A Better Alternative to the Prevailing Economic Models in Healthcare

 

1.    The Shift from a Demand Driven Economic Model in Dentistry to a Supply Driven Economic Model

Until very recently, nearly all healthcare was driven by demand. That is to say that people only went to see a doctor if they were injured or unwell and needed medical attention. And the same was true of dentistry. People only went to see a dentist if they had toothache, by which time it was often too late to save the tooth. As dentistry techniques improved and more teeth could be saved if treated early, dentists therefore began to encourage their patients to have regular check-ups, so that they might offer them treatment before they even knew they needed it. Thus treatment started to be driven by those supplying it rather than by patient demand.

What really cemented this trend, however, was the fact that, after the second world war, most countries in the west instituted some form of universal healthcare system funded out of taxation, in which dentistry was usually included. This meant that cost was no longer an impediment to going to the dentist without a perceived need and resulted in a massive expansion, not just of the dental profession, but of the whole dental industry, including both capital and operational dental supplies and research and development into new techniques and materials. The problem was, of course, that this also resulted in a massive increase in cost. Today, it costs around £500,000 to equip the average dental surgery, while the UK dental industry as a whole is worth around £9.62 billion a year.

By the 1980s as a consequence, Britain’s National Health Service (NHS) began to impose restrictions on what dental treatments it would support, which resulted in dental practices providing some treatments for which they billed the NHS and others for which, in whole or in part, they had to bill the patient directly, greatly reducing the take up of treatments in the latter category. By the 1990s, therefore, many dentists decided that in order to preserve their own professional integrity and provide a better service to their patients, they had little choice but to move their practices onto an insurance based model, in which their patients paid monthly premiums to one of the many healthcare insurance companies which then started to appear.

This had two main effects, both of which reinforced the supply side driven economic model of the dental industry. Firstly, it made patients even more determined to obtain the fullest possible service for their monthly premiums, assiduously attending their six-monthly check-ups and happily accepting whatever treatment their dentist recommended. Their dentists, in return, were equally assiduous in ensuring that their patients not only received the best treatment possible but the maximum treatment possible. For while the practice insurer got paid its monthly premiums regardless of whether or not the patient visited their dentist, the dentists only got paid when they actually provided treatment, which they were therefore very conscientious in doing.

The overall effect of all this conscientiousness, however, was once again an increase in cost, which forced the insurers to put up their premiums. This also had two main consequences. Firstly, it made insurance based dentistry far more expensive than it was when I first started using it in the 1990s. Indeed, it has probably now reached a point at which many people cannot afford it. It has also greatly increased the incomes of dentists in insurance based practices. This has meant that more and more dentists have moved into this sector of the industry, leaving fewer dentists working for the NHS. In fact, it is now very hard to find an NHS dentist willing to take on more patients, with the result that, even if one cannot afford it, if one wants to obtain dental treatment, one is more or less forced to register with an insurance based practice and pay the monthly premiums. What seemed like a boon for the industry in the 1990s, therefore, and has certainly led to an improvement in standards of dental care, has thus been of rather questionable benefit to the population of the country as a whole, many of whom have found themselves in a far worse position, as indeed is very often the case when any form of healthcare is funded through insurance.

2.    The American Experience

We can see this most clearly in the case of the American healthcare system, which is very largely funded through insurance and which has resulted in per capita healthcare spending in the USA being more than double what it is in the UK. This is largely due to the fact that, when those in receipt of a service do not directly pay for it, they tend to be more interested in quality than cost, while those who control the purse strings tend to be more interested in whether they can recoup the cost rather than in keeping costs down. The result is that those providing the service tend towards providing the best service they can in order to attract patients, while the insurers then use this high quality of service to justify higher premiums. In fact, both the healthcare providers and the insurers benefit from this arrangement and almost certainly collude in pushing up healthcare costs to levels which, anywhere else, would be regarded as extortionate. They get away with this, however, because it is not usually the patients, themselves, who pay the premiums, but the their employers, who are willing to offer generous healthcare packages as part of their overall remuneration in order to both attract and retain staff.

