YOU would be forgiven for thinking that, when it comes to health and medicare, we do harbour some strangely ambivalent attitudes.

Society invests millions in looking after sick people, prolonging their lives, only for many to end their days in pain and penury, and deemed a drain on State resources.

For statisticians and politicians alike, an ageing generation has become a ‘problem’. Hardly a week seems to go by in the UK without some controversy or other about NHS patients denied some life extending cancer drug as a result of a ‘value for money’ assessment by the bizarrely named ‘Nice’ quango which acts as judge and jury in the ring of public funding and medical excellence.

Political posturing surrounds a terminally ill prisoner, released from a Scottish prison on compassionate grounds, only to be serially hounded from the wings of the international stage because he hasn’t died within a prescribed time scale. Lust for vengeance, it appears, still weighs stronger in some quarters than the greatest human instinct, the preservation of life and the means through medical advances, to achieve it.

Then there’s the price of treatment. The columns of this newspaper have hosted a long-running debate about the alleged high cost of dental care, and the belief that it is even higher here than in the UK.

And dental patients, who feel hard done by, might consider they had been kicked in the teeth by the rising cost of general medical health treatment and referrals.

All in all, we need to face up to the reality that costly local medical care is an inevitable fact of life. There is no such thing as ‘free’ health care. Even treatment on the much maligned, but clinically hard-to-better NHS, has to be paid for, albeit by indirect taxation – except, of course, if you’re a patient freshly bussed in from Romania or Bulgaria.

For many Jersey residents, the General Hospital has earned a reputation, well-earned over time, as good as any NHS provider on the mainland.
It caters adequately for the ‘normal’ accidents and ailments sustained in a self-contained society. But here’s the difference: given its size, it cannot deal with many areas of specialist treatment or emergency.

As a result, there’s a lucrative traffic in consultancy and referral to the UK. There, top-notch specialist surgeons and their teams, equipped with state of the art procedures and equipment, operate within NHS Trust guidelines and the recommended cost limits of the major household-name private health insurance providers.

No glitzy extras, plastic pot plant fascias and fancy yuppie addresses. Here, you can easily spiral into the ‘Hello. How are you? See you in six months,’ consultancy orbit more akin to the rarefied atmosphere of the top end of Harley Street, which inevitably forces ‘clients’ regularly to stump up significant excesses to their gold-edged invoices.

Bad weather and inconvenient travel apart, the necessity for local patients to seek medical attention on the mainland does, perversely, have a huge benefit; namely, the opportunity to receive the very best attention on offer in the UK from some of the foremost practitioners in cardiology, oncology, neurology and orthopaedics.

Of course, it’s not just a case of UK care succeeds where local fails – far from it. Both are locked into a shared system of medical and clinical practice for the good of all patients.

The beef – and it’s the same for the dentistry campaigners – is the pricing policy. Now, obviously, there’s an elephant in the room, and that is the economy of scale of the NHS, which certainly underwrites mainland facilities and professional team-building.

On the broader front, one has to applaud the continuing attempts by our local Health officials to renegotiate the agreement with Whitehall to keep us in the same British health family.

While optimism currently prevails, with the UK’s new coalition government serving notice of its intention to claw back every extraneous penny of public spending, it’s hard to see how new arguments will receive a more sympathetic hearing than the ‘Primarolo cosh’ – however convincingly presented.

In the end, it all comes down to money: those who have it, those who want it and those with the power to take it away.

And in the context of Health, it’s a highly emotive issue, with ‘fairness’ at the top of the agenda.

Given the pressures of the 2011 Business Plan – no NHS-style ring-fencing on this side of the water – it will be down to wiser counsel to apportion the details of the full £500,000 savings.

In principle, a small rise in Social Security payments and the introduction of modest prescription charges would pose little hardship to most islanders. However, after administration costs, relatively few pennies will be saved, and though means-tested, it would hit the ‘hidden poor’.

In the political context, however, it would hammer another nail in the coffin of public opinion over how the public cake is being sliced.

Forget single-sex wards and rumbling unease about health tourism, even the indulgence for hospital consultants to undertake private work during publicly funded time. The watchword is ‘transparency’ and the burning issue is the cost of individual health care.

You could be forgiven for making a crude comparison between a date with the doc and a flight with a budget airline which quotes a fare then piles on extra charges afterwards.

Subsequent bills for anaesthetics, pathology and medication could cause post-operative traumas of their very own.

It’s not a case of biting the hands that feed and care, but when you’re expected to pay to live, you surely have the right to demand the best and most ethical rate for the job.