Why REFORM’s Insurance Model is a Dangerous Fantasy

 The Unravelling of a Promise: Why REFORM’s Insurance Model is a Dangerous Fantasy for the NHS

 

 

It is a truth universally acknowledged, if not always loudly stated, that the National Health Service is more than just a healthcare provider to the people of the United Kingdom. It is a cornerstone of our national identity, a post-war covenant that binds us together. It is the promise that from cradle to grave, your health will be cared for based on need, not on the size of your wallet. This principle is woven into the fabric of our society, cherished by voters across the political spectrum, from lifelong Labour supporters to One Nation Tories.

This is the fundamental reason the insurance-based healthcare model championed by parties like REFORM is not just politically untenable, but a dangerous fantasy. Their proposal is not a new idea; it is a tired, imported concept that fails its first and most critical test: it does not understand Britain.

The emotional and ideological argument is clear, but the practical one is even more damning. Put simply, REFORM’s sums do not add up.

Proponents of an insurance system point to models in other countries, like Switzerland or the Netherlands, as beacons of efficiency. What they gloss over is the eye-watering cost. These systems rely on a complex web of mandatory private premiums, co-payments for GP visits, prescriptions, and hospital stays, and significant state subsidies to keep them afloat. The administrative overhead alone is staggering, with vast sums spent on advertising, profit margins, and negotiating contracts—money that in the NHS goes directly towards patient care.

Let us break down the fantasy:

1. The Myth of ‘No New Taxes’: Transitioning to an insurance system would be astronomically expensive. The upfront cost of dismantling the NHS bureaucracy while simultaneously building a new, labyrinthine regulatory framework for private insurers would run into tens of billions. Where would this money come from? Either through massive government borrowing (contradicting their rhetoric of fiscal responsibility) or through new, stealth taxes to fund the necessary subsidies. The promise of a low-tax, insurance-based system is a mathematical impossibility.
2. The Hidden Costs on the Public: REFORM’s model might promise to protect the “core” NHS, but the logic of insurance is one of risk and exclusion. To make a profit, companies must charge higher premiums for older people, those with pre-existing conditions, and those in risky professions. The idea that a 70-year-old with diabetes would pay the same monthly premium as a healthy 25-year-old is pure fiction. The British sense of fairness would be shattered by a system that actively punishes the sick and the elderly for their misfortune.
3. The Administrative Black Hole: The NHS, for all its challenges, has one of the lowest administrative overheads of any major health system in the world. Introducing multiple competing insurers would create a duplication of management, sales teams, claim assessors, and billing departments. This does not create efficiency; it creates a parasitic layer of cost that sucks funding away from nurses, doctors, and hospitals.

The allure of the insurance model is often sold with the language of “choice” and “competition.” But what choice does a patient having a heart attack really have? They go to the nearest A&E. Healthcare is not a consumer market like buying a mobile phone; it is a public service, often used at our most vulnerable.

The real debate we should be having is not about replacing our model, but about responsibly reforming and properly funding the one we have. This means a serious, cross-party conversation about sustainable funding, integrating social care, and streamlining services. It requires ambition and political courage, not a reckless leap into a system that has been rejected repeatedly by the British public.

The NHS is not a failed business model; it is a beloved national institution. Proposals to replace it with an American-style insurance system are not just politically toxic, they are built on a foundation of fiscal fairytales. The British people are not naive; they can spot a bad deal. And REFORM’s numbers simply do not add up. To gamble with the health of the nation on such a flawed prospectus is not just irresponsible—it is un-British.