People in England should be forced to pay a £10-a-month NHS "membership charge" if we want to save the service from ruin, according to a new report by the think tank Reform. 

Solving the NHS care and cash crisis also recommends that people staying overnight in hospital should pay ‘hotel charges’. 

Reform, which has long advocated free-market reforms to the NHS, is funded by companies which would benefit greatly from the introduction of changes to the way we pay for healthcare. These have included General Healthcare Group, the UK’s largest private hospital firm, but more significantly a large number of corporations in the private health insurance industry. 

In recent years Reform has been funded by: Prudential, Legal & General, Scottish Widows, Aviva, Benenden insurance, Gen Re (reinsurer of health products) and US health insurance giant UnitedHealth, which has faced accusations of overcharging and malpractice. The industry’s trade body, the Association of British Insurers, is also a donor. 

Prudential was Reform’s most generous funder in 2012, handing over £67,500. What it received in return is not known. Reform describes itself as determinedly independent and states that none of its research is funded by either companies or individuals.

However, in the mid-noughties, a lobbyist for Standard Life Healthcare, which is now part of PruHealth, grumbled about the communication challenge facing the private healthcare industry (page 6 of pdf). When money for health services is tight, how to get more British people to buy private health insurance, without being seen to undermine the NHS, was proving difficult. 'The problem we will always have is that we’ll get accused of “Well you would say that, wouldn’t you?”’ he told an industry roundtable on the Future of Healthcare.

His proposed way of getting around this challenge was to use third parties: ‘It’s actually not us who needs to be saying it; we need other people to do so.’ The lobbyist confirmed that the private health insurance industry was working to ‘get some of the think tanks to say it, so it’s not just us calling for reform, it’s professionals, it’s outside commentators . . . it does need others to help us take the debate forward’.

Reform has led much of the debate on how the NHS should be funded in future. For years it has called on government to ‘grasp the nettle’ and introduce radical changes, such as user charges for health services and a bigger role for private health insurance. In 2009, for example, as the country prepared for a general election, it produced a report on the ‘Future of Health’. This advocated a greater use of ‘insurance-based private funding’ in Britain’s health service. It was co-sponsored by PruHealth.

According to today's report by the think tank: “There is an urgent need to open up a public debate on the way we provide and pay for health and social care.” It calls for a “Big Conversation” with the public, which it says needs to be conducted “in a grown-up way without beating up politicians who raise [the issues] in public”.

A public debate on the NHS is one that we should all be demanding. If there is not enough money to support the service – the desperate crisis in funding is disputed, although the cost to the NHS of introducing some free-market reforms, such as PFI, is not in dispute – we need to have a discussion on how we are to fund and access healthcare. Politicians are inclined to avoid leading this debate. But, in their absence, it look as though it is being led by the private health industry.  

So, let us begin by being up front about who is speaking and why. If the insurers are putting their words in the mouths of seemingly independent bodies like think tanks, who have both political influence and can command significant media attention, this is not a good place to start.

A Quiet Word: Lobbying, Crony Capitalism and Broken Politics in Britain by Tamasin Cave and Andy Rowell is published by Random House.

 This article is cross-posted from Spinwatch with thanks.