Should the NHS be free? No, This is contrary to the economic law that supply balances demand by moving the price. As we all see, it does not work. Health treatment should be left to the markets, subject to the law. Brian Gilbert, Hampton, Middlesex

As a GP, along with other staff facing the realities of today NHS, I welcome your comments regarding the current political dogma. All parties seem to be ignoring the full horror of demographic change and its impact on a creaking system. More managerial jargon and face-lifts will be exposed sooner rather than later. Sugar-candy mountain is not an appropriate philosophy. I suggest an analogy of the boy with his finger in the dyke faced with the prospect of global warming. At 46, I am seriously worried about my healthcare in my old age. We need honesty about the future, not platitudes. Liam Broughton, Lincoln

The NHS makes great play of the fact that it is the third largest employer in the world, with around 1.4 million employees to service some 55 million people. So why is it that Germany with 82 million people to service can do so with a smaller health service and yet deliver more doctors, nurses, critical beds per head of population and achieve, by almost every measure, better healthcare outcomes than the UK? The reality is that the Department of Health has generated the most inefficient and bureaucratic healthcare system in the Western world. If our approach is so enviable, how come no one else is trying to copy us? John Galpin, Cookham

We must be open and honest about the NHS. There are far too many managers spending time creating work that is of no relevance to health. New staff are obliged to attend courses that are of no benefit to the job. If Matron was brought back, ie, one person responsible for all nursing and cleaning staff instead of committees, hospitals would be cleaner. If nurses were once again trained on the wards instead of in univerities, there would be no need for degree modules devoted to "bedside manner"; neither would there be nurses who are "too posh to wash". Name and address withheld

The NHS is simply a vehicle to line the pockets of medical "professionals". And before anyone says that medics have "our lives in their hands" and require remuneration commensurate with this responsibility - think again. Medicine is the only profession I know of where, when cock-ups happen, colleagues rally round to protect those who are clearly at fault and the service (the NHS) picks up the tab. This is not responsibility; it is a cop-out designed to maintain the god-like status of these individuals. My advice is to check out private health care. You will see, after doing some basic arithmetic, that you can get a better service for half the price. Derek Sinclair, Dundee

The debate on the alternative methods of financing the NHS has gone on for almost as long as the service itself. However, the article makes some assertions which are not supported by facts. Particularly, balanced examination of insurance-based systems will find that there can be a real problem for the less well-off and those suffering from chronic or terminal conditions. Any alternative would need to ensure that such cases were guaranteed treatment. The cost and problems of collection and payment of bills is one which is usually ignored. Comparison of total expenditure as a percentage of GNP/GDP is useful when looking at alternatives. Finally, the use of expressions such as "MRSA-riddled NHS" must do wonders for the morale of those staff working in the service. Name and address withheld

The British public have, in the NHS, exactly what they deserve. A population obsessed with the price of everything and no comprehension of the value of anything vote for those who will deliver a "free-ride". The NHS model is based on the old Soviet Union - that model of efficiency and delivery. The current system of targets would be exactly what Gosplan might have planned. In truth, the system is run for the benefit of Unison, the RCN and the BMA. Don't hold your breath waiting for a change. There are far, far too many vested interests. Eddie Reader, Sutton Coldfield

If the NHS were to operate a triage system to specify which conditions would - and would not - be treated (with all others being treated at the patient's expense), not only would its finances improve dramatically, but the market for health insurance - to cover conditions not treated in the NHS - would also improve. John Blackley, Austin, Texas

Those who can afford to pay, should. Those who cannot or who would otherwise go without appropriate treatment, should be paid for. When people pay, they can and will demand how services are delivered through their choice of provider. Good providers will have more income, will afford better management, will deliver better results. It was ever thus. The NHS dream is a nightmare of muddled ideology, political interference, relatively poor management, insufficient resources. It is not working - time for change. Andrew Grant, Kingston upon Thames

The NHS cannot, in its current format, be reformed, the best we can do would be to break it up and privatise the parts and at the same time switch to insurance-based healthcare provision. There is no requirement to have political control of healthcare in order that an efficient and equitable service may be established, this is pure dogma. Roger Davies, Aberdovey

Politicians have not failed the NHS - they have provided unprecedented amounts of cash for the NHS. They have every right to know how the money is spent and have some influence. The steer could not be more focused. So what is the problem? The huge NHS system has become self-serving - where conscience and humanity of care sadly come second to maintenance of the status quo. The healthcare commission requires even more teeth to identify poor quality and to deal with managers and clinicians who fail to live up to expectations. Less bureaucracy but much more effective management is what is required - certainly not less management as some professional groups would wish. Paul Buss, Chepstow

Patience Wheatcroft was wrong to cite the dentistry situation and a model for future growth in the NHS. In many parts of the country it is almost impossible to get NHS dental treatment and what is available is at a price, which many find prohibitive. We must look to other means of financing our nation's health service. Tony Wright, Benfleet, Essex

Perhaps your columnist should read Nicholas Timmins' excellent biography of the welfare state and see what healthcare was like before the NHS. If we go down the road of insurance some individuals will inevitably enjoy far higher coverage than others. How strange that the public don't appear to be clamouring for the increased marketisation of health care. Maybe they're aware that it would do little more than enrich health insurance companies. Jay Wiggan, Nottingham

I have not seen a doctor for a check-up, nor a dentist, nor an eye doctor in a decade because I cannot afford it - and I'm middle class! I pray that Britain does not follow the US example in health insurance. The only ones who benefit are the insurance companies. Try to fix your healthcare system so that more people can see a doctor. I would happily pay more in taxes to have a National Health Service, but that will never happen in my life time. Robin Castellanos, San Antonion, Texas

Many commentators have expressed concern that healthcare cannot continue to be funded through taxation indefinitely. As far as general practice is concerned, there is a simple alternative. As a GP who resigned from the NHS in 1994 because of my frustration at the increasing political control, I set up a practice where patients pay a subscription, either annually or monthly, which gives them unlimited medical care with any of the practice team. A system is in place whereby some patients pay a smaller subscription or no subscription at all if their financial circumstances restrict how much they can afford. If such a system replaced the current primary care funding arrangements patients would pay their general practice directly and the Government could make a "health grant" on behalf of those patients who were unable to pay the subscription due to their financial circumstances. In my own independent practice, such a system of care allows us to work outside political control and not be encumbered by targets and politically driven protocols, while still having full access to NHS secondary care. Richard Willis, Salisbury, Wiltshire

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