For once, just for the sake of argument, let’s take Andrew Lansley at his word and assume that however keen he is on getting private providers in to do the work of the NHS, he’s not doing it because he’s corrupt, or because his wife is, or because he’s ideologically hell-bent on privatising whatever he can get away with, but that he’s doing it because he sincerely believes it’ll make the Health Service work better and more efficiently.

This may be the case. The trouble is, though, if you make this assumption it becomes kind of hard to explain the thinking behind the patient vouchers announcement he made on Tuesday evening. He wants patients with long-term medical problems to be given vouchers so they can get healthcare from either the NHS or a private insurance company, as they choose. And the thing is, there’s practically no way this is going to do anything other than help screw over the NHS. This, it seems to me, is overwhelmingly likely to be how it’s going to work:

1. Some patients who get vouchers will use them to buy care from private insurance companies.
2. The money for this comes out of the health budget, and would otherwise have gone to the NHS. The NHS loses money.
3. Hospital trusts which are already on shaky financial ground suffer more. The quality of care they can offer patients also suffers. More patients choose not to use them (see step 2).
4. Some patients turn out to need more care than is covered by the voucher (e.g. because their illness gets worse, or they planned to supplement the voucher with their own money to buy better care and find they can’t afford it for whatever reason). The extra care they need is provided by the NHS, because the NHS is never going to deny care to someone who needs it. The NHS has to spend more money to provide this care, out of a budget that’s been shrunk because the Department of Health assumed the NHS wouldn’t be providing this service.
5. The NHS is (more) financially screwed.

This isn’t new – it’s basically the same mechanism that meant that government subsidy to the railways has more than doubled in real terms since the privatisation of British Rail. For-profit providers of public services and infrastructure know that the government is never going to let something as vital as the rail network or the health service fail, so once they’ve landed the contracts they want, they have every incentive to go over budget, pay large dividends to their shareholders and bonuses to their senior managers, and generally do everything they can to get as much cash as possible out of the deal while spending as little (and hence providing as crappy a service) as possible. Seriously, anyone want to place bets on it not turning out like this?

In all the discussion about why we should be opposed to Andrew Lansley’s NHS reforms, one of the points which seems to pop up most frequently (in this excellent article here, for example) is the potential conflict of interest that could exist when healthcare commissioning powers (and budgets) are handed to GPs.

The argument is simple: under the reforms, GPs are to be handed control of large budgets and the power to decide both what healthcare to buy to meet their patients’ needs and the generosity of their own salary and benefits packages. As such, people will no longer be able to absolutely trust that their GPs are making treatment decisions with patients’ best interests at heart, since they might be reluctant to pay for expensive treatments if that meant their own remuneration would suffer as a result. But how convincing is this? I’m not saying the reforms aren’t misguided in general, but on this one point, I’m not so sure. And by that I do really mean I’m not sure – anyone who has something useful to contribute on this to try and convince me one way or the other is more than welcome to do so.

There are two possible ways this conflict of interest might be a cause for concern:

1. GPs really will start spending less on patient care and providing worse treatment at the expense of lining their own pockets.
2. Patients will worry about the possibility that their GPs will do (1), and as such will no longer have the faith they do at the moment in the advice their GP provides.

For the most part, (2) seems to worry most commentators more than (1). This focus might be political – many GPs are themselves opposed to a lot of the NHS reforms, so it’s clearly counter-productive to suggest that they’re motivated by greed if you want to keep them onside. Equally, however, people might be worrying more about (2) simply because they don’t think (1) is likely to be that widespread – it seems reasonable to suppose that having chosen medicine (and specifically general practice) as a career, the vast majority of GPs care quite a lot about patient care. Besides which, if (1) ever actually occurred it would be a fairly clear violation of the Hippocratic Oath (“…I will apply, for the benefit of the sick, all measures [that] are required …”).

So, if (1) is unlikely to happen much anyway, does that in turn make (2) unlikely? I don’t think so. Oath or no oath, doctors are human and therefore fallible and imperfect, so it’s perfectly plausible that a small minority might end up doing (1). And, crucially, all it would take for (2) to occur is one case of a doctor providing inadequate care and enriching themselves to garner enough media coverage to turn it into a full-blown scandal.

