Might be a controversial opinion over here in the UK - where you've been used to having free-at-the-point-of-access to the NHS for decades - but I think for the long term health (excuse the pun) of the NHS, we should switch to a means-tested system. Retain the existing NI / tax funding, retain free-at-access for those who do not have the means to pay, but for those who are better off switch to a subsidised system where those individuals who can afford to pay do so on a sliding scale dependent on their ability to pay.
I would also suggest that for those who can afford it, we should be encouraged to get private health cover. The NHS and private health should provide the same levels of cover, but the only way to achieve that IMO is to move more people into the private system and take some of the pressure off the NHS. Perhaps one way to do that is to legislate that employers must provide private health care to their employees who earn over a certain amount (tie it to existing thresholds, such as when Child Benefit gets phased out). Payment to be taken from the pre-tax salary. Wouldn't be too hard to do - a lot of employers already give their employees the option of doing this, it would just be a shift to having it mandated instead.
And yes, under the above ideas I would be one who would be (at least partially) "paying my own way". And I would happily do so.
I would also suggest that there should be some cases where "free-at-access" can be waived and an individual forced to pay full whack. It's harsh, but if someone goes out on a Saturday night, gets sloshed, and falls over breaking a leg or something stupid like that ... they should be (if they can afford it) be paying the full cost of their treatment. Ambulance call outs aren't cheap, it's high time people in this country became a little more aware of what it costs the NHS when they choose to do something stupid and end up needing an ambulance trip. (Been there, done that, got the hole in my bank account a little over 20 years ago in Australia).
In the German system you pay 14% of your salary (split between employer and employee) but can opt out of this and get private health insurance. This obviously becomes attractive to higher earners as private becomes a cheaper option than paying 7% of your salary.
I really don’t agree with your forced-to-pay-full point though. Care should be provided on medical need and medical need alone.
My take on all of this is health care is actually very routine and very simple. Care itself isn’t really the issue, it’s how it’s provided, managed and funded. What makes it such a mess in the U.K. is under-funding and repeated political and ideological driven reforms, re-structuring and centralisation. I’d take one of the many successful health care management models used around the world, work out how much it will cost to run in the U.K., work out what percentage you all need to pay to fund it and have this as a separate ring-fenced health tax. I’d have an independent body running it. Job done and move onto fixing education.
Last edited: