Over the past week, much has been said to mark Saturday's 60th anniversary of the NHS. Like many in Britain, I have been brought up to believe that free health care for all must be a good thing - a view that has only been strengthened as a result of my experiences of healthcare in countries such as America, on the one hand, and the former Soviet republics, on the other. However, I increasingly wonder whether our state provision of such care is really the best way to guarantee access to affordable healthcare for all.

After all, in the most recent index of European health services, published last October, every country in western Europe and Scandinavia scored much higher than Britain, with the exception of Italy and Portugal. It is noticeable that the top five countries all have systems based on the German model, in which competing insurance organisations are independent of health service suppliers. Is it time to consider the merits of a national health insurance plan, in which the government continues to guarantee that we all enjoy a basic level of healthcare but ceases to be responsible for supplying that care? Is there anything to suggest that the single National Health Service was any better able to respond to local healthcare needs than the 2,688 municipal and voluntary hospitals whose 480,000 beds the government took over on 5 July 1948?

Our 2002 report Health and the Nation suggested how we might respond to the challenges facing the NHS at the beginning of the twenty-first century. For instance, it noted, "The biblical inclination towards a decentralised state ... suggests that a degree of localisation is acceptable, providing that it does not foster runaway inequalities which fragment the national example of love, care and justice." However, it went further, challenging us to adopt a more holistic conception to health and wellbeing (or "shalom") and to recognise the importance of relationships to the health of individuals, organisations and society. It asserted that relatives, friends, communities, and churches, not just the state, should all share in the responsibility of caring for those in need.

If our politicians were no longer seen as accountable for the nation's health, perhaps we could break free from the unrealistic expectation that they might discover a solution to problems such as how to fund increasingly expensive new treatments for an increasingly demanding and informed electorate. Perhaps we might even begin to ask some tough questions of ourselves: Are we prepared to care for the vulnerable and marginalised in our lives even though it may be an uneconomical use of our time or energy? Do we take our responsibilities to our "brothers" sufficiently seriously to be prepared to prioritise their needs over our wants?

Alternatively, if we continue to blame the government for the state of the nation's health, are we prepared to let the state intervene ever more intrusively in health-affecting behaviour such as our eating, drinking, smoking, and sexual habits?