The UK National Health Service is designed as an expression of social solidarity and provides universal access to health care funded through general taxation and free at the time of need. Similar systems have been developed across the Nordic countries and elsewhere but, despite frequent statements of support from all mainstream political parties, all such systems now find themselves under grave threat. Rapid advances in biomedical science are producing exponential increases in the costs and sophistication of investigations and treatments. Politicians everywhere, undoubtedly reflecting the priorities of their electorates, are unwilling to increase levels of taxation to match these increasing costs. This reluctance is easy to understand, but the identification of market forces as a solution to the worsening tension is extremely perplexing.

Markets are motivated by the pursuit of private profit. This motivation can be used to increase efficiency and hold down wages but markets can thrive only if they can generate increasing demand for their products. Health care, despite enormous recent efforts, is not easily packaged as a product and the relationship between demand and need within health care remains intensely problematic. At what …