Living in Shanghai, I've had to navigate a healthcare system very different from the one I grew up with in Britain. It makes you realise how uniquely sentimental we are about the NHS. We treat it like a national religion, where questioning the structure is seen as heresy. But from out here, looking at the news of record waiting lists and systemic burnout, it feels like our devotion to the model is actually hurting the people.
A loop with no exit
The NHS debate gets stuck every time. One side says it's perfectly fine and just needs more money. The other says it's a socialist relic that should be sold off to the highest bidder.
There's a huge middle ground that we almost never talk about: European-style social insurance. France, Germany, and the Netherlands use it. It's not privatisation in the American sense. But it's not the state-run monopoly we have either.
The "more funding" trap
The polite consensus is that we just need more funding and better management. Get some grown-ups in the room and the existing model will start working again.
But my time in London local government taught me that more funding often just feeds the bureaucracy rather than the front line. Demographics are the real problem. We have an ageing population that is simply outstripping what a tax-funded monopoly can provide. When stability leads to a three-week GP waiting list, is it actually stable?
What I think
I think we need to stop being so precious about the NHS brand and start caring about outcomes.
An insurance-based model — similar to what they have in France — might be the only way to ring-fence healthcare funding so it doesn't have to compete with every other department for a pot of general taxation. It's about being honest about what things cost so we can actually provide them.
Why insurance could work
Currently, the NHS has to beg the Treasury for money every year. In an insurance-based system, the money is literally tied to healthcare. It can't be diverted to fill a hole in the pensions budget or pay for a new rail link. It's a more honest way of saying this is what we pay for health.
Hospitals are currently funded for how many people they process, not necessarily how well they recover. In a managed competition model, where hospitals are funded based on actual patient outcomes, you create a natural incentive to get things right the first time.
What I'd suggest
Moving to an insurance model would be a generational shift. But we could start small.
Look at Europe. Stop looking at the US as the only alternative. Germany spends more, but they get much more.
Be honest about co-payments. In France, you pay a small fee to see a GP — about £20 — and you get most of it back through insurance. It stops people using the GP for trivial things and makes them value the service.
Decouple the politics. Healthcare is too important to be a political football. An insurance model moves funding away from the Chancellor's autumn statement and into a stable, long-term system.
If you find yourself waiting weeks for a basic appointment, ask yourself whether you care more about the concept of the NHS or the reality of getting better. Sometimes the most humble thing a nation can do is admit that someone else might have a better idea.