Did I really see someone write "The NHS should ... provide care only to those who have contributed"?

I didn't ask to be born disabled. I've contributed a lot to society *after* all the childhood healthcare I had. ... who's going to draw the line on provision?

Jane Stemp, Wincanton, Somerset

The peoples of England have chosen socialized medicine. With socialized medicine comes rationing, long waits, reduced survivability. Despite common knowledge of this, there are some in the United States that also are wanting socialized health care. Let's hope we're able to resist it.

David Thomason, San Diego, CA, United States

Don't pay for IVF and ban abortion.

Problem solved.

Charlie, Candler, NC, USA

An agreement between drug companies and the NHS to pay only for treatments that work could be a way forward. Also not replacing trident would give us £100 billion to play with, as well as getting out of Iraq and Afgahnistan. Buy the Heroin give it to addicts,solve our crime wave and aid Afg economy

ian, durham, england

Let me guess, Libby: You're healthy.

Ed, Wailuku,

I sure am glad that I live in the US where healthcare means you call your doctor and get an appointment. I have had appointments "today" a few times. I understand that you can wait for three months for an MRI. I have never had to wait so much as three hours. Tsk. Tsk.

Cyrus Bear, Saint Paul, USA/MN

Why should rationing be at the delivery end?
Treatment should be the priority, not cut randomly because 13 billion's been wasted on rubbish IT and hospitals employ more clerks than consultants. Ration the managers.

UK treatment is delayed by targets, red tape and job creation. Fatal combination.

Susan Wade Weeks, York Central, UK

Rationing healthcare is the only logical way to keep healthcare happening. There is only 100% of healthcare available. Thus, logically, it can be split between people that need it, but only to 100% . It's pure folly to think that Santa Claus deals out healthcare to everyone, forever.

Mrs. Dana Higgins, Oldham, UK

Rationing is inevitable. What is chilling from the list of choices is the one that favours the breadwinner and the parents of young children. Quite popular, as the majority will be in these situations at some time. Cancer knows no boundaries so should win politically, but will it under G.Brown?

D.L. Stephens, York, England

Sorry to hear about your mother, Libby. She must have been a remarkable lady to produce you. It is encouraging to see some people at least realising that a nationalised health service has had its day and a core service with insurance for the add ons is the way forward.

Mike Fowle, Felixstowe, UK

What gauls people more than anything else is the huge amounts of wasted money being poured into the NHS. I would guess that running NICE would fund quite a few treatments alone! Its about time the whole system was overhauled and de-centralised, de-politisised made the peronal service it should be

tony Southampton, Southampton, UK

Perhaps we should follow the example set, many years ago, by Oregon. They held a referendum on what should and should not be covered by state funding.

Some luxury or non-essential items such as fertility treatment and many forms of cosmetic surgery would be candidates for exclusion from cover.

Chris, Ashford, Middx, England

Absolutely right. Provide new drugs to Patient X and you have to decide which other patients should be denied another treatment. I wonder, however, whether a little less might be spent on charlatan IT consultants, administrators (proliferating much faster than medical staff) and NHS pensions?

Frank Upton, Solihull,

Why don't people admit it - the NHS is a fraud. "Best possible care for ALL FREE" was how it was sold and the myth perpetuated. Be honest, go back to the drawing boad Now we have the horrifying concept of the state deciding which sick person is worth saving and who is not.

Dr J Findlater, Carnforth,

Libby is absolutely correct. We all carry around potentially fatal conditions and now live long enough to be affected by them. Medical advances make available a much wider variety of treatments, but if we spent the whole of GDP on health we still couldn't treat everyone for everything.

gordon, Didcot, UK

An absence of democratic accountability makes a bad situation worse. Plebiscites on medical need would be unwieldy and create perverse decisions.

Perhaps local areas need thier own NICE to decide on local priorities?

Tony, Wirral,

Self-responsibility in all health matters one CAN control, NHS aid/treatment in all matters one can NOT, lawsuits to recover damages from those refusing to act responsibly, cost-cutting innovation & moderation in all behaviours. THAT'S the remedy - for ill health AND NHS budgets.

Larry, Middletown,

We have a free at the point of need Health Service and an open immigration policy. The two don't mix. The extra money poured into the NHS since 1997 has been more than matched by the number of people pouring into the country to take advantage of it. The taxpayer loses out completely. What a waste.

Sean Hunter, Glasgow,

A brave and sensible column. Isn't it odd how we accuse the government of "wasting our money" when it's spent on something that doesn't interest us, yet tend to forget it's still "our money" that funds the NHS? Someone has to take hard decisions as to how it's spent - I'm just glad it's not me.

Barry, Wallington, UK

Heres a shocking idea- How about i pay a monthly amount and a company gives me a list of services i can access if i need them, if i want more i pay more. You know like every other service or good, seems to work well food, shelter, clothing, cars, ipods.....

Gavin, London, GB

Excellent article! Where discretion should lie should definitely be publicly debated. Personally I don't think fertility treatment should be funded, but I believe cochlear implants for children should be, yet neither infertility nor deafness are life-threatening conditions.

Shav, London,

The rationing needs to be made more logical but we also need to allow self funding in parallel with NHS treatments. Troubling as it sounds, if I want to buy a few more months of life later on, I should be able to - without compromising my right to any NHS care that I have paid towards all my life.

Melissa, London,

The NHs will never be efficient until it is run by doctors independent of the state.
The state is poor at running the health service. Let the state provide personal insurance and let the medics run the health service.
This model works very well in France. Great service and no waiting.

M Reid, Northampton,

The huge cost of IVF and similar non-life threatening treatments drains resources which could be available for e.g. cancer saving drugs. In the longer term, costs of such new treatments will come down due to economies of scale & so in the longer term cancer and IVF treatments will both be affordable

PP, London,

British people simply do not pay enough for their health services. In Belgium, compulsory health insurance costs about 200 euros per month (according to means), and even then there is a small amount to pay for a visit to a doctor and for a prescription. These costs are similar throught the Eurozone.

Andrew May, De Panne, Belgium

I agree, no budget in the world gives everything wanted. The NHS should a)provide care only to those who have contributed and only to those who cooperate in their care, b)only provide strictly medical care and c)act premptively to prevent many illnesses.

helen, Norwich,

The state cannot have it both ways, expecting citizens to pay huge sums but deciding (rationing) who gets cured. This is not on. The only option therefore is to pass full responsibility to the citizen and privatise.

malcolm, ely,

"there will never be enough money to meet every need" is too defeatist. Treatment is limited by the huge costs of research, but the expectation is that eventually research will basically be done with, and there will be the capability of easily treating almost any condition. Not now, but not never.

Graham Rounce, London, UK

If the NHS didn't give care to everyone who asks but rather only to those who have contributed, perhaps then there would be the money to give the latest drugs. It is decidedly unfair to deny treatment to those who paid their dues for years and yet treat the medical tourist at no charge.

Nona, New York City, USA