The welfare state is out of date. The principle of 'Free at the point of delivery' must be replaced by 'Paid for at the point of delivery', so that those who can afford to pay for their healthcare and children's education do so in proportion to their earnings. The result, argues Ross Harvey, would be huge savings as market efficiencies are introduced to moribund sectors, without leaving the country's poorest behind.

After the Second World War, few people had a bank account. They were about one third as rich, had ten years less life expectancy, penicillin was the most expensive drug and a hip operation wasn’t even the stuff of sci-fi yet. So the state had to contrive a cashless system for the nation’s welfare and ‘free at point of delivery’ was born. This required a bureaucracy that over the years has fed on itself and is now so large that there is no template for its management and its expense devours funds needed at the coalface. It is a property of technology that it replaces people but change is the only constant and the only serious alternative to wider mpoverishment.

The sacred formula ‘Free at point of delivery’ must be stood on its head to become the next big idea ‘Paid for at point of delivery’ – except for those whose income tax returns entitle them to get it for free. Whatever the cost, the amount you pay will depend upon last year’s income tax return.

"Smartcard" technology has recently made great strides. The French are experimenting with giving every individual a smartcard with their complete medical history on it. This, in the land of the grand projet, is surely a more practical approach than our own absurdly grand projet of a centralized computer database that has already cost billions and is, apparently, still nascent. Such a smartcard could link to Inland Revenue records of last year’s income tax return and so access a new reading every year. This is not a measure of net worth* as it entails no further intrusion than has already been undertaken to tax one. [Continue reading]