One element missing from current discussions of the health and social care bill (Report, 19 January) is a straightforward account of what will happen if it becomes law. From a detailed study of the bill and academic and policy literature about it, plus many discussions with experts, I've distilled this simple scenario of England a few years after the bill's enactment.

The NHS will no longer be a provider of services, as GPs, hospitals and community health services will all be outside the public sector. The NHS will be a publicly funded budget and a brand name for a subcontracting operation for competing private organisations, subject to European competition laws which will allow private companies to predominate over other (eg third-sector) providers.

Since competition and collaboration are incompatible – and co-operation between providers will be punishable by law as anti-competitive – co-ordinated services for people with chronic or complex conditions will break down and disappear except within the restricted framework of tied providers under the so-called "integrated care" model developed by the US health insurance industry.

Because the post-credit-crash NHS has a more or less fixed budget, services judged to be "of lower clinical priority" will no longer be provided free. Increasingly common NHS charges will create a demand (ie a market) for health insurance, which will mainly be affordable by the most affluent and which will also drive up costs because of administration fees and private profits.

The trigger for the roll-out of top-up insurance will be the impending introduction of personal health budgets, which represent a first step towards user charges. Clinical commissioning groups will operate on an individual basis so as to be compatible with the insurance companies, unlike the traditional GP service, which is population-based and pools risk across the whole country. Illness will begin to cause bankruptcy as is common in the US. Inequalities will increase enormously. Large amounts of public funds raised through taxation will be redirected as profits for the private companies which will provide NHS services and NHS commissioning support, and direct NHS charges (or health insurance payments to cover these) will become a normal item of household expenditure.
Dr Alex Scott-Samuel
Liverpool

• Those expressing concern about forthcoming NHS changes need look no further than my area, West Sussex, for an indication of where we are heading. Across the county GP practices are seeking to levy rental charges on other NHS services that provide treatment within surgeries. This is leading to the ridiculous situation where the local talking therapies services will have to pay hundreds of thousands of pounds of public money to rent space in surgeries in order to provide help to people referred by the GPs from those same surgeries. The rationale given for this is that each surgery has to "maximise its income". This is an example of how the marketisation of the NHS is leading to a waste of public money.
Name and address supplied

• The proposal that credit rating agencies should decide the fate of hospital services (Report, 19 January) is final evidence of the intent behind the health bill to commercialise the NHS. Now that the BMA, RCN and Royal College of Midwives have all expressed outright opposition to the bill and Andy Burnham has pledged to repeal the legislation if elected, the health unions and others should work together to persuade the government to drop the bill. Lib Dem activists can play a crucial role in pressing their leadership to change course. Already 98 crossbench peers and 11 bishops have voted with the opposition in at least one Lords division on the bill. At report stage, they should at the very least amend this legislation to ensure the continuing responsibility of the secretary of state for a free and comprehensive service, the maintenance of the public sector as the dominant provider of services and the retention of the commissioning function and funding in public hands.
Dr Anthony Isaacs
London

• Suggested ratings for NHS clinical and neurological hospitals: Standard, Poor & Moody.
Bob Dear
South Croydon, Surrey