What alternative health system could Britain have built in the 1940s?
Short answerA national insurance fund could pay negotiated provider prices and preserve charitable hospital networks, although Britain chose a centralized NHS.
NotesThe proposed blank-slate alternative for the 1940s would make National Insurance operate as an actual insurance fund, possibly administered through the Bank of England. Hospitals and charitable providers would negotiate prices with the fund, while government support would top up what citizens paid according to their means. That arrangement could preserve Britain's existing charitable hospital networks while financing broad access to care. Britain instead adopted a top-down centralized NHS. The proposal is explicitly retrospective, using later experience to imagine a different institutional path.