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Yesterday may have marked the NHS's 75th birthday, but there was no reason to celebrate. Whilst children's choirs sing happy birthday and the country raises a 'cuppa', I kept my party hat away. For, the system is no longer "fit for heroes". The NHS does not work.Waiting lists sit at a record high of 7.4 million, whilst median A&E wait time is a dangerous 3 hours 2 minutes. Ambulance services repeatedly miss their targets, causing half of those who need rapid treatment to die. Occupied beds sit at a worrying level of 92%, reducing overall capacity. And in December 2022, only 54.4% of cancer patients waited under 62 days for treatment, in contrast to the target of 85%. In short, the NHS is not just in crisis, it has essentially collapsed. The NHS is no longer the envy of the world, rather it is fast becoming a laughing stock. It is no wonder no other countries have followed suit in our system. Indeed, the only comparable systems were in the Soviet Union and Cuba, where hospitals were in a similarly dire state.Why is there a crisis?The left would have you believe that it is wholly situational. They blame the pandemic, Conservative "underfunding" (despite record spending) and Brexit. The system is not the problem they claim, rather poor governance and recent events have made it impossible for the NHS to act the way it should. This is plain wrong. The NHS is systematically flawed, and the only real solution is a complete overhaul of our healthcare system. Of its systemic flaws, none is more prevalent than its sheer size. The NHS is the fifth largest employer in the world and the largest state-owned employer in the free world. Its goliath size comes with challenges, one of which is management. Currently the NHS is managed top-down and with Trusts; policies, however, remain Westminster centred. The current system can be characterised by excessive bureaucracy and micro-management, held back by short-term political priorities. Indeed, there are more bureaucrats in the NHS then there are beds.Socialists like to lecture us on the dangers of private monopolies. Yet, the NHS is the largest monopoly of them all. Monopolies are terrible for productivity and give the consumers no choice. Patients have little choice within the system. Many cannot choose their doctor's surgeries. And patients are unable to see a specialist without a GP referral, which all too often involves further immense bureaucracy and long waiting times, such as waits up to seven years for an ADHD pre-assessment.Meanwhile our infrastructure is constantly on red alert for the threat of strikes loom. The NHS can keep certain costs down, but it does this by suppressing wages and creating less than ideal working conditions. If we want our NHS to remain competitive and for the best doctors not to quadruple their income on fixed salaries at London's new Cleveland Clinic, the NHS must radically change.The alternative –Simply more tax and spend won't fix it. Sweeping structural change is needed.Common rhetoric suggests there is but one alternative to the NHS: America's bankrupting system. This is not the case. No rational individual would argue in favour of this, for it is mind-numbingly ineffective as a healthcare system. Other options exist which may be far more effective.The government should pursue a competing social insurance scheme, similar to the Netherlands, Germany, and Switzerland, as we have proposed previously . This system will separate government from providers and patients. The government would have no direct management role, ending the health service's known problem of limitless bureaucracy and unstable policy direction. In this system it would be compulsory for universal enrolment for social insurance, and insurers would be banned from refusing service. Premiums would be calculated by income, with the poorest paying nothing. This system would be fair, for it would be a one-tiered system where all receive the same (exceptionally high) level of care. And, crucially, all services would be free at the point of access, unless the consumers choose to pay in order to have lower premiums.Short-term bandages –Clearly in the current political climate the above is a stretch. Thus, it may be helpful to explore things we can do in the short term to make the crisis slightly less bad. This could be through outsourcing. Despite what Julia Grace Patterson or WeOwnIt would like you to believe, outsourcing does not mean privatisation. As Kristian Niemietz of the Institute of Economic Affairs puts it, it is a "failed conspiracy theory that never dies." Outsourcing means hiring private firms to do certain jobs within the NHS, typically non-medical such as IT. And for all the fear-mongers out there, rest assured that it will continue to be free at the point of receipt. Let's face it, private companies are likely to be better than NHS bureaucrats at delivering certain services. Remember that terrible NHS app? If this was outsourced to a tech firm rather than developed in house, maybe it would have been a success. Conclusions –Our medical professionals are heroes. They do a stellar job, especially given the terrible environments they are made to work in. The system is letting them and their patients down. In the interim, more outsourcing should occur. In the long term, the government should completely overhaul our health system and replace it with a social insurance scheme. That way we will finally have a system "fit for heroes" as Attlee and Bevan envisaged. Oliver Ind is a Summer Intern at the Adam Smith Institute