Stephen Bush argues that the UK faces unsustainable healthcare cost growth, with spending projected to rise from 8.3% to 14.5% of GDP by the mid-2070s. He contends that relying solely on taxation to fund an ageing society and improved treatments is politically unviable. Bush favours reform models similar to rich-world peers, combining universal healthcare with co-payment systems to drive innovation through consumer choice. He identifies three viable paths: broad-based tax rises, shifting costs to private individuals, or a combination of both. The column warns that without reform, deeper cuts to other state functions will be necessary, or the financial sums will simply not add up. Published August 26, 2026, the piece appears in the Financial Times Inside Politics newsletter, edited by Georgina Quach.

Bush frames the debate as moving beyond "austerity denial," noting that while the better off currently fund a state providing services primarily to the sick, old, and those in acute crisis, this model is becoming increasingly unsustainable. He suggests that incorporating co-payment could allow for better standards while maintaining universal access, positioning the change as an inevitable evolution rather than an election-winning policy.