>>Unless things have changed drastically in England in the last 18 years, IIRC, it was just a way of rationing health care.

Not entirely. Healthcare always needs to be rationed or it will happily consume the entire GDP. The way to ration care in a single payer system, is the waiting list.

>>I told you about Andy's slipped knee cap in 1999. If he would have had to wait for the NHS to take care of it, he would have had to wait about 2 years since it wasn't life threatening. It did not matter to the NHS that he was in pain 24/7 because of the condition and had no quality of life.

That has been one of the main criticisms of the NHS, so much so that heaps of work has been done on care plans, severity scores and maximum waits. E.g. for urgent consultant-led orthopedic treatment the maximum permitted wait from initial referral currently is 2 weeks, including consultation and workup for treatment. For non-urgent treatment it is 18 weeks. The NHS also has developed protocols in other areas where it did badly. E.g. stroke centers and protocols, myocardial Infarct (heart attack) rules for access to PCI treatment even overnight, enhanced recovery protocols for hip fractures so that almost everybody has a care plan including operative treatment within 36 hours.

>> Fortunately, Andy was able to afford private health insurance and so was able to get it taken care of outside of the NHS.

Which is the rationing at work. In locales with dual public/private systems, people often prefer for elective surgery to be done privately. Every patient who goes private, reduces load on the public system. Where is the victim? FWIW, a family under this model in NZ can expect to pay under $1000 per annum (not per month) for surgical private insurance. How much did Andy pay?

>> Why did he have to pay a huge percentage of his earnings to support the NHS...

Contributions from salaried employees can be quite high when you add in the employer contribution but assuming that Andy was self-employed, his National Insurance contribution currently would be a flat £2.40/week plus 8% of annual profits between £5K and £43K. Maybe £4K per year if he was making more than £43K- but that's not all for the NHS, it covers all benefits, allowances and pensions. Depending who you ask, around 80% of NHS funding still comes from the general tax pool.

>>... and still need to purchase private insurance just in case the NHS was not available to deal with his health issues?

So that he wouldn't be rationed. I'm sorry if he was quoted a wait in years: now it's 18 weeks maximum, or 2 weeks if his severity score (including severe pain and incapacity) warranted it.

Changes like this see the NHS the highest ranked healthcare system in the Western World according to the Commonwealth Fund, or not quite so good according to the OECD reporting.