Not only does this have an overall inflationary effect, however, in that the employers have to put up their prices in order to cover the higher cost of employment, but anyone who is not in employment or isn’t in a high enough paid job to merit such a healthcare package is effectively priced out of the healthcare market. Prior to the introduction of the Affordable Care Act (ACA) in 2010, this was especially true in the case of anyone with a known chronic condition for whom the insurance premiums were even higher.

Indeed, it was for this reason that the Obama administration introduced the ACA, which made it illegal for insurers to refuse to insure applicants based on their medical history or to charge them more as a result. While they could adjust premiums based on location – some areas of the country being inherently less healthy than others – this meant that they had to charge all applicants from a particular location the same average amount based on actuarial tables for that area. The problem with this, however, was that, while paying this average amount for health insurance resulted in a considerable reduction in cost for applicants with chronic conditions, for the fit and healthy it constituted a considerable increase, thereby actually deterring the fit and healthy from participating in the scheme. The result was that, despite fining people for non-participation, participation fell away every year for the first few years during which the ACA was in operation, forcing insurers to further increase the premiums for the mostly older and less healthy people who remained, thus deterring the fit and healthy even further.

In fact, the only way that Obamacare could be stabilised and saved was by increasing the income threshold under which people qualified for Medicaid, with the result that the federal government  effectively ended up subsidising people’s insurance premiums. What this also did, however, was create a new hybrid system which combined America’s traditional insurance based model with the taxation based model generally found in Europe. Because the system is still driven by the insurers, however, who have simply found another way to recoup the exorbitant costs passed on to them by the healthcare providers, it has done nothing to contain those costs which continue to spiral out of control.

3.    Supply Side Pressures in the Universal Healthcare Model

If the American, insurance based economic model for healthcare is thus one to be avoided, the European model based on taxation also has its problems, which are largely due to the fact that the purse string holders in this case are governments, which have their own agendas for healthcare. These almost invariably lead to supply side pressures on the service which are seldom conducive to economic sustainability.

A good example is the British National Health Service which, due to an accident of history, actually started off very well in this regard. This was because, unlike hospitals, which have always had itemised accounting systems, which they have always used to generate itemised bills for whoever was paying them – which, today of course, is the NHS – general practitioners have traditionally tended to conduct their business in a much more haphazard way, typically charging their wealthier patients significantly more than they charged the poor, many of whom they often treated pro bono. Given this extreme flexibility in their charging practices and the enormous range of fees charged in different parts of the country, it was therefore very difficult for the NHS to work out a common basis upon which to pay them.

Just as importantly, the new fledgling NHS did not want to burden the thousands of GP practices throughout the country with having to generate itemised bills for the first time or, indeed, create a new accounts department of their own in order process these itemised bills, both of which would have added a significant amount of cost to the service. The answer they came up with, therefore, was to pay all participating GPs a flat rate for every registered NHS patient they had on their list: a cheap, simple and pragmatic solution which also had the benefit of ensuring that the service would be entirely demand driven. For given that GPs would be paid this flat rate regardless of whether or not they saw the patient, they had no reason to drum up trade by offering supply side inducements. Indeed, the perfect patient for a GP under this system was one he never actually had to see.

The problem with this, of course, is that those who pioneered the creation of the NHS and continued to promote it didn’t just do so in order to provide free medical care for all at the point of use but also to improve the nation’s health, an objective which was seen as requiring something a little more proactive than simply providing everyone with a GP to whom they could turn for free advice and treatment whenever the need arose. The problem with this, however, was that determining what needs to be done to improve the nation’s health is a lot more complicated than diagnosing what is wrong with an individual patient and deciding on treatment, not least because, being multifaceted, it is a problem that has to be tackled from a number of different directions.

