A few more people who appear to have understood the NHS debate

I am generally pretty despondent about the standard of the debate between politicians, and in most of the MSM and even large parts of the 'blogosphere, as most people appear to think that there is a stark choice between a "free at point of use" State-monopoly NHS and a US-style system (that by all accounts appears to be just as awful, except for different reasons), while completely overlooking the vastly superior models in other European countries (and many other places in the world), the key to these being a complete separation of the 'funding' and 'provision' sides.

I'm happy to say that I stumbled across a few more people who have grasped this basic point, and hence addressed each issue separately today.
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Nigel Sedgwick kicked off his comment on a fairly indifferent post on the Adam Smith Blog with this:

On the issue of the NHS, there are at least two very important and entirely separate questions.

Firstly, there is the issue of whether we should have a universal welfare system for healthcare (beyond just accident and emergency). With such a welfare system, payment is made as currently in the UK, through taxation according to income, with equal benefit accruing to every resident citizen (and to many other residents beside), irrespective of income and of tax paid.

Secondly, there is the question of whether that healthcare should be provided through hospitals run entirely by central (or other) government, or whether there should be an insurance based system (as with current private healthcare) with hospitals run privately or by charities (and perhaps also by government), with patients freely choosing which hospital to use...

And follows this up with his own very sensible suggestions and illustrations of how it could work, and how similar systems work in other countries.
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Charlotte Gore had this to say:

The real debate comes into the nitty gritty of who runs the hospitals and employs all the doctors and nurses. It’s here we’ve got room for manoeuvre to make the NHS better. For example, why does the state need to run all the hospitals? The answer is that it doesn’t. The chapter on health care in the Orange book made a very compelling case for an insurance model, where each individual treatment is paid for by medical insurance and the money goes to whomever the patient chooses to carry out the treatment for them - rewarding good efficient hospitals and seeing to it that the people running bad hospitals get fired.

You can have multiple insurance providers competing with each other - in fact that’s almost certainly essential. You can have private hospitals, too. All of them can be private, in fact. The difference is the state would only get involved to subsidise people’s insurance premiums when they can’t afford to pay them.

In other words, you can radically change the way medical treatment is provided without removing the basic ‘universal, free at the point of use’ element. The rewards from such changes are obvious - the cost of medical care should come down and the quality of care should go up. If we look at the Singapore model and the Dutch Model we can see how these sorts of systems do deliver better outcomes...

I'd mark her down for the idea that the state would only subsidise insurance payments for lower income people; that smacks of means-testing to me, a particularly spiteful form of taxation on anybody who does their bit to stay out of poverty - such payments should be universal or not at all, but apart from that, good stuff.
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Finally, Subrosa Blonde went into some detail on how the German system works (and why it's better):

There are those who say '[The NHS is] an entity admired the world over', what nonsense. Which other country has adopted the British system of healthcare? None. If it was so admired surely there would be at least one or two.. Let's get one fact straight; it is not free, but free at the point of delivery. It is paid for by NHI contributions from those who work and further subsidised by the treasury (taxpayers)...

I doubt if many who 'love the NHS' have ever had the (mis)fortune to use the healthcare system of any other European country because if they had, they would realise the NHS is failing in many ways and it is by no means perfect. We have some of the worst results for the treatment of cancer and heart disease in Europe and we (parts of Scotland in particular), have the worst results for longevity. Other countries have similar social problems yet they provide better healthcare.

In Germany for example, blood test results are usually available within 24 hours. My GP here tells me to telephone in a week. There is no extensive waiting time for specialist appointments in Germany where 90% of the population contribute towards around 1,000 semi-private, fiscally independent, sickness funds (only 10% use private commercial insurance). The premiums are calculated on an 'ability to pay' basis and joining a fund is compulsory...

The NHS is Britain is now nearly 10% of GDP, a similar figure to Germany. So often we hear that the present problems within the NHS are caused by the increasing elderly in our population: 15.5% of Germany's population are over 65 with the UK's just slightly higher.

I have used the example of Germany because I have experience of their healthcare system and its quality. It still surpasses the best Britain can offer by way of results and it is not as expensive as the figures bandied around by politicians. It is not my intention to suggest we adopt the same system as Germany or any other European country, but we need a debate about healthcare...

Billions of pounds have been poured into a healthcare system in past years and we see little improvement by way of results. Of course we have some shiny new hospitals but it is the treatment which matters. If we want the treatments that produce the best results, we have to look and listen to those who work in our system, medics and nursing staff - they know what is needed, not politicians. It is the job of politicians to decide the best way to fund a system without interfering in the running of it.

I'd mark her down for suggesting that National Insurance contributions (about £80 billion a year) pays for the NHS (cost > £100 billion a year), because aren't National Insurance contributions also supposed to pay for old-age pensions (about £70 billion a year)?, and for the fact she doesn't seem to emphasise that all health providers in Germany are competing (on quality rather than on price, of course).

Sure, apart from GPs and small practices which are owned privately, German clinics and hospitals are usually owned by insurance companies (particularly health insurers), by local councils, universities, trade unions, churches or charities, but they are still competing for the same patients, and that is the main thing.