I cannot agree more with Joseph A. Muscat (February 9) that our sacred cow of a free national health service (NHS) for all needs to end. The concept of a free NHS emerged to help those who could not afford medicines, private doctors and private hospitals. Politicians quickly got on to free health services as a great vote-catcher. It is time for a re-think. If a non-means-tested free NHS - and non-means-tested free tertiary education with stipends - are to continue, taxes will need to increase (instead of a decrease in income tax, as promised). Our NHS has already been responsible for an increase in VAT from 15 to 18 per cent. In a recent Bondi+ programme, the French NHS (with no waiting lists) was quoted as number one in global comparisons. What was not stated was that French employees pay 21 per cent national insurance from their wages and that some measure of means-testing exists in the French system (besides a wealth tax!).

Means-testing the NHS and tertiary education means the less well-off will still have free access to these services, but the well-off would have to pay some or all the way for services rendered. Means-testing will need to include an inventory of property in Malta, so that the authorities would have a fairer idea of how well off or not people are.

A substantial proportion of medical students are now leaving Malta without giving any service to the Maltese taxpayer who has paid their tuition fees and stipends. They should be made to pay back to the Maltese exchequer their tuition fees and stipends if they choose not to work their pre-registration period in Malta. My generation paid tuition fees, had no stipends, and used public transport and feet to get to university and medical school.

Our welfare state bubble needs reining in. That is now more obvious than ever.