Daniel Finkelstein
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The instant I heard how the NHS was treating Colette Mills and Debbie Hirst, the image came to me. Here we go again, I thought. Sootynomics.
When I was a boy I had a precious Sooty and Sweep record. You wouldn't think Sooty worked that well on record, would you? Not given that he was silent. But I thought it was hilarious, particularly the bit where the two puppets are ineptly preparing a dinner party. “What are you doing, Sooty?” exclaimed Harry Corbett as we hear woodwork noises. “Planing down a tree to make a cocktail stick?”
Funny though I found it then, I am sure I would have forgotten this moment of comic genius by now were it not for this - throughout my adult life I am continually coming across people planing down trees to make cocktail sticks.
The comedy comes, of course, from Sooty's failure to appreciate how big a tree is, how small a cocktail stick is and therefore how fruitless the effort is. Except that for Collette Mills and Debbie Hirst, Sootynomics isn't comic. It's tragic.
They both have cancer. They wish to benefit from a relatively new drug called Avastin, but the drug has not been approved for use by the NHS. It does do some good, but it is not regarded as cost-effective. So the two women decided that they would buy the drug themselves.
Fair enough? Apparently not. The two women have been told that if they pay for the drugs, NHS treatment will be denied to them. They have to pay for all their care privately, an impossibly large sum, or receive it all through the NHS. Alan Johnson, the Health Secretary, was firm on the subject. They cannot, he argued, “be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs”.
But the reason he gave was not a medical one - that drugs needed to be administered together by the same doctor on NHS time. Or a practical one - that it would be a bureaucratic nighmare to have some drugs for sale and some not. It wasn't a legal one either: it isn't at all clear that the law prevents this mixture of the NHS and private treatment Instead he said this of the request by these gravely ill women: “That way lies the end of the founding principles of the NHS.”
Now Mr Johnson is a compassionate man and an intelligent one, too. He's not, in my experience, generally dogmatic. So what on earth possesses him to deny cancer treatment to these terribly sick patients? Where could such an idea come from? Sootynomics.
Last year was the 50th anniversary of Tony Crosland's book, The Future of Socialism. While re-reading what was, when it was published, one of the most important books of social democratic thinking, I was struck by how dated it had become. Crosland spent half the book in earnest dispute with people advancing ideas that are, to the modern eye, completely ridiculous. He patiently explains, for instance, over an entire chapter, why guild socialism - a barely comprehensible scheme in which trade groups control industry - wouldn't be a bright idea.
What has changed over the past 50 years is this: we now appreciate, or at least have some inkling, how big and how complicated the world is. When there are staff employed in the occupational therapy unit of the IT centre of the people who make the dye that colours sliced bread packaging, how exactly does guild socialism work? The idea of a fully planned economy, painstakingly criticised by Crosland, now needs little effort to refute. It has simply fallen away.
Yet there remains an extraordinary amount of public policy confidently advanced without any idea of the massive contrast between the size and complexity of the world and the puny measure being proposed, without any understanding that the world rages on like the sea - unstoppable, uncontrollable.
The absurd idea, for instance, that you can tackle obesity by banning food advertisements on children's television (an apt example of Sootynomics, come to think of it) or stop climate change by using fewer carrier bags at the supermarket. I remember one of my colleagues calling for a boycott of Tesco because it was killing the high street. The last time I looked, Tesco was still trading.
Alan Johnson's NHS ruling is a perfect example of the same syndrome. What is the fundamental principle whose end he fears? Not that care should be free at the point of use, since he already believes that to use Avastin, you must pay for it. No, the principle to which he clings is that all patients should receive the same care. There should be equality.
Do you see what I mean when I say it would be comic if it wasn't a tragedy? Mr Johnson looks at the world with its vast disparities in wealth, with its teeming masses and its warzones and its starving slums and its clipped suburbs and thinks he can make the world more equal by preventing a couple of women buying Avastin.
Actually, never mind the starving slums and the warzones, there isn't even equality inside the NHS. There are cancer drugs you can have prescribed in Scotland that you can't have prescribed in England. You can pay for some dental services while receiving others on the NHS. You can receive two different but related treatments and pay for one of them as long as you don't have the treatments together in one place as one episode.
Alan Johnson is trying to hold a line that cannot be held. As more expensive drugs become available and are deemed “not cost-effective” the Mills and Hirsts will multiply. The offence against their rights will be seen increasingly as unacceptable and the pursuit of an elusive equality ever more obviously futile.
You may as well stop planing down the tree now, Mr Johnson.
daniel.finkelstein@thetimes.co.uk

Daniel Finkelstein is a weekly columnist and Comment Editor of The Times. His blog, Comment Central, is a personal round up of the best political opinion on the web. Before joining the paper in 2001, he was adviser to both Prime Minister John Major and Conservative leader William Hague
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Solution? Simply pay for Avastin from a separate (but co-operative) doctor, DONT tell the NHS.
Remember it is every Englishman's duty to mislead and lie to the government on every possible occasion!
Mike Bibby, St ALbans, England -not EU
"So a person equally in need of Avastin but who can't afford it should suffer because she is market 'loser' - unable to earn a decent income or not having inherited wealth! Obviously as a lesser breed in economic terms she should be allowed to wither."
Robert Grundy
I would argue that person on a low income gets a pretty good deal out of the NHS as they get the average level of treatment that can be afforded once all the money is collected from everyone at every income level. Someone topping up their treatment with whatever money they are left with after tax is surely their right as a human being?
