The American crisis

                   Des Spence (American Crisis BMJ 19.8.09) sneers at
private patients
in the UK who "choose to squander their money in the misguided pursuit of
choice".

     Surely it is precisely this lack of choice in the British
version of the
National Health Service which is responsible for so many of its worst
features.

    A system dominated by a government monopoly and lacking any
meaningful element of choice or  competition is bound to be inflexible,
and
unable or unwilling to respond effectively to patients who feel they have
a
genuine grievance.

   Americans appear to be well aware of deficiencies in their own
system, but
it is not surprising that so many of them are suspicious of President
Obama's
proposal to forcibly introduce a monolithic government-run  service
modelled
on the British NHS.

  Lack of choice is one of the prime characteristics of a
dictatorship. Choice
and competition can only flourish in a democracy. Americans are
instinctively
aware of this, and Spence's condescending article can only help to confirm

their suspicions.

Competing interests:
None declared