What models of funding are best for a healthy and just society?

The National Health Service was created in 1948 with the aim of ensuring that access to healthcare would depend on need and not ability to pay. “The essence of a satisfactory health service” wrote the health minister Aneurin Bevan, “is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.”1 In Bevan’s view, this required a healthcare system paid for out of general taxation rather than, say, a ringfenced tax or insurance with contributions tied to benefits. From the beginning, then, the link between payment for and consumption of healthcare was deliberately broken. Equality of access was to be accompanied by inequality in financing, with contributions based on people’s ability to pay.

And there, you could argue, the story ends. Apart from some minor adjustments, the source of funding for the NHS has remained the general pot of taxes, with a small amount of additional revenue from patient charges. But there is now a growing sense that things might have to change.