country, with the exception of Finland and possibly Ireland, and gets average health outcomes as a result. So rather than moderate outlays for a moderate return, the UK spends less than average and gets an average return.

You might be wondering why Mr Massie doesnt have any specific suggestions as to how the UK should run a better health service. To some extent that is largely because he is a right-wing toady who writes for the Spectator, and the conservatives are all at sea when it comes to healthcare. While people may complain about single-payer systems there is little doubt that they are cheaper to run than public-private hybrid systems (such as the Swiss system that is about 25% more expensive per person) or largely unregulated private systems (such as the US healthcare system that costs twice as much as the NHS and delivers much worse outcomes).

Those are the simple facts but the conservatives are loath to admit it, for ideological reasons. And so we see occasional half-hearted hit pieces like this, from journalists too dishonest to concede the benefits of the NHS and too gutless to reveal their true intentions on the issue.

That aside, Mr Massie is perfectly correct when he says that the voters would immediately crucify any government that dared to touch the NHS. What he omits to mention is that their reasons for doing so have a perfectly valid basis.

The above comments reflect so much of the blinkered nature of the debate.

The core of Cameron's point is that the issue is the direction the trends are headed in. After you strip out inflation the NHS budget has increased in real terms from £400Million in 1947 to £120Billion in 2010. An average increase of 4% a year for over *60 years*.
A modernisation programme has pushed that increase to 8% over over the last 7 years.
Discussion regarding this is painfully elided by misinformation and also an interesting diadectic approach which benchmarks the spending as a % of GDP (so figures of between 6-9% get trotted out). Once however you look at the spending as a % of Public spending the spending direction becomes clear.
NHS Budget
1980 - £11.8 Billion - 11% of PS
1990 - £29.3 Billion - 14% of PS
2000 - £49.1. Billion - 19.1 % of PS
2010 - £120 Billion - 24.1% of PS
The country cannot afford the direction this is headed in, especially in relation to demographic trends, and yet the contorted nature of this debate means that these figures are not publically discussed because 1) Labour wants to ensure that the public are persuaded that they are the champions of the NHS 2) the Tories do not want to be seen as potential NHS hooligans.

The sad reality is tho that structurally the public purse will go bankrupt before the public get to see outcomes that reflect their assumptions on how the NHS ought to be.

The NHS is not perfect, and with yet another restructuring, may improve or worsen. I have my fears it will be the latter but it is beside the point.

I would query however that it delivers "modest outcomes for a modest outlay".
Consider health spending per capita in 2009 ($) 2815, US 6719, France 3420. Life expectancy - UK 80, US - 78, France - 78. Further figures on hospital beds, number of doctors and so on at http://www.who.int/whosis/whostat/2009/en/index.html.

The above suggest the NHS delivers a service equal to other countries at a bargain price. Furthermore, and crucial to the widespread affection in which it is held, the NHS is equitable. If you are living in lifelong poverty or are well-off the NHS service provided will be equal.

That certainly compares very favourably to the deeply unbalanced, inequitable, profit-based US system, that bizarrely some politicians are holding up as an example to be copied!

Each system has its advantages and disadvantages - the NHS historically did poorly in waiting times, the (fast improving) rates of survival with coronary heart disease are below European averages. But equally everyone has heard of US horror stories of people unable to access cancer care due to cost or bankrupted by the cost of medically easily manageable chronic disease.

Reasoned, evidence based debate is needed not bitter polemics like the article presented here.

During my time working on wards within the NHS I found that most nurses were compassionate and caring. They engaged with their patients and tried to make sure that they were as comfortable as possible. Some nurses were brusque but this was often in order to complete all the tasks they had to do. Those who needed help with their meals, were helped. I have spent many hours helping to feed elderly patients. The food although not always imaginative was on the whole nutritious. Patients were assessed by dieticians and given food appropriate to their needs. People with special dietary needs, such as those needing a low sodium diet or for religious or ethical reasons, were catered for.

An elderly person ward requires a high ratio of nurses to patients. Even though sometimes the ratio approached one to one, there often was not time to stay and hold a hand of a patient and just comfort them. There was the constant need to wash patients who might have diarrhoea; to monitor their vital signs; to dress patients; to help them to toilets; to feed and give medication. I saw the very best nurses spending time massaging creams on to patients with dry skin.

There is always more that you would like to do to make a patient feel comfortable and cared for. The nurses on the wards were mostly conscientious; came from every corner of the world and were not sullen.

This is what predictably happens then a Conservative government continues to add patients and services to a health-care system without the proportional addition of money,

Maggie Thatcher said: "The trouble with socialism is that eventually you run out of other people's money" She didn't bother to say that when you take the people's money then spend it on absurd foreign military adventures, there's not enough left to provide the services that the people give you their money to deliver.

We should not put down the British system too much. Thus could become the model for American health care... Discussing health care systems makes me glad I live in France.

To some extent that is largely because he is a right-wing toady who writes for the Spectator, and the conservatives are all at sea when it comes to healthcare. While sazky people may complain about single-payer systems there is little doubt that they are cheaper to run than public-private hybrid systems (such as the Swiss system that is about 25% more expensive per person) or largely unregulated private systems (such as the US healthcare system that costs twice sazky as much as the NHS and delivers much worse outcomes).I offer a certainty for a PhD thesis topic: how the American invasion altered the socialist medical system in Iraq. Pre-invasion, you got sick, you saw the doctor and perhaps went to hospital, and the State paid for it. Horrified by this, the provisional occupational authority brought in a civilian authority on how health was cared for in the United States sazky , and he went back to Minnesota smugly happy for having installed fee-for-service (at probably the time of greatest need for health care in Iraq's history). Few Iraqis saw any reason to pay the doctor for things that had always been free, and of course, whatever was passing for the government of Iraq at the time had stopped paying their stipends.They engaged with their patients and tried to sazky make sure that they were as comfortable as possible. Some nurses were brusque but this was often in order to complete all the tasks they had to do. Those who needed help with their meals, were helped. I have spent many hours helping to feed elderly patients. The food although not always imaginative was on the whole nutritious. sazky .Patients were assessed by dieticians and given food appropriate to their needs. People with special dietary needs, such as those needing a low sodium diet or for religious or ethical reasons, were catered for.