It's prompted by the Chief Exec of NHS England on BBC Radio 4 this morning saying - after praising the Government - that the NHS is unaffordable (massive funding shortfall 30bn in next decade).
This prompted a BBC Radio 5 Live phone discussion on "What Should be Cut to Save the NHS?" Various top ups and additional charges were then mentioned by callers.
My Plan to Destroy The NHS
Suppose I am very very rich, and very very selfish. The NHS annoys me intensely. It costs lots in tax revenue to run, and being very rich, I pay proportionately more of my income on it, and of course far more in terms of hard cash, than almost anyone else. I also resent the fact that my business empire is unable to cash in on providing the services that people would buy from my private businesses if the NHS was not there.
BUT, the public loves the NHS, even many Tories are fond of it, and to propose scrapping it would provoke howls of outrage. Plus there's no evidence I can marshal that the public would get a better service if it were provided by the private sector - rather the opposite in fact.
What would I do? Here's what I would do.
First, I'd ensure a team of expert PR run the Tory party - people adept at twisting facts, spinning, and indeed telling bare face lies and getting away with it. And I'd have my private health companies etc. fund them generously.
Next, once elected, I'd get them to introduce phase one: the introduction of a market system in which GPs buy services from NHS hospitals, or anyone else, based on variable price, etc. This can still be called "NHS" because it's still free at the point of use. This would all be justified by lies about how the evidence shows it's more efficient, etc.
This new system allows e.g. my private pharma and health care companies to cherry pick the services that are lucrative and compete with existing hospitals without having to provide the expensive back up necessary when things go wrong (that's all dumped on the old hospitals), offer loss leaders to pull in the more lucrative patients, etc.
What next? At this point I'd get the Tory spinners to start talking about how the NHS is "increasingly unaffordable" (what with the aging population, advances in expensive medical treatment, etc.). I'd have this phrase repeated endlessly in the media, in a mantra like way, until it becomes part of the zeitgeist. It will take time. Eventually, this "problem" will be felt to require a "radical solution".
Once the Tories are back in power, I'd have my PR men talk about the "unfairness" of preventing people from adding their own funds towards what the state is providing to buy a service they would prefer. After all, this increases "choice" and "freedom" and so must be a good thing. And it would bring increased funds into the health care system as a whole. Surely a good thing. Then - the all-important phase two - top ups would be introduced (despite not being on the Tory manifesto on which they were elected). For any ailment you can now choose from a range of treatments at different cost, only some of which the state will fully fund (the cheaper ones). It's your option to make up the shortfall and go for the more expensive treatment among those offered you by your GP. You have that "freedom". Lucky you.
If it's felt this sudden introduction of across the board top ups won't wash with the public, top ups could instead be introduced gradually (the policy already exist for some cancer drugs and could be e.g. extended to more drugs, then all drugs, then to some medical procedures, and so on))
Of course, the plebs will be told the NHS is still, and will always be, there providing necessary services for all. But the "increasing unaffordability" point will be used to justify a "necessary realism" about what, precisely, the state can ultimately fund. This will be used to justify the growing top up system.
Phase three: state funding is then reduced more and more. Topping up becomes more and more unavoidable if you want half decent medical treatment. More and more people take out health insurance to cover differing levels of top up, and so more and more have less and less of an emotional stake in protecting what's left of state-funded treatment. There's less and less resistance to further cuts.
Rich people like me cash in on the boom in health insurance. I'm now making enormous profits on both sides of the equation - supplying pharma and medical services, and supplying insurance services. And I am now paying less and less tax too.
Eventually, state funded treatment will be a third-world-level rump relied on by perhaps just the poorest third of the population. Fuck 'em. My wealth has increased astronomically.
Well, that's what I would do. Of course it couldn't be done in one go. It would require several Tory terms, probably with some Labour periods intervening, so I'd have to make sure that whatever is achieved at each stage is very hard to undo.
Of course this is a nightmare scenario. Hopefully it's not the path on which we are actually embarked. I'm probably just being paranoid. But every now and then it crosses my mind. After all, what I called phase one is just being completed.
If this is really where we are headed, then expect to hear lots more about the "problem" of "increasing unaffordability" that requires "tough" and "radical" solutions. Then, later - probably not in this parliament, and probably not from mainstream Tories to begin with, but from e.g. self-styled mavericks writing in The Spectator - some hints that a general top up policy might be part of the solution. At the very least, expect recommendations that top ups be introduced for a wider range of drugs, etc. But you won't hear this from ministers until phase one is complete, as that might give the game away.
POST SCRIPT. I just googled "NHS top up payments" and found quite a lot on the Labour introduced cancer drug top up policy. Including this from Janet Daley at The Telegraph - go here. Daley is exactly the sort of person I had in mind when I mentioned "self-styled mavericks".
Follow up piece here.