 Doctor Julian Spinks will start with a kind of insurance policy here, a health warning on this conversation, which is that those working in the NHS are world-class. Our front line doctors, nurses, hospital porters, cleaners, they do an amazing job. But does the system need a rethink? Well, certainly the system doesn't work as well as it should. It's been under-invested for decades. And certainly in general practice, we found this. We are now losing doctors, we're hemorrhaging doctors at the moment, which is why we've got those big list sizes and that's why people can't get appointments and so on. So certainly work needs to be done, but I think we've got to be very careful what we want and because there's a danger that we might actually throw the baby out with the bathwater. I mean, money is obviously a factor. The issue is that Britain faces major economic challenges now post-pandemic. The cupboard's bare, isn't it? I mean, we're going to have to look at efficiencies within the health service rather than pumping more billions in. And I think that's what's so difficult. If we had loads of money in the NHS to start off with, we would have actually got through the pandemic much easier. If we have more beds, France has got twice as many hospital beds for the size of the population. In particular intensive care or just beds primarily? Generally, to be honest with you, because there were people who didn't end up in intensive care but needed to be in hospital, Germany's got three times as many hospital beds as we do. Now, I'm not saying we need that number, but it's gone down and down and down for about 30 years. We've got GP practices closing so the smaller numbers of those choice goes down. So that does need to be tackled. Having said that, for example, the GP service is incredibly financially efficient. The practices I run get around £150 per person per year to provide everything. And that covers all our costs, our staffing and so on. And for that, people get on average six consultations a year. So, you know, it's considerably less than you pay going to a vet or going to a lawyer and so on. And it's difficult to see how you'll replace that that cheaply. But if the private sector can scan people more cheaply or do hip replacements or heart surgery more cost effectively, if they could actually tender for those jobs, what's not to like? Well, we've been trying that and sometimes it is very successful. In others, it's been a disaster. We had a whole series of independent sector treatment centres that were set up, which were paid more than the NHS, ended up doing less work. And in fact, they were being paid even though they didn't do any work at that time. And they could cherry pick the easy patients. So all the tricky ones ended up in the poor NHS hospitals and they were getting the ones. So you've got to be careful that you don't actually sort of buck the trend and actually make a situation worse. Having said that, using private providers, GPs are all effectively private providers because we've been partners, we're small businesses, we are not with the employees of the NHS with a budget. And in fact, I was a fund holder and that was a very successful time because I work with my patients, I had a pot of money so we could give them more choice without having to go down the idea of having an insurance policy or something like that. And I love our GPs and it's great to have a GP here. I'll show you my lump in a minute. But before we do that, there's another issue which is the culture of the NHS in relation to the patient. Some people take the view that if the public had to pay 10, 15, 20 pounds for a GP appointment, they would turn up on time and they wouldn't ask for that appointment if they didn't need it. Certainly my experience has been, for example, with weight loss. When we've had free weight loss things, actually people don't turn up. Whereas when they pay to go to a commercial company, they are more likely to. But the other end of the spectrum is you're then coming into who can actually pay for it and who can't. And I look at it and what I would dread is ending up having to deal with a health insurance company rather like a car insurance company or a house insurance company. If you've ever dealt with those, they're a nightmare. And when you talk to Americans, they really hate their insurance companies. Sarah, James, I'm going to come to you in a second. You're on Brook. You broadcast and live in the United States where the setup is very different. It's completely privatised. What are your views of the UK system? Well, first, the US system is not completely privatised. It's dominantly government-run. But it's credit card healthcare, isn't it? No, well, 50, 60% of all the dollars spent in the United States on healthcare is spent by the government. So it's a mixed system. In a sense, it's the worst of both worlds. And I don't advocate for hybrid systems. I want to see everything privatised. It strikes me as stunning that in every other industry we understand that central planning doesn't work. We've tried central planning bread production. We've tried central planning food. We've tried central planning all kinds of things. It doesn't work. It creates shortages. It creates lines. It creates mal investment. It creates unbelievable inefficiencies. And yet in healthcare, somehow we think is special and unique and different. It's not. It's an industry. It needs to be produced by GPs, by nurses, by hospitals, by people who produce the service and their customers to somehow believe that we can take this unbelievably complex system and centrally planted, given a bunch of bureaucrats, the power to decide how to allocate resources, who should get what what are the best treatments, instead of letting a market work where it works so beautifully and where it's allowed to work in every product where we allow markets to work, we get beautiful results. Why not try it in here? Well, we know that's often how unscrupulous dentists operate that they'll take out your molar because they want to make a few more quid. Will we have people profiteering from operations that patients don't need in order to make money or dispensing drugs in order to fulfil the bottom line? Saving lives. Saving lives, you're wrong. I'm all about saving lives. I want to save lives. It shouldn't be a matter of profit, should it? Of course it should be a matter of profit. Food is a matter of profit. Without food, we would all starve and yet food is a matter of profit. And we go into the grocery store, a supermarket and it's amazing the variety and we get food from all over the world and we get better and better food. And particularly if we demand better and better food, we can go to different grocery stores. Each one of us can select what kind of food we get. So no, look, there's always going to be some unscrupulous somebody. There's always going to be crooks. But to design a whole industry because they might be a few bad apples. To design it around the bad apples is a mistake. Let's root out the bad apples. Don't the insurance companies inflate the cost of health care, though, for profit? I mean, isn't that the point in America that the cost of treatment and the cost of medication is just inflationary? No, what inflates the health care cost in the United States is Medicare and Medicaid, which is like the NHS is zero cost at the point of service. That's what inflates the cost of health care in the United States. And look, in spite of the fact that health care costs are very high in the United States, 70% of all medical innovations happen in the United States. That's not an accident. It's because a segment of the U.S. health care system is still private. But the principle here is don't we want to give consumers choice? Don't we want to give doctors and medical practitioners the ability to be to be innovative, to use the ingenuity, to think for themselves, to provide alternative services, to compete with one another so that we can get the best life-saving treatments possible. But if, God forbid, you're having a coronary incident in your living room, the first thing the paramedics going to say to you is, show me your credit card. First of all, that doesn't happen. That doesn't happen. It doesn't happen to the U.S. It doesn't happen to the U.S. You get the bill at the end of it, though, don't you? Sure, you get the bill at the end of it, but the insurance company gets the bill. And the beauty is that properly constructed insurance markets, true markets, not the kind we have in the United States that are heavily regulated and controlled and put into these one-size-fit-all kind of models. But true insurance companies are cheap. They're not expensive. And if you're worried about the very poor, then subsidize them. Give them a voucher that allows them to buy a health insurance policy that provides them with all those basic coverages. And so when the medic walks in, he knows that you have insurance. He takes you to the hospital. You know, they take their card. Everybody has one of those cards. And you know, they give you the best treatment they possibly can. Why? Because they're trying to make money. And the fact is that when you go to any kind of business today, you get treated well. Why? Because the company that's treating you is trying to make money. It doesn't work to treat your customers badly. That's not a profitable way to service your customers. Thank you for listening or watching the Iran Book Show. If you'd like to support the show, we make it as easy as possible for you to trade with me. You get value from listening. You get value from watching. Show your appreciation. You can do that by going to IranBookShow.com slash support. I go to Patreon, subscribe star locals, and just making a appropriate contribution on any one of those, any one of those channels. Also, if you'd like to see the Iran Book Show grow, please consider sharing our content. And of course, subscribe. Press that little bell button right down there on YouTube so that you get announcement when we go live. And for you, those of you who are already subscribers and those of you who already supporters of the show, thank you. I very much appreciate it.