Stakeholder health insurance

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7304.107 (Published 14 July 2001) Cite this as: BMJ 2001;323:107

Time for evidence based policy analysis

  1. David G Green (david.green@civitas.org.uk), director
  1. Institute for the Study of Civil Society, Elizabeth House, London SE1 7NQ
  2. Graduate School of Business, Stanford, CA 94305, USA
  3. King's Fund, London W1M 0AN

    EDITOR—In their commentary to my article Dixon and Appleby seem to have been deeply taken aback by my claim that the NHS fails the poorest people in society and responded with a personal attack, asserting: “Green's aims are disingenuous at best.”1 The ordinary meaning of disingenuous is to be insincere or to have secret motives.

    The essence of my argument is this: the rich can always take care of themselves and it is the government's responsibility to ensure that the poorest people have access to a reasonable standard of health care. But what should that standard be? Should it be perceived as a minimum or core standard, in which case it will always be possible to claim that it is too low? Or should it be seen as comprehensive, in which case it will be unachievable, as the BMA's recent inquiry acknowledged.

    My proposed scheme tries to deal with this conundrum by removing the decision about the appropriate standard from the political domain. Instead, the standard guaranteed by the government should be linked to the choices made on their own behalf by people with middle incomes. I propose that the government should guarantee this standard for everyone. Yes, the rich will be able to afford more, but they can do so now under the NHS. That will not change, but the deeper reality is that all healthcare systems must be affordable, whether they are paid for by taxes on earnings or by private payments made from earnings.

    My claim is that, compared with the standard currently provided by the NHS, such a guarantee would be a substantial improvement for the poorest people in the United …

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