Robert McIntyre, London,
Alan Johnson is giving these women the equal right to die more quickly. He must be very proud of himself.
Marcos, London, UK
Daniel:
Did you notice that Dr. Ron Paul moved up to fourth place in the Michigan GOP primary? He got double the percentage of the vote than Frum's Guiliani with much less media coverage. Go figure...
Please keep criticizing the guy... It can only help.
Robert Miller, Halifax, NS, CANADA
I presently receive a regular prescription to treat my elevated blood pressure and cholesterol. Because I'm a pensioner, the drugs are issued free on the NHS and in addition, I buy for myself aspirin and cod liver oil which are recommended enhancements to my regime.
Can I now look forward to a multipage missive from some idiot administrator telling me that my NHS treatment is to be terminated??! And also that any consequent (and near certain) hospitalisation for stroke or heart attack must be privately funded?
Keith Loxley, Aylesbury, UK
Unfortunately UK governments of both persuasions think governing means micro-managing and telling us what to do - they are too easily able to suppress the population which is not used to having any direct say in anything.
It's not perfect but under the US constitution the government has from its outset had far less power and interference in people's lives and lets them get on with it, also the population can raise and vote on specific issues which we are not allowed to.
If only the UK realised that the democratic powers are so weak here for the individual and we are very institutionalised here in a socialist way (socialist with small "s") with the most centralised government in the western world.
I'm for less government, london,
Alan Johnson, the Health Secretary, in Labour, right! well labour are all loony control freaks, I thought every one knew that ,so if he says you cannot have one lot of drugs from the NHS and one from a private source then that's how it is. Simple really and no need for an explanation. Alan Johnson, the Health Secretary, is Labour, right?
D Case, Newquay,
If it is not considered OK to 'mix' private and NHS treatment, then surely, in consequence, private patients should not be allowed NHS beds or have emergency treatment on the nhs, when things go wrong?
Nicki, Southampton, HAMPSHIRE
So Mr Grundy likes to see 'rich' people die. But that's socialism for you. It doesn't matter that there's a treatment that could save your life, if you earned more than Mr Grundy in your lifetime you deserve to die. Nice.
mark mcfarland, dubai, uae
Robert Grunday's comment is like saying that because I pay for music lessons for my kids they should be thrown out of their state school.
Allowing these women to pay for Avastin while receiving the rest of the car they are entitled to on the NHS is not denying anyone else anything.
KC, Oxford,
It's high time that socialist poiticians stopped regarding unequal ability or desire to make the most of opportunity as a condition that can be corrected by an act of political will.
Get real in your lofty, leftie ivory towers. It's a National Insurance scheme. That means the insurance company (i.e. the government) will pay an amount towards treatment to recover health. If the insured (patient) chooses to have something added to the basics being paid for then that is, or should be, allowed. Every insurance scheme in the world works that way and has no problem at all with the provisioning/billing involved. Why not this one? Unless, of course, the issue is political control instead of a genuine desire to help out.
KR, Stockport,
Should cancer patients suffer equally, have equal survival rates? Should ideologues be allowed to stuff their half-baked 'principles' down other people's throats in the guise of policy? The answer to both questions is clearly yes, according to Mr. Johnson, of whose intelligence I am not so confident as Daniel Finkelstein. Now, what if Mr. Johnson or a member of his close family developed cancer and could obtain benefit from a drug such as Avastin. Would his ideology survive the challenge? Or would he find reasons to claim that he and his family were not the same case at all and therefore not subject to the rigour of the rules? I hope we never find out but, looking around, we see everywhere examples of blatant hypocrisy by our law-makers, whose apparent high-mindedness so often gives way to craven self-interest. Trust in government? They surely jest. Sooty might do a better job.
anne, bournemouth,
Spot on Mr Finkelstein.
Robert Grundy`s comments, like Johnston`s ruling only show
how true Churchill`s comparison of capitalism and socialism
was. "Inequality in the sharing of reward was capitalism`s only
vice. Equality in sharing of misery was socialism`s only virtue.
Denver Watt, Osaka,
So a person equally in need of Avastin but who can't afford it should suffer because she is market 'loser' - unable to earn a decent income or not having inherited wealth! Obviously as a lesser breed in economic terms she should be allowed to wither. Social Darwinism? Or Marie Antionette remixed - they'll have bread anyway so why complain if someone else has cake on top of that too! No matey, you either opt in or you opt out. And if you go private it will release money for other patients to receive much needed care. In any case we all have to die - lets just hope it is not a painful death. Your arguments about plastic bags is poor. While not a sufficient condition, fewer non-decomposable plastic bags must be a necessary condition for a more sustainable future. Since the link between school success/ earnings is broken - it will always fail. Paul Owen is however right about politicians being more equal than others and hypocritical about it.
Robert Grundy, London,
How right you are. This notion of equality is what has ruined our schools too. We are lucky that politicians have been unable thus far to interfere too much in the universities or else they would go the same way.
Equality. It tends to be something beloved of politicians until they are involved themselves. Tony Blair finding good schools for his kids. Diane Abbot educating her son privately. Oh and a more recent example: why aren't politicians who break rules treated the same as citizens who break rules? Is Peter Hain more equal than I am? It would seem so.
Paul Owen, Birmingham, Uk