How can we fix health care spending? Views from across the political spectrum

Health care spending is set to double in the next 50 years. Should we be worried? Last month, as part of the launch of our new project ‘Good health for all: reimagining the welfare state’, The King’s Fund’s Sarah Arnold shared her analysis of the reasons behind this increase and what we can do about it.

But of course, there are lots of different perspectives on how to put health care spending on a sustainable footing. Through our new project, we want to hear from a range of views and engage people in discussions on the big issues affecting the health and care system and the wider welfare state. Here are four perspectives from people working on health spending – and we’d love to get your take in the comments below. 

David Blumenthal MD, MPP, Professor of Practice of Public Health and Health Policy, Harvard TH Chan School of Public Health, Research Fellow, Harvard Kennedy School of Government, Samuel O. Thier Professor of Medicine, Emeritus, Harvard Medical School

‘Many US health care experts have long admired the United Kingdom’s National Health Service as a model of universal access, efficient administration, patient affordability and strong primary care. We have watched with concern as that strong model has encountered significant problems in recent years.  

‘Distant observers should be humble in making recommendations, but it does seem that several remedies – none easy – would be helpful. The first is adequate funding to make up for past austerity, including for social services. In a country with an underperforming economy, this will be a significant challenge. Second, the UK must invest heavily in primary care as the most cost-effective way to manage an aging population with multiple co-morbidities. Third, the UK should minimise its frequent, disruptive and counterproductive reorganisations, which cannot substitute for adequate funding and robust primary care.’  

Ruth Curtice, Chief Executive, Resolution Foundation 

‘At the 2025 Spending Review, the lion’s share of the new money went on health – 90 per cent of the real increase in annual spending went to the Department of Health and Social Care. Resolution Foundation analysis has shown that the gains from health spending are generally flat across the income distribution, compared with many other areas of spending that disproportionately benefit those with below average incomes. A doubling of health spending over the next 50 years at current levels of taxation implies cuts in funding for other services and therefore a shift in state support away from the lower end of the income distribution (potentially worsening health in other ways).  

‘As The King’s Fund work articulates clearly, whether or not a doubling of health care spending is a worry depends on how it is funded. We need to face a fundamental choice – if health spending increases with income, then a country with tax-funded health care should expect an increasing tax burden. Do we?’  

Dr Kristian Niemietz, Editorial Director and Head of Political Economy, Institute of Economic Affairs 

‘For decades, it has been an article of faith that the NHS is ‘underfunded’, and that throwing more money at it is always and everywhere the right thing to do. I am glad that The King’s Fund’s new project is highlighting the fact that the UK is already one of the world’s top spenders on health care (in per cent of GDP – see The King's Fund's long read for more information), and that increases in health care spending are not always the best course of action. 

‘I hope that future instalments of this project will go further and break out of the dominant, narrow, state-centric mindset altogether. While the Fund recognises that there are alternatives to further expansions of the NHS budget, so far, the only alternatives they are prepared to consider is expanding other branches of the welfare state instead. Why not consider the possibility that an overbearing, interventionist government might not always be a force for good? Why rule out non-state solutions by design?’  

Professor Mariana Mazzucato, Chair of the WHO Council on the Economics of Health for All, Professor, University College London, and Founding Director, UCL Institute for Innovation and Public Purpose

‘Asking “Is an increase in health spending a problem?” is not the right question. Asking “what are our health goals and how do we structure the economic system to deliver on those?” is. The recent Office for National Statistics data on declining life expectancy and the 2020 Marmot Review on widening health inequalities show the need for this change in framing.  

‘It is clear a siloed approach to health where it is seen as only a cost to the economy is not working.  

‘The World Health Organisation’s Council on the Economics of Health for All, which I chaired, demonstrated that health needs to be viewed as a long-term, capital investment for economic growth, not a short-term cost or trade off against spending in other areas. 

‘This requires taking a whole-of-government approach in which health for all outcomes are treated as a shared mission, not just the responsibility of the NHS or Department of Health and Social Care, but across education, housing, transport, environment, food and communities. It also requires putting health for all at the centre of economic thinking: innovation, finance, value and capacity.  

‘Health For All must be a core pillar of economic strategy. There is no healthy economy without healthy communities.’