When you are older and poorer, take comfort in one thing. Your earnings went in ever heavier taxes. There may be less for life's necessities - clothes, food, transport, a roof over your head, helping your family or saving for retirement. But if you are sick you can hope for Gordon Brown's promise of a "world-class health service". His line, and that of most on the left, is that the failures of the NHS have been the result of "underfunding".
The evidence proves different, as Politeia's latest study shows. The system itself is so flawed that even the most generous funding would make little difference. Look no further than the old East Germany where, by the time of German unification, the state-directed health system had reached a stage of decay similar to that of the NHS. The remedy was not to prolong the Stalinist structure and throw more money at it, but to introduce the West German market model.
As Georg Baum, one of the country's most senior health officials, explains: "People's needs are best met ... where competition exists and ... private suppliers work for patients." Competition, he says, "is at the very heart of the philosophy ... of healthcare" in Germany. Suppliers are mainly private, with all primary care in private hands and hospital care shared between public (55% of beds) and private and voluntary (45%). East Germany's old state-planned system was swept away, and within two years it was reorganised along West German lines. Private doctors and dentists offered primary care, and hospital medicine was taken over by charitable or private providers or by local government.
Funding in Germany, as in France, is linked to the individual and based on compulsory insurance contributions and additional co-payments. In both countries, costs are spread across the population, with poorer people fully covered from public funds.
In Germany, sickness funds are seen as "better guardians of people's rights ... than state bureaucracies". In France, according to a senior official at the French audit office, Jean L de Brive, the funding system involves individuals directly. They "can choose between different private and public providers, and ... the system can allow for increased expenditure without increased levels of tax if people are ready to accept a reduction in the rates of reimbursement and an increase in the cost of top-up insurance". Primary - GP and specialist - care is mainly private, and hospital care is divided between public (75% beds) and private (35%).
These systems are far nearer to the original NHS inspired by Beveridge and announced by the cross-party wartime coalition in the 1944 white paper. That was to be based on mixed providers - GPs and hospitals - and mixed funding, in the main tax and insurance. But, after the war, Aneurin Bevan abandoned the mixed scheme and went instead for a centrally planned and run system, nationalised and to be funded almost exclusively from tax. The upshot has continued to be a chaotic, unwieldy structure incapable of providing the healthcare that individuals need. It is one where the state dominance over the medical profession supersedes the vital doctor-patient relationship.
This government, like its predecessors, will discover the truth of Beveridge's warning that tax alone can never be enough to fund the health service. It will also find - as others before it have done - that the complicated and expensive attempts to restructure will founder, as every major plan has done each decade since 1946. The only winners are the bureaucrats and officials, the parasites of our health service. Indeed, already, the huge increase in funding has had little impact on the proportions of specialists, GPs or nurses.
While the "headcounts" may have increased, the proportion as a total of the workforce remains the same, or has even fallen. Consultants amount to only 2.4% of almost 1 million workers, and qualified nurses are outnumbered by managers and support staff. It may be that all systems fall prey to excessive bureaucracy. But the UK's priorities appear to be of a different order to those of France, for instance, where there are 3.3 doctors for every 1,000 people as opposed to 1.8 here.
Radical reform is needed - perhaps along the lines suggested by Deepak Lal, who points out that the planned expenditure by the NHS per capita in 2005-6 is no greater than the premium charged by the Kaiser Permanente insurance scheme (which has a spread of liabilities similar to that of the NHS) for much better healthcare. Why doesn't the government just decide to buy everyone comprehensive health insurance? The failings of Britain's healthcare system can no longer be blamed on under-funding, because our funding levels are rapidly catching up with those of France and even Germany.
This year (2003-4), annual spending on health per capita is around £1,270 to £1,300, not far from Germany's £1,390 - or the last available figure for France of £1,344 in 2000. And the gap between the proportion of GDP spent on health in Britain and in continental countries is also growing smaller. While it is true that spending as a percentage of GDP in 1998 was 6.8% in the UK and 9.3% in France and 10.3% in Germany, that gap is closing. By 2001, the UK spent 7.6 % to France's 9.5% and Germany's 10.7%, and this proportion is rising at a higher rate than for France and Germany, according to the most recent figures.
Now, thanks to Gordon Brown's ineffective extravagance, it is much clearer that the deficiencies in our healthcare are the result of the system - the very system that the chancellor is trying to preserve.
· Sheila Lawlor is director of Politeia; Systems for Success: Models for Healthcare Reform, by Georg Baum, Jean-Louis Beaud de Brive, Deepak Lal and Sheila Lawlor, is published by Politeia