That’s not to say, of course, that many of the factors affecting the health of the nation had not already been identified long before the creation of the NHS. With the establishment of the Ladies Sanitary Reform Association in 1862, for instance, it had already been recognised that the nation’s health was largely determined by a combination of living conditions and education. By the 1890s, as a result, this had led to many local councils employing Health Visitors, whose job it was to visit families with children, advise mothers on such matters as hygiene and nutrition, and provide regular checks on the children’s development.

Instituting programmes of vaccination and screening had also long since been recognised as ways in which the nation’s health could be significantly improved. The first ever vaccine for smallpox, for instance, which set the world on a path towards eventually eradicating the disease, was developed by Edward Jenner as early as 1796. Admittedly, it wasn’t until the 20^th century that the first tests for screening purposes were developed, but even this practice was well established before anyone ever conceived of instituting a national health service. The first test to screen for syphilis, for instance, was introduced in 1906, just a year after the Treponema pallidum bacterium had been isolated by Schmudinn and Hoffman. What the NHS did was provide a vehicle through which these and many other approaches to improving the nation’s health could be coordinated and rolled out at a national level.

This did not mean, of course, that, with the founding of the NHS, a national health improvement programme was put in place overnight. At first, it was more of an evolutionary process which unfolded as and when issues arose and solutions became available. Screening for cervical cancer, for instance, one of the biggest causes of early mortality among women, didn’t begin in Britain until 1964 and screening for breast cancer didn’t start until 1988. Even more surprisingly, Health Visitors weren’t incorporated into GP practices until 1974. It wasn’t until after 1997, in fact, when the Blair government began instituting its large scale reforms of the NHS, that we began to see the kind of joined-up, comprehensive approach to improving the nation’s health that, today, is almost taken for granted. Nor should it come as a surprise that the key factor in this was a change to GP contracts, such that, instead of merely being paid for the number of patients GPs had registered with them, they were both required and incentivised to be more proactive by engaging in a whole range of new supply side initiatives, from offering old age pensioners annual winter flu jabs, to inviting patients to join national screening programmes, to holding specialised clinics targeted at specific groups, ‘mother and baby’ clinics being one of the most common and popular.

If this sounds like we were finally approaching the ideal primary healthcare system, however – as the Blair government clearly dreamed it would be – it is because we still haven’t yet realised that by transforming GP practices from the usually rather small, demand side driven operations they had previously been – typically comprising a couple of doctors and a shared secretary/receptionist – and turning them into the multi-facetted supply side driven operations they have now become, we didn’t just increase the number and variety of clinical interventions they were able to perform, we added a whole new layer of complexity to their management and administration, thereby greatly reducing their efficiency and adding to the cost of each intervention. 

Worse still, all this additional activity within the primary healthcare sector inevitably led to more referrals to hospitals and other second tier facilities, putting upward pressure on demand throughout the NHS, to which it was largely unable to respond by being more efficient. Indeed, to many staff within the NHS, the demand for greater efficiency is more or less equated with a demand for compromises to the service provided and is therefore widely resisted. What’s more, given that increased demand without a commensurate increase in either efficiency or resources does, indeed, tend to result in a poorer service – in this case longer waiting times – the public tended to agree with NHS staff on this matter, putting pressure on the government to increase NHS spending which few governments have been able to resist.

The really bad news, however, is that this greater emphasis on preventative medicine and on supply driven healthcare services played perfectly into the hands of the pharmaceutical industry which was more than happy to exploit it.

4.    The Malign Influence of Big Pharma

It is a common misconception that the mission of pharmaceutical companies is to develop new medicines to cure disease. Curing disease, however, is the last thing they want to do. For the moment one cures someone’s disease, they stop taking whatever medicine one was selling them to obtain this outcome. While pharmaceutical companies may still produce medicines that do, in fact, cure diseases, this, therefore, is largely for PR purposes. They make most of their money and put most of their research effort into developing treatments devoted to two non-curative aspects of healthcare.

