Mark Steel: Gallstones? NHS choice will cure you

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You can see why they've announced this plan to change the health service, because it looks similar to the way they transformed the railways into competing units, and that's been such a success who wouldn't want to use a similar system to deal with triple by-passes and liver transplants?

Once the doubters have been pushed aside, hospitals will be free to modernise in the way Virgin modernised the train service. So they can have five almost-empty wards for business class patients, then in second-class have 60 people sat cross-legged by the toilet, under posters telling you how wonderful everything is, with slogans such as "Dying's more jolly when you're left on a trolley".

As with the railways it will become less bureaucratic. Instead of going straight to the operating theatre, you'll be wheeled into A&E, then told they can't take you to the kidney department as that's run by a different operator so you need a dialysis off-peak saver with a reservation you can only book online.

And as with the train companies, hospitals will be encouraged to cut costs on wasteful issues such as safety, until one of them manages to kill 21 customers in the world's first stethoscope disaster. Free to maximise revenue, health trusts will be able to prioritise. So burns victims can be told: "We've cancelled your operation, as the shareholders would prefer our surgeons to rebuild Katie Price for a photo-shoot with Heat."

Cameron emphasised these plans will "free the NHS from ideology", as he's concerned only with "what works best". This may be slightly dishonest, for example because one of the most efficient health services is Cuba's. But it's unlikely Cameron will declare: "I'm not interested in ideology. I just want what works best. That's why I'm reforming the NHS along the lines laid out by Fidel Castro's annual speech to the presidium of Communist Revolutionary Citizens, called All Hail to Proletarian Healthiness and Removal of the Workers' Gallstones."

Cameron believes every aspect of life should be governed by the free market. So it's hardly a coincidence if he says: "I've looked at all the methods of running a health system and you'll never believe it, but I reckon it will be best if we move towards using the free market."

What may be difficult for Cameron is one difference with the railways, because at least British Rail was disliked in the first place. But the NHS is revered by most people, and the most unpopular parts are often those already privatised such as cleaning and catering. So he's claiming the reforms will increase "Choice".

But choice isn't a requirement of a health system. If you're lying on the road after a car's rammed you, you don't want three sets of paramedics round you with brochures, while you say: "Hmm, St George's has more scalpels but St Thomas's has cleaner bedpans, I just can't make my mind up."

The Government's other attempts at privatisation and cutting spending are being blamed on the deficit, but they can't do that with the NHS, so they make this claim of creating choice. But giving hospitals the choice of raising extra funds will mean they soon have no choice but to raise extra funds. Operations will be auctioned on eBay, enterprising health districts will advertise a liver sale, and parts of operating theatres will be converted into themed restaurants where diners can enjoy a meal while watching someone have their appendix out.

Because in polls, railway privatisation is popular with 99 per cent of millionaire train company executives, so the only people cautious about Cameron's NHS reforms are those with vested interests, such as people who work there, patients, people who might one day use it and dinosaurs like that.

Mark Steel is currently on tour:

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