Last week I had the privilege of speaking to a learning set of six former NHS managers who have kept up their learning for over 20 years. They have done well. One is in the House of Lords, two are regulators, and one has got rich. What could I say to them, I wondered? I decided to return to my iconoclastic roots, and here are the 10 iconoclastic thoughts I shared with them.

1. Growth should not be the priority for the economy. Rather, following the advice of Juliet Schor, we should reallocate our time away from paid work, move to “self provision,” grow or make things for ourselves, adopt “true materialism,” which means recognising all the material consequences of our actions.
2. The NHS budget should be cut, so forcing the radical changes that are needed
3. Priority should not be given to healthcare over social care – with one being free and the other means tested
4. Governments should fund and regulate healthcare but not provide it
5. Health workers should be trained for jobs not professions
6. Doctors are not scientists
7. Medical students should be selected randomly among those reaching a minimum (medium) academic level
8. Assisted suicide, drugs, and prostitution should all be legalized
9. Cars should be made impossibly expensive
10. Prepublication peer review should be scrapped

I’m obviously not much of an iconoclast because these grand figures agreed with almost everything.

Competing interest: RS is employed by UnitedHealth Group, which is working with the NHS in England, although he doesn’t work with this part of the company. He is also on the board of the Public Library of Science.

Richard Smith was the editor of the BMJ until 2004.