An insurance-based healthcare system would put patients back in power

SIR – While Sir Keir Starmer’s article was interesting and encouraging (‘The NHS is not an out-of-bounds shrine. It need unsentimental reform’, Comment, 15 January), it misses the real reason for the failure of the NHS.

“Free at the point of use” means that we consumers benefit from handouts. We are expected to be deeply grateful for what the NHS can, will or is willing to deliver and not ask for more. This opens the door to lack of accountability and resulting bureaucratic inefficiency.

Reforming universal healthcare in the UK through insurance, where the less fortunate are subsidized but most of us pay our fair share, would put us in a contractual, non-charitable relationship with our healthcare provider and put us in a position to call the shots to have when we do this we don’t get what we pay for.

Rev. His Honor Peter Morrell
Nassington, Northamptonshire

SIR – I read with interest Allister Heath’s article (Comment, 12 January) which suggests the NHS is ‘dead’. That this should be possible is morally unacceptable. Healthcare needs to be saved, but rebuilt from the ground up as soon as possible.

In post-war Britain, Aneurin Bevan introduced a radical free-at-point-of-use NHS, based on a small, successful service in a Welsh town employing five doctors and its tiny hospital funded by community payments. By nationalizing Britain’s hospitals and health services, Bevan expanded this modest system to become nationwide, ignoring a better system in Canada known as Swift Current Health Region Number One, which now provides the country with its state-funded health service. The system is superior as it has built-in financial deterrents to overuse.

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Unfortunately, Bevan’s main concern was political. He wanted to show the British public how the Labor Party could quickly deliver on its election promises. In doing so, he laid the groundwork for the decline of the NHS, creating a severely underfunded and underresourced service while turning it into a political football.

Having worked as a doctor in Canada and the UK, I have personal experience with both systems.

dr Arnold Powell
London N2

SIR – I am suspicious of the (DNA) statistics quoted by the NHS (“NHS junk is inevitable when everyone thinks it’s free”, Commentary, 14 January). I once canceled an outpatient appointment by phone. The day after the appointment, I received a call from an angry member of staff questioning my non-attendance. I said I had canceled and was asked what phone number I used. When I replied that I had used the cancellation number specifically provided in the confirmation SMS, I was told I had used the wrong number.

A DNA tag is still in my medical record to this day.

Anthony Gales
Henham, Essex