In 1948 when the NHS was born, the challenge of universal coverage was to include everyone, regardless of ability to pay. This remains an important objective, but it is no longer sufficient. Now that health care can improve public health, via the mass delivery of effective care, the test of universal coverage is that health systems should be seen at their best where they are needed most. Otherwise health care will widen rather than narrow inequalities in health. This cannot be achieved by pandering to the loudest voices, whether these come from the worried well, local interests, or corporate health care.
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