It is no coincidence that in the US, where top-up payments are a standard feature, healthcare costs are one of the major causes of personal bankruptcy – and this is despite the fact that Americans already spend more than twice as much on healthcare. Even allowing for the haemorrhaging of public funds into the private sector through poorly negotiated PFI deals, botched GP contracts, inflated consultancy fees and IT failures, tax-funded healthcare, as well as being the most equitable model, remains the most economically efficient system.
The decision to introduce top-ups sets a critical precedent, enabling future cash-strapped governments to restrict expensive new drugs or procedures to those with the means to pay for their treatment privately.
For a vision of the future, one only has to look at the decimation of "NHS" dentistry, or the provision of social care, where the extension of top-up payments has led to the effective privatisation of the service, with a rudimentary "safety-net" available only to those with no savings, irrespective of a lifetime of tax and national insurance contributions. "Allowing" (a more accurate term would be "forcing") cancer patients with modest savings to pay for part of their treatment, and denying those procedures to poorer patients, marks a new stage in the long-term dismantling of the NHS, just at a time when the American middle-classes are recognising that an insurance-based system with cash top-ups is unsustainable.
Charles Hopkins
Norwich
We must tackle science ignorance
Creationism has no place in science lessons ("'One third' of teachers back lessons in creationism", 7 November). If creationism were to be taught on the same footing as other scientific theories, we would need to change our definition of science to include explanations of the world that invoke the supernatural, that are irrational and faith-based, and that are not backed by any real evidence. Then, of course, we could also teach children in science lessons how to read people's characters by feeling the bumps on their heads (phrenology) and by the shape of their noses (physiognomy), or how to tell fortunes using the stars (astrology) and to converse with the dead (spiritualism).
Evolution is a science since it explains the development and diversity of life and is backed by a considerable weight of evidence. We accept evolution as proven and true in scientific terms because of that evidence.
Fewer than one in five science teachers backed the teaching of creationism in science lessons, but for me that is still a worryingly high number of science teachers who clearly do not know how to differentiate between actual science (evolution) and pseudo-science (creationism). This is something that must be tackled, but it won't be tackled by teaching pseudo-science in science.
James D Williams
Lecturer in Science Education
University of Sussex, Brighton
How mixed diets help world's poor
In your report on the GM purple tomato (27 October), you refer to the hopes that "Golden Rice" will deliver health benefits to vitamin-A deficient people in South-east Asia. "Golden Rice" has been a 10-year promise of the GM lobby that has yet to deliver any real benefits to needy people.
Nutrition and development experts have questioned this single-nutrient approach to tackling health problems, favouring instead more diverse diets that deliver a whole range of other valuable micronutrients. Just two tablespoons of yellow sweet potatoes, half a cup of dark green leafy vegetables, or two-thirds of a medium-sized mango can provide a child's daily requirement of vitamin A.
Projects run by the UN and others are helping poor people provide themselves with such diverse, nutrient-rich diets.
Ironically, these programmes are designed to overcome the negative dietary impacts of the previous technological Green Revolution of the 1960s and 1970s, hailed for raising yields of major crops, yet which greatly reduced availability of the many incidental green, leafy vegetables that before the widespread use of herbicides grew alongside the main crop.
"Golden Rice" maybe the answer to a GM lobbyists' prayer, but it is not the solution to world hunger or malnutrition.
Robin Maynard
Campaigns Director The Soil Association, Bristol
Let's judge Obama at end of his term
The "narrative" of the Barack Obama presidential victory fascinates me. An inspirational candidate, bringing hope to the world, an agent of "change" (not defined), media-friendly, charismatic, great communicator, representing a new generation, endorsed by celebrities, healing the nation, divinely mandated: "God Bless America." We saw exactly the same type of thing with Tony Blair and we all know how that turned out. Are we really so stupid that we keep falling for this ridiculous messiah narrative?
I'm on Kafka's side: messiahs always arrive a day too late. There is only one substantive reason to believe that Obama might make a good president: he opposed the Iraq war. That makes him vastly better than Blair, Brown, Bush and Cameron, but he's yet to take a single hard decision as the leader of his nation. Why can't we wait until the end of Obama's term in office before we start worshipping him? I'm still waiting for Jesus Christ to deliver on his promises!
Mike Hockney
Newcastle upon Tyne
As commentators rush to put Barack Obama's victory into historical perspective, too little attention has been paid to the immense political courage of President Lyndon Johnson in pushing through the Civil Rights and Voting Rights Acts of 1964 and 1965, when he well knew that as a result the Democrats would "lose the South for a generation".
Since an African-American president would have been highly unlikely without this legislation, Obama's election is therefore a massive tribute to Johnson's memory, as is the Democrats' associated, if belated, success in rediscovering the "lost South" with electoral progress in states such as Virginia and North Carolina.
David Docherty
London W4
How absurd that Alex Salmond should claim the president-elect is a Scot (letters, 8 November). Everybody knows where President O'Bama really comes from.
