In many countries, payments by patients provide the lubricant that stops taxpayer-funded health systems from grinding to a halt as their users grow older, fatter and less fit, and a constant stream of pricey new drugs are released to treat the lifestyle diseases that result. But not in Britain, where a literal interpretation of the rules of the National Health Service (NHS)-that treatment be available for all equally, irrespective of ability to pay-has threatened to bring it crashing down. The point at issue has been whether patients who buy treatments that the nhs will not provide should be deemed to have opted out of the system altogether, and made to pay for all their care. Allowing "co-payments", the health secretary, Alan Johnson, told Parliament last year, risked overturning the nhs's founding principles.
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