There have been one or two attempts along the way to bring NHS spending into the National Insurance (NI) net – one under Gordon Brown, who partially paid for a big rise in healthcare spending via an increase in NI contributions, then a few years back via the ill-fated Health and Social Care Levy. 

But neither attempt led to anything: NI has never achieved the status of continental style social insurance, and is today widely regarded as just an additional form of income tax. The contributory principle hasn’t meant anything for a long time now.

As it is, the NHS has to take its place against other spending priorities, limping hopelessly from one cash-starved crisis to the next in an age when rising healthcare expectations and the challenges of an ageing society threaten still greater disappointments to come.

Only Labour can realistically hope to initiate the necessary root and branch reform; for the Tories, any such undertaking would be electoral suicide. But there is no appetite for it in a party which, despite its Blairite pretensions, remains as wedded to the socialist underpinnings of this public sector leviathan as ever.

So we beat on, in the words immortalised by F. Scott Fitzgerald, “boats against the current, borne ceaselessly back into the past”.