The NHS has supposedly had its funding ring-fenced by the government. But we now know that's not really true. Demand is rising and so are real costs. Effective budgets are falling, as even the IFS has now noted.
The choice available is a blunt one because belief in the possibility of massive efficiency gains is myopic. The reality is we either find more money or health care outcomes will get worse. That's not rocket science; that's fact.
I will not argue for worse health care outcomes. I do question some policies (preventing heart disease forever simply, and inevitably, guarantees more uncomfortable deaths from cancer, for example). But generally, it's a brave person who says we can live with increased risks and feel comfortable with doing so.
In that case cash is needed. This is not the moment to suggest a detailed programme for raising that moeny, but one idea I put forward to the meeting I was at on health and tax justice yesterday was simple. We could charge VAT on private health care. If we did HMRC says we'd raise just over £2 billion in extra funding.
I call that a no brainer. It's affordable by those who would pay. It's an exemption that is not needed. It's a tax that could redirect resources to meet need. Let's start debate there.