the American healthcare system. But as the Institute of Economic Affairs has highlighted repeatedly, the American system is not universal healthcare. The poorest citizens only have access to Medicare whilst the richest have insurance packages. There are nations that provide universal healthcare insurance programmes without mimicking the US system. The current Dutch healthcare system, which was introduced in 2006, introduces a regulatory framework and ensures universal participation, but patients, insurers and providers collaborate to deliver healthcare. The Dutch government does not operate any hospitals or insurers, it does not conduct hospital planning, and it does not subsidise any hospitals. A 2016 OECD study found on average, waiting times in the Netherlands for important operations like cataract surgery and hip replacement are at 30 per cent, whereas in the UK, it is between 70 and 90 per cent.
To improve the NHS, there should be free entry and exit for private providers. If they fail to attract enough patients, they should not be bailed out. As Niemietz wrote, a system that prevents market exits also prevents market entries. If underperforming providers are never allowed to fail, better-performing ones will never be allowed to expand. Clinical Commissioning Groups (CCG) must be allowed to compete. Patients should be provided with information about how they perform and free to choose which one they register with. This would create brand recognition for every CCG and improve competition. In fact, that competition can be improved further by allowing patients to opt out of NHS commissioning. Competitive packages can be provided by insurers, employers and trade unions. Insurers would be awarded the chance to run their own pharmacies, ending the political reorganisation of healthcare and the start of market reorganisations. Voluntary spending should be encouraged to end the burden on the state and allow people to manage their own healthcare.
As Margaret Thatcher said: ‘When people are free to choose, they choose freedom.’ The NHS is not based on freedom of choice. Private healthcare is a luxury to those who can afford it. The Government must initiate reforms that allow choice, competition and universal healthcare at once. This would result in the end of the NHS in the long-term as there would be no national healthcare provider, but a series of them. Until politicians are brave enough to complete the reforms started in the 2000s, British healthcare will always fail to compete.