The first concerns the development of prophylactics designed to prevent otherwise fit and healthy people from contracting diseases of which, in many cases, they have been deliberately made unduly afraid, a subject to which I shall return shortly. The second is to provide people who have chronic and incurable conditions with drugs that either ameliorate their symptoms, pain killers being the most obvious example, or regulate some physiological or biochemical process, drugs to reduce blood pressure being among the most common.

From the point of view of the pharmaceutical companies, the great thing about this latter type of medicine is that once they have got patients hooked on a particular non-curative treatment, in most cases the patients will go on providing them with an income stream for the rest of their lives. Given the west’s aging population, moreover, there are no end of chronic and incurable conditions to exploit. All the pharmaceutical companies have to do, therefore, is ensure that GPs adequately screen their patients for these conditions and prescribe the appropriate drugs: a requirement which, as it happens, is already largely addressed by the NHS’s Quality and Outcomes Framework, under which GPs can qualify for additional payments if they fulfil certain conditions with respect to such issues as the management of hypertension and prescription safety. By simply ensuring that hypertensive patients undergo regular blood pressure tests and then adjusting their medication accordingly, a GP will consequently qualify for additional payments under both of these headings.

Fair enough, you might think: it aligns perfectly with the government’s policy of improving the nation’s health through preventative medicine. The problem is that, according to the government’ own website, these additional payments can be worth as much as 10% of a GP practice’s overall income, more than a billion pounds a year across the NHS as a whole. What’s more, this sum does not include the cost of the medication prescribed.

Indeed, so lucrative is the Quality and Outcomes Framework for both GPs and the pharmaceutical industry that one can only wonder how and by whom the NHS was talked into paying for it. Of course, the justification will have been that, by constantly monitoring chronic conditions such as high blood pressure and adjusting treatment accordingly, lives are saved. Having personally experienced the persistent pressure my own GP has put on me to come to the surgery to have my blood pressure tested, however, I cannot help but think that these tests are more in the interests of the practice than my own. Indeed, it is what first prompted me to do some research into this matter, which, in turn, has led to the writing of this essay. For looked at in a certain light, it could be said that, by incentivising GP practices to proactively pursue patients with chronic conditions, the Quality and Outcomes Framework has basically turned them into sales operations for those who manufacture the relevant treatments, making the NHS, the drug companies and GPs co-conspirators in what could almost be described as a fraud on the taxpayer.

What’s more, the same could also be said about the way in which GPs are now used to proactively promote the most common form of prophylactic: vaccines.

Again, my observations on this subject are largely drawn from personal experience, but having finally succumbed to the pressure my GP was putting on me to have my blood pressure tested, I recently visited the surgery to make the necessary appointment. To my astonishment, however, the first thing the receptionist did, after she had brought my details up on her computer, was try to ‘sell’ me three different vaccinations: one for influenza, one for pneumonia, the other for shingles. When I declined all three, moreover, stating quite clearly that I just wanted to make an appointment for a blood pressure test and wasn’t interested in anything else, she was both shocked and offended, having almost certainly been told that the vaccines saved lives, that only the ignorant and misinformed refused them and that it was her duty, therefore, to overcome such ignorance and ensure that everyone who was entitled to them got them. What she would not have been told, of course, is that the practice got paid for administering these vaccinations and that it was yet another very lucrative side-line.

More to the point, she would also not have been told that the main reason her GP practice was being paid to promote these vaccines was that, in December 2022, the US pharmaceutical company, Moderna, signed a ten year contract with the British government to produce 250 million mRNA vaccines a year in the UK, a certain percentage of which would be bought by the NHS. Indeed, it is hard to imagine that such a deal could have been done without both a captive market and contractual guarantees of this kind, meaning that the NHS now has no choice but to ‘sell’ these vaccines to its patients, using GPs and other staff in GP practices as its sales force.

