Government policy on health seems to take the form of crisis management. Furthermore the crisis being managed tends to be the public's grumbling rather than the public's health.

The optimistic idealistic visions of the mid 20th century and our inability to enact them appear to have cast a long shadow.  Our choice sometimes seems to be between either a perpetual sense of moral failure, or a release into cynical values. While technology and commerce surge on, our political culture has become one of downcast fidgeting and artificial fronts.

Our country today is completely different from that of sixty years ago when the NHS was created. Where is our vision of today for the next sixty years?

I offer the following model  of a future some decades from now. The economy has been growing steadily during this time and we are much wealthier than we are now. In addition  technology has caused the cost of manufactured goods and many services to fall. Healthcare however is still expensive due to its intense use of qualified personnel, new drugs, and people's increased longevity. People can afford the essentials of life and many luxuries and still have plenty of money left over. The choice in front of them is whether to spend this on still more luxuries or on their health.  I suggest that the percentage of the countries GDP spent on healthcare will be much higher than it is today. This will not be a result of something running out of control, but rather a reflection of peoples priorities; an expression of what they want.

A future society in which a much greater proportion of people's income is spent on health sounds benign enough, but the way that the NHS is funded seems to create a constriction to the flow of funds in that direction. The public is not convinced that extra money raised in taxes for the NHS will go where it is needed. They fear that it will be wasted by poor political decisions or an expanding bureaucracy. This sceptical attitude is further encouraged by those politicians who allude to a 'solution to the problem' that will transform an inefficient bureaucracy into an efficient one, and provide all the healthcare that we require without the need for any extra funds. The result is a health service that does not respond to demand.

In practise the NHS in it's present form is flagging in the cause of ever better healthcare, and the baton is being picked up by the private sector. Once a significant number of people are on private health schemes, it becomes even more difficult  for governments to raise taxes for a better NHS and we are locked into a vicious circle.

The record of the private sector in fields such as the utilities, pensions, and insurance causes pause for thought. When these services are mass marketed the competition between companies seems to be less about who can best serve the public and more about who can best bamboozle them. The thought of people having to visit such a jungle in order to arrange their health insurance is one that I find daunting and depressing. If we are to avoid this, it may be necessary to change some of the original principles of the NHS in a way that preserves our status as a humane society while at the same time recognising the realities of today.

We should not be scared to think radically about the future of The NHS; the more ideas that can be aired and discussed the better. A possibility that occurs to me is that the NHS could provide a steadily improving free service paid for by the same taxes as today but further subsidised by a levy charged on an NHS premium service. People could access the premium service either by paying for specific treatment or subscribing to a range of different health insurance schemes, all of which could be designed to be reasonable contracts, and be fairly and clearly presented. These would be more affordable than private schemes because patients would only be paying for the upgrade plus the levy.

Judging by the number of doctors and nurses who cannot find work today it would seem that we do have the human resources to staff both a standard service and a premium service. Those who promote the politics of envy should reflect on whether they are possibly blocking avenues that might be of all-round benefit to everyone.

I know that I am advocating a version of a dreaded two tier health system. I would like to urge people to keep an open mind about whether this has to be a great evil if it is planned in the right spirit. This two tier NHS would be one that was allowed to grow according to demand rather than one bound by a fixed budget, and an individuals natural desire for better, quicker health care need no longer be countered with pious stony disdain.

Such a suggestion as outlined above is controversial in today's climate. The NHS has been described as a national religion, but debate on the subject must not suffocated by any sort of narrow self-righteous dogma.