What bothers me about the conflict of interest claim is rather different: put simply, if conflicts of interests really are a concern, how far would GP commissioning really make things worse compared to the status quo? As things stand GPs are paid pretty generously compared both to their counterparts in other OECD countries and to their specialist colleagues in the UK. This is the result of pay negotiations between GPs and the government, so in effect GPs had an indirect say in how much of the health budget should be set aside for their pay – and since the result of the last round of negotiations in 2004 was a big funding increase, it seems likely the GPs’ say is quite a big one. Did some other government spending commitment take a hit as a result of more money being allocated to GPs’ pay? Unless the government taxed or borrowed more to cover the shortfall, it must have done.

So what’s the substantive difference between this and what would happen under GP commissioning? Under the present system, GPs can already negotiate for their pay from a strong position, and do so in the knowledge that any extra revenue they get as a result is money that’ll come out of government spending elsewhere – most likely elsewhere in the health sector – so there’s still plenty of potential for spending on patient care to suffer at the expense of GPs’ wages. If we should worry about whether to trust GPs when they get commissioning powers, should we really worry about it any less now?

None of this is to say that we shouldn’t oppose the NHS reforms – there are any number of reasons why we should, set out very well by Richard at NHS Vault and any number of others. Nor am I saying that GPs won’t pay themselves too much at the expense of other health spending if the proposed changes go through. But if this is the case, then there’s plenty of potential for that to happen already. In this one respect at least, I’m not convinced Lansley’s reforms would be significantly worse than the present system.

It has come to light, quite formally, what the government plans to do with the NHS. David Cameron’s senior health advisor, Mark Britnell, declared that the NHS will be “shown no mercy” to a conference of health executives eager for news of how deep the axe will fall in their sector. It seems for them, the harvest will be good this year.

For us, this will not only mean a facelift for an institution which we are rightly proud of stand loyally by, but a complete revaluation of what health care actually means in this country.

Britnell has said the National Health Service will no longer be a service, but an insurance provider, identifying the next couple of years of imposed economic hardship and austerity as being the “best time” for the NHS to undergo this transition. Needless to say, The Shock Doctrine comes to mind.

The question we have to ask ourselves is one the Americans are painfully mulling over now – is health care a right or a privilege? Granted the natural distrust Americans have with any inward expansion of government thanks to their barking mad corporate media outlets, the British population have an altogether different problem relating to the demographics of opinion: general apathy with pockets of condensed yet ostracised outrage. This of course can be attributed to the national experience with the political process in general, but that is another rant.

What is important to measure is what will happen to the cost of health care and medication if the sweeping privatisation is enforced. The government is priding itself on its incredibly debt driven education policy at the moment, but what will happen if the proposed health insurance is abused by escalating and uncontrollable health care costs, unmitigated by the state and completely determined by private monetary profit margins? Yup, insurance denied, loopholes are found, tragic stories are born and a new norm takes shape. And that will happen, no ifs and buts.

Anyway, it doesn’t actually matter if I’m paying the bill or not; how much does it cost? is the more pertinent and determinative question which is central to the issue.

There is a reason why Britain has similar performance in health care when compared to the U.S. despite spending almost half of what the U.S. does in terms of %GDP on it – as expensive as our private option is here, it is nothing compared to the astronomical costs in the U.S. To offer an anecdote, I recently had an ACL reconstruction here through BUPA, and received all the receipts for the hospital room, anaesthetic, the surgical procedure and medication. The actual medical costs amounted to £4,500. Curious to U.S. alternatives afterwards, I researched and received a few quotes regarding the price of the exact same procedure in a U.S. hospital for a U.S. resident. The average sum in this instance amounted to $35,000 without medication. Looking at it now, a website has stated that actual costs can range from $20,000-$50,000, which seems in line with what I found 2 years ago.

Health professionals and administrators have a lot to gain with figures like that, as do the insurers who broker the price behind closed doors. There is absolutely no reason why such a gulf in cost exists between the procedure in the U.K. and the U.S., but under the U.S. model, health care is perceived as a privilege so the costs are measured accordingly.

Our private health care market has yet to be properly exploited because of the size and functionality of the free, state provided alternative, which provides a counter-balance in terms of said costs. By diluting its effectiveness, capabilities, and manpower, the free marketeers wish to expand the private arm of the sector to become dominant – which will, contrary to their whimsical meanderings about the economy and what is good for it, mean health care costs will rocket as the free option disappears. There is good evidence for this given the model the U.S. has been operating under; when health care is privatised in its entirety, we are at the mercy of businessmen who are driven by monetary profit at the real cost of our actual wellbeing, regardless of insurance or not.

The costs are and will be the issue, and the costs will determine coverage and dictate the law governing it.