What makes this even more disturbing, however, is the fact that, unlike the collusion between the NHS, the drug companies and GPs over the monitoring of chronic conditions, where no one is likely to be hurt, mRNA vaccines are inherently dangerous. As I explained in a previous essay on the Covid pandemic, this stems from the fact that while all vaccines not orally administered are intended to be injected into a muscle, occasionally the needle enters a blood vessel, the evidence for which is usually a small spot of blood at the puncture site. In the case of traditional vaccines, this is not a problem because they actually contain the antigen to which we want the immune system to respond and to which it responds in exactly the same way whether it is encountered in a muscle or the bloodstream. This is not the case, however, with respect to mRNA vaccines, which only cause the antigen to be produced when the mRNA molecule enters a human cell and issues the necessary instructions.

In fact, one of the biggest obstacles scientists had to overcome in perfecting mRNA technology was not in engineering ‘messenger’ RNA molecules to deliver the required message, but in actually getting the mRNA into human cells in the first place. For in their natural state, mRNA molecules would naturally be regarded as foreign substances by the immune system and would themselves be attacked if they were not protected in some way. The solution scientists came up with was therefore to encapsulate the mRNA in lipid nanoparticles, which the immune system does not see as alien and which also aids the absorption of mRNA molecules by the recipient cells.

What this also means, however, is that once a lipid-coated mRNA molecule has got into the bloodstream, it can travel anywhere in the body unmolested. And one of the places through which all surfers of the bloodstream pass, of course, is the heart, to the cell walls of which the mRNA molecules then attach themselves. They are then absorbed into the cells and instruct them to produce the desired antigen. This is then expressed on the surface of the cell where it is attacked by the immune system, causing inflammation to the cell itself: a condition which, in the heart, is known as myocarditis, which just so happens to have been one of the main causes of non-Covid related excess deaths during the Covid pandemic.

Of course, there are people and organisations, including most governments and most of the mainstream media, who continue to deny that there were any non-Covid related excess deaths during or after the Covid pandemic. Apart from the research I did on this myself, however, and which I included in the above mentioned essay, there have now been multiple studies conducted all over the world which have concluded that thousands of excess deaths have occurred since the introduction of mRNA vaccines and that the most likely reason for this is the one I have just outlined. And yet here we are, three years on, and the NHS, the pharmaceutical industry and British GPs still continue to promote these vaccines.

Each year, in fact, millions of them are being given to patients who have no idea of the risk they are taking. The problem, however, is not just this high level of ignorance among the general public, which has always existed and which has always meant that patients have never really had much choice but to place themselves entirely in the hands of their doctor. The difference is that, in the past, they only went to see their doctor when they had a problem, such that the act of placing themselves in their doctor’s hands was not just voluntary but active. In the predominantly supply side driven healthcare system that has developed in Britain over the last two decades, however, people are herded into conformity in a way that makes them almost entirely passive. And although they are told that what is being done to them or given to them is for their own sake, in reality it is mostly for the benefit of the system itself, enabling it to thrive and grow at what is often the expense of the host upon which this new parasitic organism now feeds.

5.    The Alternative

Of course, it will be pointed out that this inversion of roles is not unique to the NHS. Indeed, it can happen in almost any bureaucratic organisation in which the staff lose sight of the bigger picture and start to regard the organisation itself, its reach and effectiveness, as an end in itself. What is often missed in making this observation, however, is that it can only happen in supply side driven organisations. It cannot happen when the organisation’s staff is constantly being reminded by the general public, its customers, that those providing the service are there to serve us, not we them.

Of course, it will be further objected that in the case of healthcare, we, the customers, are hardly in a position to tell healthcare professionals what we want; it is their job to tell us what we need. In structuring the relationship in these terms, however, not only do we put ourselves in an extremely invidious position, but we also underestimate our ability to make our own judgements.

To better appreciate this, just ask yourself one simple question: Would you consent to being given an influenza vaccine if you had to pay £50 for it?

