There are a number of certainties about a Scottish winter.

It will be numbingly wet and cold. Trains will be disrupted. Heating bills will rocket. And the NHS will once again totter on the brink of crisis.

It comes round like a hardy annual. Frontline clinical staff overwhelmed, operations cancelled, beds blocked by people who can't be discharged and GPs under massive and sustained pressure. Our health professionals will heroically cope, as they always do. But it really shouldn't have to be this way.

The health service is often described as the jewel in the crown of the Scottish public sector. In many ways, this is true. Patients are generally treated with respect and the standard of care is broadly high. It is certainly the most respected, and most used of our institutions.

The problem - and once again, the winter influx of patients will show this - is it is no longer fit for purpose. As the requirement for more and more money to fund the NHS grows, so the waiting lists increase and hard choices have to be made.

It's sobering to discover that, while the health budget in Scotland has grown by 5% above inflation for the last seven years, the number of patients waiting for an outpatient appointment has risen by an incredible 89%.

The wait has gone up for inpatients, too, though "only" by 5.6%. So it's not really surprising that a new opinion poll this week shows confidence in the Scottish Government's ability to deliver on healthcare is falling.

The NHS is a dependable political target: perceived blame for its failings is constantly thrown around Holyrood like custard pies at a Laurel and Hardy convention. Yet, regardless of party, the job of cabinet secretary for health is an impossible one.

Expectations are always higher than delivery can ever be; funding levels can never match demand; and the opposition will always use it as a political football. If Shona Robison ever goes home from a day in parliament feeling utterly dejected, it's easy to see why.

It may be unpalatable and even unthinkable to say it, but healthcare in Scotland and throughout the UK is way beyond being solved by tinkering. It needs new thinking, boldness and permanent, structural change. In short, if we want a world-class NHS, we all have to recognise that comes at a cost.

The National Health Service was the crowning political achievement of the 20th century. When it was founded by Labour's Nye Bevan in 1948, the life expectancy for men was 66 and for women 71. Now in Scotland it is more than 77 for men and above 81 for women.

That is a remarkable testament to the quality of care, lifestyle changes and health education the NHS has nurtured over the past near-70 years. But when it comes to modern medical treatment, we are ignoring reality.

A system designed to eradicate Victorian illnesses such as TB and rickets (which it did successfully) is now struggling to stay at the cutting edge of nuclear and genetic medicine. We need to change not just our systems, but our way of thinking.

If we truly want world class healthcare, shorter waiting times, the end of postcode lotteries and more choice in our treatment, then we are all going to dip into our pockets more.

At present we have a perfect storm of rising demand, insufficient resource and a clampdown on public expenditure. A UK Government already obsessed with austerity is now staring down the barrel of a debt to GDP ratio approaching 90% - and that's before we know what Brexit will mean. It's clear that for the NHS in its current form, this isn't going to end well at all.

So that means we have to consider an insurance-based approach. I'm not talking about a US-style approach, where the uninsured can and do die if they don't obtain costly treatment and can lose their homes to pay medical bills if they do. To me, that is simply inhuman.

A European system of social healthcare makes more sense. There are many different models, and none are perfect. But they work in a broadly similar way: The state provides much of the funding, and individuals make a top-up contribution.

In France, for instance, where overall health care has been judged by the World Health Organisation as some of the very best in the world, some 70% of the cost is reimbursed via public funds. The individual pays the remainder, or can take out a mutual insurance policy for as little as €10 a month to cover the excess. Patients can choose their own consultants and often be seen within hours.

In the Republic of Ireland, there are both public and private healthcare systems. Charges within the public service include a fee of about €60 to see a GP, a cap of €750 a year for hospital in-patient treatment and a €100 charge to go to A&E.

Some of these costs are undoubtedly high and there can still be issues with waiting lists, but the quality of care is good and most people are satisfied with it.

These countries and most others in Europe have exemptions which any chargeable system in the UK would also need to put in place. Those on low incomes and with long-term conditions such as cancer and diabetes receive their treatment for free, so people in poor health are not discriminated against.

Those who might bemoan the end of an NHS which is "free at the point of need" might like to ponder the fact that for many people, that's been a fantasy for decades. Many of us pay for the dentist, for instance, where the very best solutions are only available privately: I was, for instance, recently quoted £900 for a decent quality crown which would last me the rest of my life. It simply wasn't available with public healthcare.

Wouldn't it be better if we had a system which cost us a little more individually, but guaranteed everyone access to the very best treatment and outcomes?

It's not fair or correct to say - yet - that our NHS is broken. But we need to take a serious, honest and objective look at what it delivers and how it is paid for. Nothing comes for nothing, and that's especially true of our health.

Will it happen? Almost certainly not, as no government wants to take the flak and face accusations from the opposition that they're smashing up our beloved NHS. So it'll lurch on, from winter to winter and from crisis to crisis.

Sticking plasters, as any doctor or nurse will tell you, can only do so much. We need to treat the underlying condition quickly and properly. Let's have the courage to take a deep breath, pick up the surgeon's knife, and get on with it.

Comment by Andrew Collier, a writer and broadcaster on Scottish politics, business, and religion. Andrew is a former SNP communications strategist and speechwriter for Alex Salmond and Nicola Sturgeon. He is also a former Scotland correspondent on the Sunday Times.