The Coalition’s plans to overhaul the NHS are idiotic, but they are also the culmination of a decade of stupid thinking about the National Health Service. The Conservatives plan to get rid of all 10 strategic health authorities and the 152 management bodies known as primary care trusts. In their place, GPs will be asked to group together to form “social enterprises” that will take on the management of hospitals and other health services.

These plans do not just reflect the market fundamentalism of many in the coalition – after all Thatcher attempted no such such thing. They also draw upon a decade of idiotic rhetoric about the NHS which has heroised doctors and demonised managers. For years NHS management has been treated as a byword for waste. Statistics about the number of non-frontline staff in the NHS  have been bandied about as though they self-evidently demonstrate a lack of prudence, without reference to what those in the back rooms actually do – which as Owen noted some time ago is often actually quite a lot. This kind of thinking, meanwhile, has not simply been restricted to the right. All three parties gushed over  the importance of protecting “frontline” staff at the election. Similarly the BBC’s Casaulty – perpetually characterised by cliched, unsophisticated liberal leftism – constantly juxtaposes good doctors, who, you know, actually want to save people’s lives, against those involved in the dirty business of resource allocation.

Quite simply – and to treat all this rhetoric with the contempt that it deserves – doctors and nurses are seen as virtuous because we can physically imagine them patching people up, and anyone else can go to hell. And this is why Lansley hopes to achieve a level of popular support as he begins to dismantle the NHS, and in doing so cuts out a whole load of managers (he aims to halve management costs) and puts the good doctors in charge.

The idea that GPs could do a better job than people who specialise in management is an appealing falsehood. As Imran Ahmed notes:

The idea that creating a market of GPs, most of whom would be cluelessly stumbling through epidemiology, health economics, procurement and other features of health system management that they are completely unprepared for, would create an optimal system is simply ludicrous…

GP practices are clinical enterprises, not businesses, nor sophisticated Government bodies with the complex range of skills and expertise to use tax payers money sensibly to get the best for less.

Quite simply, specialisation matters. The capacity of an organisation to achieve its goals, and to deploy its resources effectively is greatly enhanced when people are able to focus on specific tasks, for which they can enjoy utilise specialist training and experience. This principle was noted (by no means exclusively) by Adam smith nearly 250 years ago when he hypothesised that instituting a division of labour in a pin factory could increase production 78 fold. In a case of the NHS, it is bleeding obvious that mammoth task of allocating resources and of delivering such an important service to so many necessitates a specific set of skills, and the full attention of individuals with relevant experience. And GPs cannot simply be expected to replace this – however virtuous their direct contact with patients might make them appear.

Yet perhaps the most serious issue with the Coalition’s proposals is a political one. The consortia of GPs that take on the management of much of the health service will be answerable not to the ministry of health – i.e. our elected government – but to an “independent NHS board”, which will set standards and will, in theory, be “free from political interference”. This is all well and good unless, like me, you think the provision of healthcare to us all is a political issue. It is all well and good unless you think that there should be some kind of democratic control over the means to keep all of us alive, and that the buck should stop with somebody who governs by our consent.

I did something different this Saturday. I stood in a freezing park in London and took a deliberate overdose of tablets in the company of some of the UK’s most well known scientists.

No I haven’t joined some kind of doomsday cult. In fact, none of us were ever at any risk. We were overdosing on homeopathic remedies…

For those of you who don’t know what homeopathic remedies are (I know I didn’t understand it until recently) I suggest looking at this website. Homeopathy means taking a (usually scary sounding) active ingredient like Nux Vom (Strychnine), Belladona(Deadly Nightshade) or Arnica and diluting it to 30C – in other words until there is 0.000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 1% active ingredient in each tablet. To put this in perspective, there is probably about as much of Julius Caesar in the tap water of Rome than there is active ingredient in these tablets. However, homeopaths claim that water retains a memory of the substance, which has a therapeutic effect. They then mix this water ‘solution’ with sugar and lactose and it retails for £4.99. A packet of sweetener costs £1.

Although the tablets themselves are not dangerous, people sometimes take them instead of taking actual medication in the belief they will cure real illnesses – and that is potentially dangerous. So last Saturday, a group of scientists decided to stage a publicity stunt to draw attention to this.