£50? That’s not a lot. But it is enough to make you think: to make you ask yourself whether it’s worth it and to ask others what they think. You might even try to find out how many people die of influenza each year in Britain and which groups are most at risk. If you’re smart, you’d also probably want to find out how effective the vaccines are. After all, you don’t want to pay your £50 and still get the flue. Finally, you might try to find out whether there is any downside to getting the vaccine: whether there are any adverse reactions from which you might suffer. For, being self-inflicted, that would be even worse than still contracting the virus.

The point I am trying to make here, however, is not just that paying for something makes us weigh up the pros and cons about taking it to a far greater extent than if we are just given it, but that we are actually much better at doing this than we generally imagine, even when it comes to something like healthcare. Even more importantly, our tendency to just take whatever we are given, rather than question it, not only means that we effectively abdicate our responsibility as sovereign adults to make our own decisions, but that we hand over all power in these matters to those who are doing the giving, especially in cases in which we have already admitted to the superiority of their judgement. Worse still, having already subordinated ourselves to the healthcare professionals, pharmaceutical companies and NHS managers who not only run the system but control what it does, they then feel empowered to scare or otherwise coerce us into complying with their superior judgement, just as they did with respect to the Covid vaccines.

The unpalatable truth, therefore, is that the only way for ordinary people to have any control over their healthcare is to return to a demand side driven system in which we, the customers, pay for our healthcare, not through taxation or insurance, but out of our own pockets at the point of use.

Of course, at this point, most people will throw up their hands in horror, it being most people’s worst nightmare that they could get injured or become ill and not be able to afford the medical attention they need. If both of the two prevailing economic models for funding healthcare are as seriously flawed as I hope I have already demonstrated, however, there is an alternative model, which, as far as I can see, is entirely free of these flaws. In this model, the funding is provided through savings.

At present, every person in employment in the UK pays around 21.8% of their salary in National Insurance (NI) contributions. The employee pays 8%, the employer 13.8%. On an average pre-tax salary of around £36,700, this amounts to about £8,000 per year in nominal contributions towards our healthcare and state pension. The truth, however, is that the money simply goes into general taxation. There is no pension fund into which the money is paid and none of it is hypothecated to healthcare.

With respect to the state pension, this is a particularly egregious situation in that most people assume that a proportion of their NI contributions go into a pension fund that will one day pay their pension. In fact, all the money goes to pay the pensions of current pensioners. In this respect, it is therefore a Ponzi or pyramid selling scheme in which the payments of current contributors are simply used to pay the scheme’s current beneficiaries. Should the scheme ever fail or collapse, as it almost certainly will, current contributors will therefore find that there is no money in the scheme from which to pay them when it is their turn to benefit from it. If the scheme were run by anyone other than the government, in fact, it would be regarded as a classic case of fraud.

Now consider what would be the result if, instead of paying NI contributions, one took that same £8,000 per year and actually paid it into what I shall call a personal Pension & Healthcare Savings Account (PHSA), out of which one would then pay both one’s medical bills and one’s pension.

The question, of course, is whether, over a typical working life of say 40 years, one would be able to save enough to meet these requirements. This, however, depends on interest rates. At inflation plus 2% compound interest, for instance, the sum one would have accumulated by the time of one’s retirement would be £492,880 in today’s money, less any medical bills already paid, which would probably not be quite enough to cover both one’s pension any healthcare costs in old age. At inflation plus 4% compound interest, on the other hand, one would have £790,612 in real terms, which for most people, I am fairly sure, would be more than adequate.

Of course, achieving this outcome would depend on the government keeping inflation low – less than 2% and preferably no more than 1% – while keeping interest rates relatively high, which is something they may be loath to do. In fact, it would almost certainly put an end to the last thirty years of Modern Monetary Theory in which governments throughout the west have continually reduced interest rates in order to stimulate demand: a practice which, while failing to produce its intended consequence, has had such a catastrophic effect on the level of debt within most western economies. The need to keep interest rates high enough to build up sufficient PHSA funds, in contrast, would force banks and other financial institutions to strike a more equal balance between the needs of PHSA savers and the needs of borrowers, such as house buyers, thereby putting an end to the reign of central banks in setting interest rates for purely macro-economic purposes.