Fiona Sweeney
Strabane, Co Tyrone, Republic of Ireland
Prospects for a UK/Dutch airport
Over the last few years, I have flown into a number of modern island airports, including Hong Kong and Osaka, and I can only support James Marsh's robust defence of Boris Johnson's idea for a airport in the Thames estuary (letters, 5 November).
However, maybe such a study should go further. Similar research is being carried out in the Netherlands, and it may be timely to float the idea of a joint British/Dutch airport project.
This would avoid problems of air-traffic routing in and out of several contiguous airports, and could take advantage of the immense Dutch knowledge of land reclamation. Such a project would involve a direct London-airport-Amsterdam (and probably Brussels) rail link, and there would be some interesting complexities over sea lanes, tunnels and bridges, but such a study might ultimately lead to creation of the biggest and best hub airport in the world.
Jim Petts
Steventon, Oxfordshire
Value of sex classes difficult to gauge
Liz Swinden is allowing her jubilation to blind her to reality in suggesting that the argument for compulsory sex education for children from five to 16 has been won (letters, 29 October).
Surprisingly little research has been conducted to evaluate the success of the various sex and relationship education programmes. As the Government's own review group noted, there is a dearth of good-quality international evidence. A review of what little research exists reveals that it is difficult to be precise about the impact of this education because of a lack of clarity on its objectives and significant variation in the delivery of programmes between and within different countries.
Ms Swinden is mistaken if she imagines that there is a fixed curriculum and uniform approach to the teaching of sex education in the Netherlands. Dutch schools have some discretion about how they teach the subject, and delivery varies considerably from school to school, just as it does in the UK.
There is no evidence to suggest that low teenage conception rates in the Netherlands are attributable to sex education in Dutch schools. A more convincing explanation for the lower rates of teenage pregnancy is to be found in the more traditional patterns of family life found in the Netherlands.
Compared with the UK, the Netherlands has far lower rates of lone-parenthood, divorce and births outside marriage, and fewer mothers are in full-time employment. Two other differences are that teenage mothers in the Netherlands receive lower welfare benefits, and a stigma continues to be attached to teenage pregnancy.
Norman Wells
Director, Family Education Trust, Twickenham, Middlesex
Wenger is showing right way to play
What a ridiculous little piece by your football correspondent attacking Arsene Wenger's football credo (8 November). If he thinks coaching a team of essentially young players into playing attractive, attacking football (and beating the English and European champions in the best match of the season) while refusing to run up huge debts for the club represents a "wacky cult", what are his own, warped footballing values?
Would he rather watch a bunch of millionaires play robotic football? Or Stanley Matthews' former team, whose current idea of creative play is not to have the Wizard of the Dribble on the wing but rather a bloke who can hurl a football vast distances?
Rod Chapman
Sarlat, France
Hang on
The statement in On This Day (7 November) that in 1783 John Austin was the last person to be executed in public in England is wrong. He was the last to be hanged at Tyburn, but public hangings outside Newgate Gaol continued until 1868.
MICHAEL GROSVENOR MYER
CAMBRIDGE
Henry V's demise
Those who take offence at the behaviour of King Henry V (Letters, 5, 7 and 8 November) might obtain succour from the fact that he eventually came to an untimely and undignified end at the age of 35. He died in 1422 at Vincennes, near Paris, from a severe bout of dysentery, which is not the most pleasant way to go. The subsequent events were positively revolting. As refrigeration techniques were lacking, his body was boiled in a cauldron to separate the flesh from the bones. The bones were then returned to England, with great pomp, to be interred at Westminster Abbey.
Michael K Baldwin
Sittingbourne
Kent
Different eras
In your article about the stage show of Ben-Hur (7 November), it is stated that the novel was a near contemporary of Gone with the Wind. Lew Wallace published Ben-Hur in 1880, while Margaret Mitchell published Gone with the Wind in 1936, hardly what I'd call "near contemporary". Mitchell was four years old at the time Wallace died. Perhaps the confusion is that Gone with the Wind is set around the time of the American Civil War and Wallace was a general in the Union army during that conflict.
Paul Dormer
Guildford, Surrey
BBC complaints
If complaints about Jeremy Clarkson's joke about murdering prostitutes reach the same level as those received in the Brand/Ross affair, then the BBC must sack him or be accused of double standards. The BBC's response to Clarkson complainants – that "the audience has clear expectations of his humour" and that "the comments should be seen within the context of the programme" – could quite easily be applied to Russell Brand. Brand's humour is both puerile and clever, Clarkson's is just puerile. But as the latter appeals mainly to Middle England, there will be no witch hunt.
NICK BURTON
CLITHEROE LANCASHIRE
New Europe
The media has been following two events recently: the US election and the 90th anniversary of the end of the Great War. What a pity that we were not being enthralled by the election of a President of the United States of Europe. When that happens, we can be sure that the casualties of the two European wars did not die in vain.
J W Wright
Calne Wiltshire
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