The funding model should be through individually rated public health contributions, not a flat rate on general taxation. The people that don't smoke, don't end up in the casualty dept pissed out of their minds or drugged up on a Friday night, and who maintain a sensible weight, should get a discounted level of contributions. All the idiots who clog up the system due to their behaviour should pay extra. Give everyone an annual health check at the doctors, and set their contribution level for the following year based on how healthy they are. People would soon take the NHS more seriously if the ones who create the burden had to pay twice as much NI contributions than those who take better care of themselves.
That's one of those things that sounds like a really sensible idea, but is a very dangerous road to go down.
Firstly, it means that you could be paying a lot of money for one mistake all your life. You could argue that's just and fine, but it gets a bit grey after a while, and it's impractical. A depressed person who OD's once and can't work but needs more healthcare is unable to pay higher contributions, but by this argument he would be forced to or would be thrown on the streets.
And where do you draw the line? If someone has heart disease but hasn't exercised to the government minimum standard for at least 10 years, do they have to pay more?
How do you prove how much you've exercised? Perhaps we could chip people.
What about people who "choose" dangerous jobs because that's all that is available? Would they be charged more, bearing in mind that many dangerous Jobs are lower paid? Would the rate go up of someone in a "dangerous job" is injured? It would also disproportionately affect men because most workplace deaths and industrial injuries happen to men. What happens when people on higher tariffs lose their job for other reasons and can't pay the high rate any more?
What about psychological issues. Whose fault is depression? It can be caused by environmental factors, so can schizophrenia. Is a soldier with PTSD partly at fault because he chose to go into the army?
But that's a side issue really.
The real question is how are you going to work all of these scales and yearly tariffs out for the entire population? There are upwards of 64 million people in the UK, so the NHS will have to potentially deal with setting tariffs for a whole catalogue of illnesses and deciding what is considered to be "self inflicted" and what isn't. Then they have to check patients once a year, evaluate each one, decide the "risk factor", set a new tariff, inform the patient, allow a period for appeals, deal with appeals, and then administer payment.
For 64
million people. You'd need a computer the size of Milton Keynes just for NHS England. And you want to
reduce the amount of paperwork and admin staff in the NHS?
By the time you've done all that, how much of these new rates will be swallowed up by admin costs?
And the really daft thing is this: it's easy to complain about people being stupid and clogging up the system, but part of the problem in the UK is that the NHS has to pick up the slack because the general social system and long term care for people with mental and psychological problems has been gutted for ten years under "austerity".
Because the underlying system isn't there, then people end up in the streets instead of being in long term care, and they end up breaking things and hurting people and self medicating on drugs and you end up with the police and emergency services more stretched, so you've ended up with a worse system which is more expensive.
This is before you think about the danger of other genetic illnesses being considered as insurance risk factors. Some racial groups are more prone to certain illnesses than others. If parents have a baby with Trisomy 21 when they "could have" had an abortion should they then pay more for the healthcare that baby will need? That is the start of a very dark road of testing parents for genetic "defects" and setting healthcare accordingly. It's been tried before: don't try it again.
Also, how much is the extra for people who refuse to wear a corona mask?