The road to hell, says DK (of the excellent Devil’s Kitchen), is paved with good intentions. And he’s right. The NHS is a stinking tax vacuum which, if left in the hands of the socialists, will one-day become the largest employer in the world (rather than just in Europe).

But in a previous post I also criticised the US’s can’t-pay-then-die system which is, to put it simply, wrong. In a civilised country it is right that provision of healthcare for those who cannot afford to pay is made from general taxation. If that makes me an impure libertarian then so be it.

But this system does not have to be the NHS. It doesn’t even have to be in place somewhere else. So here’s what I propose:

The railways in the UK were privatised by the last government in the most awful way. Ticket prices are not set by individual operators and so if I buy a ticket from Brighton to London it effectively does not matter which company’s trains I use. This ruins the point of privatisation — competition.

Oops, I just lost some of my audience by talking about privatisation; well come back will you?

The NHS needs genuine competition. The way I propose to introduce that is to allow half of all hospitals in each area to be run privately. Whatever the state spends per patient, the private hospital in the same area would get the same money. The incentive, then, would be to attract patients to your private hospital in order to receive some of that funding. Money that is not required to provide patient care is then made available to the private hospital’s shareholders. The drive for efficiency to create profits would be balanced by the need to attract patients and so be better than the NHS hospital.

The private hospital would be free at the point of use (because it receives matching funding from the state) and would be heavily regulated in the same effective way the financial services sector in the UK is (and which is clearly not working in the US).

Alongside this revolutionary healthcare system would be a change in incentives for drugs companies. Currently there is a clear conflict of interests whereby drugs companies can make more money from treating illnesses than from curing them. So the drug companies need an incentive to attempt to cure ailments. This should be done by using a competitive prize system where prizes are larger than the likely profits from symptom-relievers. I challenge some philanthropist to start up a charitable foundation to fund these prizes — I would happily contribute to that fund!

And finally, let’s be clear, Sicko is not even as unbiased as the BBC; it is a propaganda work which sits on a body of fact and then changes aspects to suit the maker’s own ends. I enjoyed Sicko, I found aspects of it (that are true) disturbing and I found aspects of it laughable. The reactions of British patients and doctors was clearly genuine — Brits do tend to laugh at that sort of question in a way that Americans do not.