It would have been easy for me as a journalist to just report on this story and let this bunch of sceptics take the ‘risk’. Except I am also a sceptic so I wanted to know for myself. And having had only 5 hours sleep the night before the stunt, I desperately needed some sugar…

So on Saturday morning I found myself getting out of bed at the ungodly hour favoured by a bunch of atheists to stand in the freezing cold outside Conway Hall in London. After deliberation I selected some Sepia (Cuttlefish ink) tablets for the job – they had an old school photographic appeal. The packaging said you should only take two. Presumably in case you are a diabetic.

Among my fellow overdosers were Simon Singh, Lib Dem MP Dr Evan Harris and the comedian Dave Gorman. There were also about 80 other protestors, some of whom had travelled across the country to take part in the stunt (and got up much earlier than me).

I had to film everyone taking their tablets first and then take mine afterwards. This was not a cunning plan to watch and see if anyone dropped dead before following suit – it’s just impossible to overdose and shoot good hand-held footage at the same time.

Watching a mass overdose ought to be spine chilling. It ought to make you think of KoolAid and Waco but unfortunately there is something undeniably comical about a whole load of people making the same action at the same time. It’s like synchronised swimming.

What was even more amusing was that, for the benefit of the hungry media, the protestors had to simulate the overdose a further 4 times so everyone could get good footage. If you can just imagine a bunch of press photographers shouting “Simon, could you just overdose again for me please?”…

Finally, the time came for me to take my own overdose. This was harder than I had hoped because while everyone else managed to take the end off their tubes and dispense all the tablets into their palm at once for dramatic effect, my tube malfunctioned. I was forced to dispense the tablets one by one into my hand like Pez – a frustratingly slow protest.

Eventually I managed to pop out a handful – enough for a serious attempt – and with my friend the mathematician and comedian Matt Parker holding the camera I knocked back the tablets – without a drink. I figured the tablets were diluted enough already without washing them down with water.

It’s now three days later and nothing has happened to me whatsoever. I feel no more or less healthy than I did prior to the overdose and I felt no more or less healthy immediately after the overdose either. It’s an unscientific form of research – and it was never meant to be anything but: it’s a publicity stunt. For the purpose of legality, I should say that I do not condone or encourage you to take an overdose of anything at all (however benign) – this was a personal decision to prove a point.

The NHS currently spends somewhere in the region of £4 million on homeopathy – money which could be funding life saving research into genuine non-placebo medicine. I hope this little protest did change some minds.

As a footnote to this story, after the event only one of my friends bothered to enquire after my health on Facebook. One sorry person. I would like to think this is because they were all really well informed on the subject of homeopathy and knew I was in no danger but I suspect the real reason was they were too busy watching Murray v Federer.

Massachusetts was not won by the Republicans, it was lost by Obama

Yesterday’s big news from the far side of the Atlantic was the loss of one of the safest Democratic seats to Scott Brown, a man who represents possibly everything that should make us very worried about the Republicans. In Ted Kennedy’s former seat, which has been blue since 1952, it was the Democrats’ to lose. And they lost it.

They didn’t lose because their opponent drives a truck, because his daughters were available or because it was, after all, the people’s seat and not Ted Kennedy’s as was far too confidently assumed. By all accounts, it was not the number of Republicans voting which swung it, but the number of independents backing Brown and the number of Democrats staying at home. It might be tempting for observers this side of the pond to blame the unerring potential for American political stupidity in falling behind a resurgent GOP just one year after the worst president in living memory retired to Crawford. Obama’s ratings are now lower than any president since Eisenhower at the same stage. But for all the fire and spittle and mad dog hysteria thrown at him by the likes of Glenn Beck and Sean Hannity, the largest part of the blame has to lie with himself.

He is perhaps a victim of the power of his own voice. Obama could probably recount what he had on his toast this morning and turn it into a dazzling charismatic performance that lifts the spirits of the world. But the problem with hot rhetoric is that it does not sit too well with cold pragmatism. Only a fool would have thought Obama’s election meant a fundamental change in the nature of American politics. But he has played too close to the centre to truly capitalise on the yearning for ‘yes we can’. He was never going to appeal to the right in America. But with his lukewarm proposals for reform failing to match up to his lofty words, as speechcraft gets bogged down in statecraft, he is increasingly alienating his left-wing base.

It’s a tragedy for the poor in America that Scott Brown will likely derail even the tiniest table scraps of health care reform that are being thrown to them from Washington. It is a greater tragedy for the poor across the rest of the planet that Obama’s meagre proposals for emissions cuts will fall flat. But it’s a tragedy that Obama has brought on himself. There’s no guarantee that a left-ward swing will prevent him from becoming a one-term president. But at least he could say he tried. At least he could say ‘yes I did’. Because one thing’s for sure. If you sit on the fence, you get splinters.