Of course, it will be pointed out that the scheme, as I have so far outlined it, also fails to take into account the fact that if one were faced with significant medical expenses early in life, this would not only reduce the capital in one’s PHSA, but this loss would be further compounded by the loss of multiple years of interest on that capital. If all payments into a PHSA were made pre-tax and had no upper limit, however, this would encourage people to make larger payments when they were able to do so, thereby enabling them to optimise their PHSA to their own needs. Because each individual’s PHSA would be their own – rather than something controlled by the state – people would also be able to choose their own retirement age, retiring early if they thought their fund was large enough or working longer if they thought they needed more time to build it up.

Of course, it may be argued that, in some cases, this may encourage people to retire at an irresponsibly young age. Not only is there no reason why people should not go back to work again if they discover that they have made a mistake, however, but the salutary mistakes of others very often engender caution and a far more responsible attitude to planning for our future.

Another potential problem is that of paying the medical bills of those who have yet to start a PHSA or who have not yet built up enough funds to cover current healthcare costs. This problem could be at least partially solved, however, by the fact that, although one would not be able to use the money in a PHSA to pay for anything other than healthcare or a pension – in that this would almost certainly lead to abuses of the PHSA’s tax-free status – there would be nothing to stop people using the money to pay for other people’s healthcare, particularly that of their children and other family members.

It is also worth pointing out that because an individual’s PHSA would be their own, any money left in it after their death would form part of their estate, on which no tax would be levied if it were paid into another PHSA. In this way, young people would be able to inherit a lump sum with which to get their PHSA started rather than have to start from scratch.

Indeed, I am fairly sure that, with a little imagination and ingenuity, any potential obstacles to implementing this alternative economic model for both healthcare and pensions could be overcome, especially if people were also encouraged to give money to charities designed to plug any gaps in PHSA coverage or the adequacy of any particular individual’s fund. The real problem – and I admit that there is one – stems rather from the fact that the change from a taxation based model to a savings based model would require an enormous transition period. I say this because, had we adopted this system in 1948, when the NHS was founded, people of my generation would now be sitting on quite substantial healthcare and pension funds, whereas, having paid most of our potential savings into a Ponzi scheme, we now have nothing to show for it and therefore require other people to go on paying money into the same Ponzi scheme in order for us to continue receiving free healthcare and state pensions. This means that it could only be new entrants into the system who would be allowed to open a PHSA; the rest would have to continue paying NI contributions.

Even this, however, doesn’t entirely solve the problem. For even after my generation of baby boomers dies out, there will still be at least two more generations who are going to be dependent on an ever diminishing pool of NI contributors, until the very last NI contributors enter retirement, after which there will be no more NI contributors to support them.

Not that, under different circumstances, even this would not have made the problem intractable. For while, under this new scheme, the average £8,000 per year which people currently pay in NI contributions would no longer be going to the government, this money would not have disappeared or ceased to exist; it would simply be going to the banks and other financial institutions which provide PHSAs and which would therefore have additional funds to invest in such financial assets as UK Treasury bonds, of which a new class of bond might well need to be created. This is because these new bonds would have to be both long term – in order to obviate the need for the government to start redeeming them before its liabilities under the current Ponzi scheme had been fully discharged – and of sufficiently high yield to attract investment from precisely those financial institutions that have the funds available but need a high yield in order to meet the interest requirements of their PHSA savers.

In short, the very same money which the government currently accesses through taxation could thus be made available for it to borrow. The problem, of course, is that, with the UK’s national debt already standing at over £3 trillion, no government would ever even contemplate additional borrowing on this scale. For if it did, it could very quickly find itself bankrupt. The main reason for this, however, is that we have spent so many years running, not just the NHS, but all our public services on a supply side driven basis, spending money we don’t have on services we don’t need and wouldn’t pay for out of our own pockets, that we are already so close to complete financial collapse that we no longer have the financial headroom to change course.