The awkward truth about funding the NHS Yesterday, Earl Howe, the health minister, made the now ritualistic genuflection before the great NHS totem when he announced the new charging plan, whose details have yet to be worked out. "Having a universal health service free at the point of use rightly makes us the envy of the world," he said. But we must make sure the system is fair to the hard-working British taxpayers who fund it. While the "envy of the world" mantra might have been true once, it isn't any longer. Yet we cleave to a sepia-tinted image of the NHS that should have been dispelled long ago - certainly by recent tales of sub-standard geriatric care and the ongoing crisis in out-of-hours provision. One of the fundamental assumptions that underpinned the introduction of universal care in the Forties was that demand for medical treatment would diminish as the nation's health improved. In fact, the opposite has happened. Increasing life expectancy means more people live to an age where they contract diseases that are expensive to treat. We are also less predisposed to queueing and rationing than we used to be. In a consumerist age, people compare their health care with other services, and expect to have the same choice and speed of delivery. Or at least they compare it in every way but one - the cost. Many people believe they pay for their medical bills through their National Insurance contributions. But this is not the case, even though revenues from the additional one per cent on NICs introduced by Labour 10 years ago do go to the NHS. The bulk of the money comes from general taxation - and while annual expenditure has almost doubled since 1999, we still spend less than in France or Germany, where mixed funding systems harness the strengths of public and private sectors. If we want to keep pace, we will either have to pay more in taxes, or find the cash elsewhere - because while the NHS may be free at the point of service, it isn't free full stop. A report earlier this year from the King's Fund, the health think tank, predicted that if NHS spending grows at the same rate as over the past half-century, it will take up 20 per cent of GDP by 2050. In reality, it will grow even faster than that. A bigger population (in every way) means more people will be using the NHS - and they will all consider they are entitled to expensive treatments, most of which haven't even been invented yet. These will have to be paid for. Yet while we have had a succession of structural reforms and efficiency drives in recent years, the basic question of how the NHS should be funded has become a political no-go area. Relying on the economic recovery to provide the revenues is misguided: an ageing population means there are fewer taxpayers as a proportion of the total, and a majority now take more out of the system than they put in. Given these realities, some form of charging is inevitable. Yet even to hint at this is to risk ostracism. When the think tank Reform made some relatively modest proposals for NHS fees a few weeks ago, there was a furious response from people who otherwise have no answer to the problems coming down the track. Reform's report pointed out that most OECD countries require their own nationals to pay for basic GP visits or even for elements of secondary care, backed by personal insurance. If we won't even make foreign visitors pay to visit the GP, then we have serious trouble ahead.