That it's almost impossible to discuss alternatives to the NHS is a tribute to its longevity, says Laura Kuenssberg.
They say the NHS chief executive has become the "rationer-in-chief" tasked with "spreading the jam more and more thinly" as the demand for care races ahead of what's available.
You'd be hard pressed to find a politician who would admit that services are being rationed but in off-the-record conversations that word comes up again and again.One of the former ministers says "people have to understand that there is rationing according to wait" - saying that is the "trade-off" with the traditional model.
"Any sophisticated Tory politician knows they'd sign their own death warrant" if they raised the prospect of a wholesale change, they say. Plenty of politicians talk about reforms to the service - whether that is working with the private sector. But whether it is required or not, it is almost unthinkable now that any mainstream politician would argue for a sweeping change to the whole system.
"If you do cut them in the short term, that just means more operations, it doesn't address stopping people being ill in the first place."
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