I just cannot in any of my wildest nightmares imagine the thought processes that go into making policy decisions like this. Applied large, we are bankrupting ourselves with this mania for government controlled top-down spending.

An environment seems to be emerging that will allow us to dismantle much of this nonsense over the next 10 or 15 years. Let's pray as much, at least.

John – I hope that Cameron's reticence in announcing more public spending cuts and replacing them with price driven free market approaches is only a calculated measure aimed at ensuring he wins the next election. If the Conservatives don't make meaningful reductions in the amount of public spending then you won't last long in power. I don't like to think about what will replace you, either.

Reply: I support co-payment

Use a private dentist? – You can't have your impacted wisdom teeth extracted in hospital, even though you pay National Insurance!

Watch ITV? – You can't watch BBC, even though you pay the licence fee!

Doesn't make any sense does it?

It has always seemed to me that if I am in a queue at a bus stop and someone in the queue hails a taxi it can only improve the position. If he is ahead of me in the queue I advance one place, if he is behind me it makes no difference to me but advances those behind him and those still to come. The approach of the left is to condemn the fact that he arrives at his destination sooner than me; but I don't care about where he goes or when, because it does not impede my progress by my chosen means of carriage.

Quite apart from the practical good sense of relieving the burden on the NHS there is a more fundamental point. The NHS was set-up as an insurance-based scheme. Spreading the collection of premiums throughout the country by way of National Insurance contributions was intended to ensure that everyone who did not have the means to pay the full cost of health care themselves would be assisted.

The system was not set-up to replace private health care but to supplement it. Yet it was set up quite deliberately as an insurance-based model so that everyone could see the level of contribution they were required to make. One reason for this was to ensure, so far as possible, that people would not make unreasonable demands on the service for fear that their contributions would have to rise in the same way that insurance premiums rise when large numbers of claims have to be paid.

Once the NHS became a political football as well as a medical service it was inevitable that those taking a populist approach would cite limitless "free" healthcare as a right. And once something is labelled a "right" the demand for it expands endlessly unless there are mechanisms in place to control demand.

Perhaps it is time to revert to the original model and create a category of National Insurance contributions specifically for the NHS (one could say the same about the state pension but that is another issue with different considerations). A clear link between what everyone pays by way of NI and the level of NHS health care provision will bring back into the equation a question which should always be a central plank of all economic and social policy, namely "what can we afford?"