The Obama administration will be breathing a sigh of relied today as the House of Representatives narrowly approved the President’s flagship health reforms. A battle still remains in the Senate, of course, and amongst the crazed zealots in the country crying ‘freedom’ whilst attempting to deny millions of the poorest Americans the right to basic health care. But this is the first victory for progressives in what, for anyone on this side of the Atlantic who isn’t a slapheaded idiot like Daniel Hannan, is one of the most bafflingly incomprehensible arguments in history.

It was Sun Tzu who, all those centuries ago, argued that to achieve victory, one must know one’s enemies. But I simply cannot understand anyone who refuses to recognise health care as a universal human right. Not least those FOX News fanatics opposed to a bill that does not even come close to free state-run health care, which should be a basic requirement for any developed nation, and indeed is a treasured asset of many developing nations. Whilst proclaiming their right to choose – an utterly irrelevant criticism in light of Obama’s reforms – they would deny hundreds of thousands of people any choice save death or bankruptcy. And that is not just for the poor and uninsured. That goes for all those whose policies just don’t want to pay out, who pick holes in every claim, because saving money is more important than saving a life in this most inhumane of models.

I can begin to understand the neo-liberals of the New Right who believe society should be orientated around a free market philosophy. I can even begin to understand social conservatives opposed to abortion and stem cell research on the grounds of their own moral compass. But I can never understand anyone who argues that human life should be left to the naked principles of the market. But then, perhaps Glenn Beck will be able to draw me a map of the retarded right-winger’s mind on his blackboard. It’s the only way I’m ever going to get it.

Guest post by Chris Girffiths

It’s not been an easy summer for Barack Obama. This month has seen yet more shrieking from the right-wings as he attempts to introduce a ‘radical’ scheme to offer US Government-backed health insurance scheme so the poorest people can get medical treatment. Hardly trying to append “SR” to the “US”, is he? But even this moderate move is seen as groundbreaking by the American Right, so sure are they that public sector provision is unpatriotic and even treasonous. Against this backdrop – which looks a lot like a Confederate flag – Obama’s got his work cut out.

The Fox-News-backed protesters are right about one thing though: Obama is a fundamentalist. This is an unpopular sentiment with everyone who’s read those really moving autobiographies; and granted, Obama’s much more likeable than Bush – but let’s face it, he’s not exactly differing from the last President in foreign policy, is he? The occupation of Iraq goes on, more troops go to Afghanistan and the aims are never set out, although we all know it’s about geo-strategic resource issues (oil, to be blunt). Obama rightly criticises British imperialism through his account of his grandfather’s experiences at the hands of the British colonial administration in Kenya, but is happy to serve as Commander in Chief of the most far-reaching empire the world’s ever seen, one that continues to ignore the Geneva Convention and support despotic regimes like Saudi Arabia. This is at odds with the lazy journalistic line that George W Bush was somehow an aberration while Obama is a return to the non-interventionist America we knew and loved – plainly untrue, as the US has intervened in over fifty countries since 1945, overthrowing democracies when they got in the way of American interests.

Aside from directly waging war on underdeveloped countries and contributing to worsening human rights in Iraq, Obama sits atop an economic system designed to subjugate the global South, meaning that informally the continents of Asia, Africa and South America are effectively under colonial rule. The World Trade Organisation continues to campaign for removal of tariff barriers in the developing world, despite the fact that all the major industrialised nations got to where they are today by using tariffs. The International Monetary Fund and World Bank carry on making ‘aid’ loans conditional on privatisation, as if Bechtel and Haliburton hadn’t enriched themselves enough already, prising open the global South for business. Is Obama going to change any of this? Probably not: he believes in American exceptionalism every bit as much as his predecessors, writing in Foreign Affairs that the US is “called to provide visionary leadership”. As leader of the free world, shouldn’t he have given us all a vote on this?

Unfortunately, the journalistic profession and many others in the US and Europe are guilty of extreme sloppiness: they’ve relied on Obama’s own accounts of his political philosophy, heavily analysed his moving speeches, and rightly celebrated the historic occasion of the election of a black President, but failed to step back and consider his policies in any depth beyond whether he was doing enough to sort out the recession. His small number of policy changes are impressive as far as they go, but our biggest worry should be what stays the same: foreign conquest, exploitation and disregard for human rights. There might be a more likeable front-man in place but real change will only come if the people who carried him to power in the first place start holding him to account by using their powerful voice to call for the dismantling of American empire.

