But on the NHS, Charlie Brooker sums up my feelings in one sweeping paragraph:
'Choice' is a mirage. Nobody wants to dial 999 and be presented with a menu of ambulance companies, police services or hospitals. All we want is to know that the local hospital is excellent, and that our taxes are being spent on incontinence pads, NMRI scanners and nurses' salaries rather than off-shored bonuses. Introduce a profit motive and you'll be sitting opposite your doctor wondering if s/he's on commission for that particular drug, got a free holiday (sorry, 'conference trip') from that hip manufacturer, or is on a tight schedule to see X number of patients to make it all worthwhile. And that's before we worry about the masonic and old-boy networks rife in medicine (disclosure: both my parents were NHS doctors).
The other problem with 'choice' is that it can't be informed. Unless you happen to be an oncologist, you won't have a clue which cancer treatments are best, for example. It's bad enough for doctors: the pharmaceutical firms never publish negative results, always publish papers carefully drawn to accentuate often minor gains, and constantly fiddle with treatments not to innovate, but to renew copyrights: the professionals find it almost impossible to make clear judgements. So how the hell is Joe Fatbloke meant to 'choose' his doctor and medication?
What the Tories want is the American situation, in which pharmaceutical companies spend 13.3% of their turnover on research, and 25% of their cash on advertising: $35 billion, or $61,000 per doctor. Yes, you read that right. Money isn't in medical innovation, it's in sales. Which leads to this (and this is only a mild example):