The NHS is Failing - Is an Israeli Healthcare Model the Solution?
Instead of squabbling, our leaders must grasp the nettle of NHS reform
It’s currently mid-February and the annual NHS winter crisis is at its peak. According to a Royal College of Nursing report, people are “routinely coming to harm” with vital equipment not available and staff too busy. Patients are dying in hospital corridors and going undiscovered for hours, while others who suffer heart attacks cannot be given CPR because of overcrowding in walkways.
Nurses' testimonies, on which the report was based, described “animal-like conditions” for pregnant women who in some cases are having miscarriages outside wards while other patients are unable to call for help.
Similarly, according to the Lord Darzi report, in 2010, 94% of people attending a type 1 or type 2 A&E were seen within 4 hours; by May 2024 that figure had dropped to just over 60%. The Royal College of Emergency Medicine estimates that these long waits are likely to be causing an additional 14,000 more deaths a year - more than double all British armed forces’ combat deaths since the health service was founded in 1948.
These reports should be urgent reading for our leaders in parliament who have been avoiding these systematic issues for a long, only being willing to throw more money at the problem and hope it goes away.
West Streeting, the Labour Health Secretary, has defended his party’s record on the NHS and attacked the Conservatives, arguing that corridor care “became normalised in NHS hospitals under the previous government”. Labour leader Keir Starmer has also gone on the attack against Reform UK leader, Nigel Farage, claiming that there is a “panic” among people who “know under his policy he wants to charge them for using the NHS”. In response, Farage said there is “panic” among Labour ranks about the electoral threat from Reform and that “Reform want healthcare to be free and the point of delivery”.
Rather than addressing the structural problems with the NHS, politicians would rather use it as a political football, or hot potato even for the next government to deal with. The most favoured NHS attack line by politicians, especially Labour politicians, is to accuse the other side of wanting to privatise the NHS and charge people for healthcare. This is despite the fact that many other developed countries are quite happy to have privately run healthcare systems that don’t suffer the same problems with overcrowding and long waiting lists.
Many will say that the only problem with the NHS is that it is underfunded. Yet this argument is completely at odds with the evidence. Italy spends 6.8 per cent of its GDP on healthcare, and Israel spends 8 per cent on healthcare, less than the UK which spends 9.3 per cent on healthcare. Yet both countries also provide better healthcare outcomes than the UK with better cancer survival rates and higher life expectancy.
Despite the high levels of public spending, the NHS performs poorly on almost all parameters. In the last year before Covid, the United Kingdom had the second-highest avoidable mortality rate in Western Europe. For the most common type of cancer, the UK also has one of the lowest survival rates in Western Europe.
Additionally, waiting times before Covid were about twice as long as the Netherlands which has a privately-run healthcare system.
As well as providing low-quality healthcare, the NHS funding model is unsustainable and places an unfair burden on workers. Funded entirely through taxation, the NHS represents a drain on the private sector, while providing declining service quality and a lack of choice in return.
Instead of continuing with our current broken healthcare model, it is time for the UK to look at alternative systems that are more efficient and provide better outcomes. In my view, the best course of action would be to look at transitioning towards an Israeli-style healthcare model where citizens choose from competing non-profit insurers, encouraging better service and efficiency. Like with the NHS, all citizens receive comprehensive healthcare, with subsidies for low-income individuals. Yet unlike the NHS, hospitals and clinics are a mix of public and private, improving patient choice and service quality. Rather than being stuck in a one-size-fits-all NHS system, people can choose their insurer and provider.
As well as being funded through monthly insurance premiums averaging around £40 a month, Israeli healthcare is also funded through a small progressive health tax on a person’s income. Unlike the UK, Israeli pensioners pay into the system, reducing the burden on younger workers and addressing the fiscal problems associated with an ageing society. A healthcare tax could replace National Insurance in the UK, which is not ringfenced for taxation. Money raised from the health tax could then be deposited into a public health fund to cover essential services such as emergency care.
Adopting an Israeli-style healthcare model would save the treasury money and empower people to take responsibility for their own healthcare. It would also be fairer. Pensioners are the people most likely to require healthcare treatment and it makes sense for them to contribute a small amount of their pension income towards public health. The combination of a health tax and mandatory premiums ensures adequate funding without over-reliance on general taxation.
Those on the Left will argue that these measures will lead to US-style privatisation, with people being refused treatment or having to fork out thousands of pounds for surgery. Yet this is merely scaremongering. Many developed countries have privately owned healthcare while maintaining universal coverage, including our close neighbours France, Germany, and the Netherlands.
To have a constructive debate about the future of the NHS, we must dispel the illusion that it is “free” and accept that we are paying a very high price for it in general taxation and receiving little in return. The level of taxation in the UK, the highest in over 70 years, is imposing a crippling cost on the private sector, dampening investment and consumer spending which are the main drivers of economic growth.
We must also acknowledge that increasing healthcare spending every year as we have been doing will require much more borrowing. Even National Insurance, which raises £180 billion annually doesn’t come close to covering the enormous £226 billion annual cost of the NHS. Unless the funding issue is addressed and efficiencies are made, the UK looks set to pay even greater interest on its debt as the markets gradually lose trust in our ability to repay it. Borrowing more from the Bank of England, meanwhile, as we did during the pandemic, risks causing a repeat of high inflation and high interest rates.
Rather than blaming each other for the NHS’s failures, politicians of all colours must work together towards adopting a fair and sustainable healthcare model that provides patients with real choice and dignity.