Watch how Barney Franks reacts to a woman pushing the Obama=Hitler line.

Image: Mises Youth Club, via Wikipedia

I was planning to avoid writing about the US healthcare row. A lot of very good stuff has already been written on it, not least on this blog, and I wasn’t sure I had anything to add. But then this article on the Telegraph website caught my eye, and I couldn’t help myself. In case you haven’t been following the story, the condensed version is roughly as follows: a number of American opponents of Obama’s healthcare plans have been making a variety of outlandish claims about the terrors of nationalised healthcare, using the NHS as an example. They were helped along in this by Conservative MEP and sometime youtube celebrity Daniel Hannan, who made an appearance on hard-right dipshit Glenn Beck’s Fox News programme to explain precisely how terrible the NHS was, saying that he “wouldn’t wish it on anybody”. Labour have now seized on this as evidence that the Tories secretly have it in for the NHS, while David Cameron has done all he can to distance himself from Hannan without pissing off the Tory party’s lunatic fringe too much.

The Telegraph article I’ve linked to above is a response to Hannan’s critics from the man himself, and frankly, it’s pretty lame. He might have been somewhat misrepresented, as he claims, but his idea that Britain would be better off with a system modelled on Singapore’s is misguided at best. You’d expect Hannan to be relatively internet-literate, but apparently he’s unaware of the existence of this report, which is linked from Wikipedia’s article on healthcare in Singapore and as such took me a whole 20 seconds’ diligent research to locate. It explains that healthcare in Singapore is largely paid for by companies and individuals, with only a third of the costs met by the government. However, thanks to extensive means testing, those on low incomes have their healthcare subsidised by the government and it seems people don’t avoid getting treatment because of the cost in the way that they do in the US. It seems to work OK; overall spending on health as a proportion of GDP is much lower than in most other industrialised countries, and the healthcare Singaporeans receive apparently compares pretty favourably too. So on the face of it, Hannan’s argument looks reasonable. But then there’s the report’s all-important last section:

“Although the Singapore health system has been very successful, it is a very difficult system to replicate in many other countries for several reasons:

• • Singapore has developed its system concurrently with the development of the country over a number of years under the backdrop of political stability enabling successive governments to introduce consistent measures relating to individual responsibility, compulsory savings and regulatory control of healthcare services and costs
  • with a relatively small population of four million people within a concentrated land mass of 660 square kilometres, the planning of a healthcare infrastructure has been somewhat easier than would be the case for larger countries.”

It’s far from clear, in short, how far the lower expenditure is due to the system of payment and how far to the ease of setting up health infrastructure somewhere as compact as Singapore. Lacking much knowledge of economics I find it hard to see how who pays for the healthcare could make much of a difference, though if anyone who knows more than me wants to explain then that would be great. Singapore’s being a small, densely populated city-state, on the other hand, does seem a pretty obvious determinant of lower healthcare costs – it hardly seems controversial that it’s proportionately more complex and expensive to sort out healthcare for the UK’s 60 million people in an area of 244,820 square kilometres than for Singapore’s 4 million in an area 370 times smaller. Needless to say, this doesn’t do much for Hannan’s argument. If Singapore’s health system is better and cheaper mainly thanks to an accident of geography, that’s hardly a reason to adopt their method of paying for it.

There’s also another, more important point to bear in mind. Hannan may believe, as he claims to, that the US system needs improving and that he doesn’t think the UK should adopt it. But does he believe that the US has better healthcare than the UK? He went on American national TV, labelled the NHS “a 60-year mistake” and reeled off a clutch of vague anecdotes and cherry-picked statistics. This strongly suggests that he does believe the USA’s healthcare system at present is better than ours. If this is the case, then he should say so. Then he should explain why the World Health Organisation disagrees with him, putting the USA 19 places below the UK in its world rankings (not to mention 8 below Morocco, a country with a per capita GDP somewhere in the region of 4% of that of America’s). If, on the other hand, he believes that the UK has a better system than the one across the pond, then it would be nice if he could explain what’s so terrible about the US trying to provide government-sponsored healthcare for the 46 million uninsured Americans, since I’m assuming “making sure people can get healthcare” is one of the criteria the WHO uses to judge how good a country’s healthcare is. Because right now the only explanation I can think of is that Hannan has a blind ideological hatred of the State having anything to do with healthcare, and if that’s all it is, he could at least have the decency to be honest about it.