SO TORY MEP, DANIEL HANNAN, RECKONS THAT THE NHS is a 60-year-mistake, does he? The comment, made in the increasing poisonous debate on Obama's plans to reform American healthcare, swiftly winged its way across the pond. Cameron, already smarting from the comments of Alan Duncan about MPs being treated like s**** and living on rations, must have uttered one of his now infamous expletives on hearing Hannan's pronoucement.

Back in BB times (Before Brown), I was a Parliamentary Private Secretary in the Department of Health. At close quarters, I watched the Tory health spokesperson and Cameron schmooze health professionals. It was a deliberate pubic relations exercise to detoxify the Tory brand when it came to healthcare. Some of my colleagues dissed the Tory attempts. ‘No one believes them. The Tories don't care about the health service,' they would tell me, ignoring a prime rule of public relations - repeat the message. And repeat the message, they have. Cameron and his ilk were following exactly the same path as Labour in the run-up to the 1997 election, when Labour had to dispel its image of being incompetent on the economy. Why couldn't my colleagues see what the Tories were up to?

But how many Tories share hapless Hannan's views. He's certainly a darling of the Tory right - remember his You Tube rantings during the European elections? But as Cameron scrambled about to denounce Hannan, how many Tory MPs have private health insurance? I wondered.

In the wake of Hannan's comments another Tory MEP stepped forward to add to Cameron's disquiet. Roger Helmer said that: ‘If the Americans came to me and said: Would you recommend us taking up a system like the NHS, I think I'd have to say No.'

Then it emerged, too, that many of Camerons closest allies have ties with prominent American right-wing politicians who have been denouncing the National Health Service. Names in the spotlight are Osborne, Hague, Graying. Gove and Fox.

And leading Tories, such as Gove, were listed alongside Daniel Hannan as co-authors of a book called Direct Democracy, where it is stated that the NHS is ‘no longer relevant to the 21st Century'.

The fact is that the Tories are more right-wing on health than they care to make out. Labour health secretary, Andy Burnham, said that Hannan was Cameron's worst nightmare. I'd have said that the Tories were the NHS's worst nightmare.

But what of the system in the USA which has sparked such a hateful reaction to the NHS? The American's may spend twice the proportion their GDP on health than we invest in the NHS, but are the outcomes twice as good?

Just as some Americans (and Tory MEPs) have painted a horrific picture of our health service - Ted Kennedy wouldn't have been treated for his brain tumour! Professor Stephen Hawkins would have been left to die - some Brits have been equally guilty of portraying the American system in grisly terms. If you're taken to hospital with a heart attack and have no insurance you are left to die! They leave you by the road side if you are in a car accident! Neither statement is true. This hyperbolic nonsense distracts from the worrying inequities of the US system.

It wouldn't be true to say that if you're in a traffic accident, that you will be left by the roadside if you don't have healthcare. You'd be taken to hospital. Granted, the paramedics will riffle through your belongings to see if they can find your health insurance card, but you would be taken to a hospital whether they found it or not.

If you have insurance, the insurance company might pay the bill (there's a lot of haggling with insurance providers in the USA). If you don't have insurance - and there are 47 million Americans without any cover and 25 million who are under-insured - then the state will pick up the tab if you are poor enough to qualify for Medicaid. If you're aren't dirt poor and have no insurance, then you're in deep trouble. About seven out of 10 bankruptcies in the USA are a result of people not being able to pay medical bills.

Most Americans get healthcare insurance via their employers. Some firms here offer healthcare as part of the remuneration package. But the number who receive health cover from their employer is much higher in America. And most Americans top up the cover they get at work - to the tune of about £7,200 a year for the average family. Even then, with employer cover and personal cover, you still have to fork out. Losing your job in the USA means losing most of your healthcare - being ill then can be catastrophic. Apart from the bankruptcies as a result of high medical bills,, a study carried out in 2007 (using 2005 data) revealed - worryingly - that more than half of Americans who had a health problem didn't seek treatment because of the cost. Given recession and job losses, that figure is likely to be higher now. For all the criticisms of the NHS, if you lose your job here, you're still entitled to the same health care as the next person.

The USA has better outcomes than here when it comes to cancer survival rates. There are explanations. First, employers and insurers demand regular health checks. If you miss health checks, you can lose cover of have to pay more. So cancers are picked up at a much earlier stage when they are far more treatable. In recent years, the NHS has moved towards more health checks to catch cancers early. But how many people know about these checks? We need to ensure that people are told about the tests and invited to their GP.

Cancer is also where the money is on the USA. Prostate cancer is often quoted as an example of excellent cancer survival rates in the USA. As I have said, the Americans carry out more tests. But it's also about money. The best insured in American are likely to be middle-aged men. So there's money to be made in diagnosing and treating prostate cancer.

Our TV screens are not full of advertisements from pharmaceutical companies promoting new wonderdrugs with the instructions that you demand this (expensive) treatment from your doctor.

For all the excellent health outcomes for those who have the crème de la crème of cover from their employers and who can afford a top-notch private healthcare and enough money to pay for all the ‘deductables' that the insurance company will subtract from what they pay out, there are many disturbing facts about health outcomes in the USA. If we take mortality rates of sick children treated in hospital, the figure for those with state cover only (which all children under 18 get in the USA), is 18.7 per 100,000. For those with private health cover, the figure is 7.9 per 100,000. In fact, infant mortality rates in the USA are worse than in the UK - nearly seven per cent in the USA and four per cent here. Life expectancy - in spite of all that high-quality early cancer detection and treatment - is not as good as the UK. So while they spend twice as much of their GDP on health care as we do, they do not get twice the outcomes.

People grumble about managers, paperwork and bureaucracy in the NHS, but it's worse in the USA where there is one administrator per two doctors. And those insurance firms have legions of pen-pushers assessing just how much of your treatment they are willing to fund. American friends of mine constantly complain about haggling with insurance firms.

Yes we can learn from the Americans when it comes to health checks and early detection - and we are moving that way in the UK and as a result we should see cancer outcomes improve. But I totally disagree with the Tories MEPs - the core philosophy of the NHS is that we are all entitled to care regardless of income is morally and ethically the one I would go for everyday.

The NHS does not care if you are poor or rich - it treats us all the same regardless of income. The Americans may call that ‘socialised' - I call it civilised.

17 August 2009