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A GP making a referral should be thinking about what is best for their patient regardless of the cost. This will change when the cost becomes an issue (I'm not suggesting a GP would make a decision to not refer for personal gain, but they may have to if the CCG is struggling financially and they are under pressure to reduce elective procedures across the board).

Restricting care in this way will inevitably lead to an increase in waiting times and a growing frustration among patients. At this point, anyone who can pay for healthcare insurance will start looking elsewhere – and you can bet that the big healthcare insurance companies are gearing up for some extremely good loss leading “introductory offers” to get us hooked.

In time (around a decade I’d guess – as this would tie in nicely with the ageing population bubble) a tipping point will be reached whereby the vast majority of the UK population will have private healthcare insurance.

What will be left as “free” will have been successively eroded in the interim until all that remains is a USA “Medicaid” clone offering only basic emergency cover to those who can’t afford to pay.

With the state system destroyed, insurers can start to up their premiums safe knowledge that we have no alternative and voila 20% of UK GDP will end up being spent on healthcare – double what is spent now with only a privileged few getting better care than we all have access to at present…

When I discuss this with friends, even staunch conservatives, they are truly shocked at this (very real) prospect and how well this eventuality has been hidden from the public in all of the reform bluster.