As ministers increasingly rely on private providers to help tackle NHS waiting lists, critics argue that healthcare should never be a source of private profit. But if outcomes, access and quality are what ultimately matter, then the case against profit in healthcare may be weaker than many assume, writes Harry Margulies

With more than seven million people still waiting for NHS treatment, ministers continue to rely on independent-sector providers to help reduce backlogs and increase capacity. Government policy remains firmly committed to making greater use of independent-sector capacity where it can help patients receive treatment more quickly while remaining free at the point of use.

Yet every expansion of private involvement in healthcare prompts the same objection: Healthcare is too important to be a source of private profit.

The argument sounds straightforward. Nobody should make money from sickness, and nobody should make money from healthcare.

But if that principle is correct, why stop there?

The first question any society should ask is whether citizens receive high-quality services efficiently, affordably and universally.

If a healthcare system guarantees access to everyone regardless of income, why should it matter whether a hospital is publicly or privately operated?

Most patients care about receiving timely, high-quality treatment rather than the ownership structure of the institution providing it. They care about survival rates, waiting times, medical outcomes and quality of care.

Governments remain the largest purchasers of healthcare services. They can negotiate prices, establish standards, monitor performance and terminate contracts with underperforming providers. Universal access and private provision are not mutually exclusive. They can coexist.

Several successful countries demonstrate this reality.

Sweden, despite its reputation abroad as a model of social democracy, incorporates both public and private providers within its publicly financed healthcare system. Private firms also play a substantial role in elder care and other welfare services.

Switzerland takes a different approach. Healthcare is delivered through a system of mandatory private insurance under extensive government regulation. The system is expensive, but universal coverage is maintained.

The United States is often presented as evidence against private healthcare, and there is no doubt that the American system has significant shortcomings. Costs are substantially higher than in other developed countries, and concerns about affordability remain widespread.

Yet the comparison between Switzerland and the United States is insightful. Both rely heavily on private insurance, but Switzerland requires all residents to purchase coverage, insurers must accept all applicants regardless of age or pre-existing conditions, and a standard package of basic benefits is guaranteed. The result is universal coverage within a regulated market framework.

A central difference is that many Americans oppose compulsory health insurance. Critics of voluntary enrolment argue that insurance functions properly only when risks are shared across a broad population. If healthier people opt out, costs become concentrated among those most likely to need treatment, pushing premiums higher for everyone who remains insured.

In the extreme case, if only one very ill person purchased health insurance, the premium would need to be roughly equal to that individual’s expected healthcare costs. Insurance works because large numbers of healthy and unhealthy people participate in the same pool.

Private provision isn’t always superior. Poorly designed incentives can produce poor outcomes in either public or private systems. Effective regulation therefore matters, as does accountability and competition. Yet experience across much of the developed world suggests that regulated competition and private participation often produce better results than systems that attempt to exclude market incentives altogether.

What should matter most, then, is whether citizens actually receive good services.

Critics of private healthcare often argue that profit creates incentives that are fundamentally at odds with patient care. If healthcare providers are expected to generate returns for shareholders, so the argument goes, they may prioritise financial performance over clinical outcomes.

That concern deserves to be taken seriously. Healthcare differs from most markets because patients are often vulnerable, information is unevenly distributed and poor decisions can carry life-changing consequences.

Yet the existence of profit does not automatically produce poor outcomes any more than public ownership automatically produces good ones. Regulation and transparency are key to good outcomes. A poorly managed, opaque public system can fail patients just as readily as a poorly regulated private one.

This brings us to a wider question. If profit itself is the objection, rather than the quality of the service being provided, where should that principle end?

If healthcare is too important for profit, why is housing not too important? Everyone, after all, needs shelter. Why should landlords, builders or mortgage lenders earn money from something so essential?

Food is equally indispensable. Why should farmers earn money from something as essential as nutrition? Why should clothing manufacturers profit from goods people need to survive winter? Why should energy companies earn profits from heating homes?

Once we accept the principle that essential goods and services should not generate profits, there is no obvious stopping point. The logic can extend across large portions of the economy.

Here is where history provides a useful warning. The Soviet Union attempted to suppress market incentives across much of economic life. Yet one of the most revealing facts about Soviet agriculture was the extraordinary productivity of small private plots. Despite occupying only a tiny share of agricultural land, these plots produced a disproportionately large share of agricultural output.

Many critics of capitalism are correct to point out its shortcomings. Market economies generate inequality, and some industries require substantial regulation to protect consumers.

But critics often compare the real-world imperfections of capitalism with idealised versions of alternative systems. No capitalist economy has ever existed in its pure theoretical form. Every successful market economy combines private enterprise, government regulation, public services and social protections.

The 20^th century saw numerous attempts to organize economies around the principle that market incentives and private profit should play a reduced role. None matched the long-term record of market-oriented economies in generating innovation, consumer choice, economic growth and rising living standards.

Supporters of socialism sometimes argue that “real socialism” has never been properly implemented. Perhaps. But political and economic systems must ultimately be judged by their results rather than their intentions.

Capitalism isn’t perfect, but it delivers better than any known alternative, and working in the context of the best practical system available, it would be blinkered to suggest that incentives don’t matter. People generally produce more, innovate more and respond more effectively to demand when they are permitted to benefit from their efforts.

The debate over healthcare should therefore focus on outcomes rather than ownership structures. If a privately operated hospital delivers better care at lower cost, patients benefit.

The purpose of public policy should ensure that citizens receive the best possible services at the lowest sustainable cost while guaranteeing universal access. Once governments begin judging industries primarily by whether someone earns a profit rather than by the outcomes they produce, policymakers risk sacrificing effectiveness in pursuit of ideological purity.

When governments regulate effectively and maintain clear standards, the real enemy is poor outcomes, not profit. 

Harry Margulies is a journalist, author, commentator, and public intellectual whose work interrogates religion, politics, and morality with sharp wit and fearless clarity. A second-generation Holocaust survivor, he was born in Austria and spent time in an Austrian refugee camp before moving to Sweden. Educated by Orthodox rabbis throughout his childhood, he ultimately abandoned faith in his teens—a journey that has shaped his lifelong commitment to secularism, critical thinking, and freedom of expression. His latest book, Is God Real? Hell Knows, has been described by ABBA’s Björn Ulvaeus as “funny, sharp, and unafraid.”

READ MORE: ‘Should the Church be beyond political scrutiny?‘. Donald Trump’s recent public clash with Pope Leo XIV over the war in Iran has once again highlighted the significant sway religious leaders continue to wield in public life. While Trump’s outspokenness has attracted criticism, Harry Margulies argues that institutions exercising moral and political influence should not be shielded from scrutiny simply because they claim divine authority.

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