Daniel Finkelstein makes the critical point about Gordon Brown's silly NHS plan:

The NHS is not like the Bank of England. The Bank is setting the price of money. The NHS has an output not far off that of Portugal. It handles something like 10 per cent of our national income. It employs thousands and thousands of people. It is a very different animal.

There are two ways of holding such a body to account. The first is through voice — the right to protest to a political representative who depends on your vote. The alternative is exit — the right to take your custom elsewhere, with the seller dependent on your patronage in order to thrive.

Mr Brown plans to remove both these forms of accountability. When he describes the new board as independent, you just have to ask: independent of what, exactly? And the answer, it turns out, is independent of you and me.

As I point out on my CNE Health blog, none of Labour's reforms amount to anything beyond making the best of a fundamentally flawed model.

We have tried 'voice', and it doesn't work. In fact it has made things worse, with the government responding to voters' concerns by spending billions of pounds more as a supposed cure for the NHS' ills.

The government thinks it has introduced 'exit', by planning for a measure of choice amongst the providers of a service. This has an upside and a downside. The downside is that it is not real exit or real choice, since the choice to be made available is a limited one at the discretion of the authorities.

The upside, however, is that once patients start excercising choice of any sort, even on this limited scale, the genie will be out of the bottle and the issue of a wider, more genuine choice will arise. Patients will demand not just the limited choice they are to be given but the ability to decide for themselves where and by whom they will be treated. And that means not just within a tax funded NHS brand, but from any willing provider they wish. And once that happens, why would they want to carry on handing over taxes for the government to allocate on their behalf?

The NHS may not be dead yet, but it's only a matter of time.