James Forsyth

The NHS isn’t free

The NHS isn't free
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If we are going to have a sensible debate about the NHS in this country, we need to deal with the myth that the NHS is free. Yes, the NHS is free at the point of use, but we all pay for it through taxation. I suspect that slightly fewer people would still ‘love the NHS’ if they knew precisely how much they were contributing towards its costs through all the taxes that they pay.

I say this as someone who has no desire to import the US system. Before I went to live in the States, I was quite a fan of the US healthcare system. But having lived there for four years, I became more sceptical of it. I was lucky enough to work for a company that offered incredibly generous health insurance, but the system was incredibly bureaucratic. I reckoned I needed to file for reimbursement about six times in four year, but on a couple of occasions I gave up: beaten by the sheer number of forms I needed to file in. (Once I worked out that I could make more money writing in the time it would take me to fill in the forms than I would get from the reimbursement). I dread to think what the administrative cost of processing these forms was and this level of bureaucracy is part of the reason why the US spends an unsustainable amount of its GDP on healthcare.

It is a pity that the debate about health care so often comes down to the idea that there are only two possible systems, the British one and the American one. Both are flawed and there are plenty of other countries worth learning from. Sadly, though, the Tories seem to have no intention of doing much thinking on health, one described NHS reform as a ‘third-term agenda item’ to me a few months back. Instead, the Tories have decided to believe that what is good for the BMA is good for the NHS and for Britain.