Okay, but that's 'healtchcare' as a lifestyle accessory.

It's missing the point that essential healthcare which isn't available locally might as well not exist.

If I have a heart attack I don't want to be waiting for a doctor to helicopter over from Poland. Likewise if I sprain my foot, I shouldn't have to fly to France for an x-ray.

It doesn't matter how good or 'competitive' these non-UK services are - if they're not immediately available, they'no use to me.

There is a difference between attempting to stamp out health tourism and actively promoting it (and then another yawning gap between promoting it and thinking that it'll solve the underlying problems with our health care systems). Stamping out health tourism is, if not impossible, then at least very probably more trouble than it's worth, but that hardly justifies subsidising it.

And as an aside, if you implement the kind of system where the country you are treated in sends the bill to the country you live in, you run into all kinds of issues. In Poland, for instance, abortion is illegal. In Denmark, it's a fairly routine operation. The Polish authorities might understandably be a tad - ah - miffed, shall we say, that Denmark not only subverts their regulations, it would also be able to bill them for it.

Now, in the particular case of abortion, I happen to think that Poland should sit down, shut up and pretend to be civilised. But suppose that Luxembourg decides that it would be profitable to do chelation therapy for autism, or British lobbyists start pushing the UK as a flag of convenience country for scams like homeopathy?

Should they be able to start a carry trade of people who go there to get free quackery that they'd otherwise have to pay for because their home state doesn't want to sponsor bullshit pseudo-medicine? And then send the bills (along with the bother and cost of dealing with the inevitable complications of using quacks their nostrums instead of real medicine) back to the patients' home countries?

And if you don't allow countries to claim reimbursement for procedures that are not reimbursed in the country they were going to bill, you risk a race to the bottom, where the countries with free, universal health care may end up supporting the cream skimming for-profit health care system of less responsible countries. And if you allow countries to refuse to pay for procedures that they can't be reimbursed for... well, there went the whole mobility of health care thingy...

In short, there's a number of highly non-trivial issues here that need to be fleshed out, and appeals to "competition" strike me as being more an example of the belief in the power of incantation than in the power of evidence.

- Jake

Friends come and go. Enemies accumulate.