It's US cash on delivery for the mother superior

For heaven's sake, the woman didn't simply say, 'Come on now, have you been to hospitals in England, they're old and Victorian?'. She went on to make a much more understandable point about 'doctors in foreign countries. . . having a slightly different way of doing things'.

Fair enough, I thought, we all want to be hospitalised at home. Alas, Madonna then spoiled it by adding, 'I like efficiency'. Whatever else you can say about the US healthcare system (within which the singer later gave premature birth to little Rocco), it is far from efficient unless you are, as she is, worth $100m.

But does ever yone want to go home when they're ill? Not according to The Times . Its silly season campaign is to persuade us all that 'health tourists' are pouring into Britain and costing the NHS millions a year in treatment to which they are not entitled. They include babies born to women whom we could call Reverse Madonnas: they fly in at eight months just as she flies out.

How serious is this? Last year 33,820 inpatients admitted non-residency. This is only a 'tiny fraction' of the true figure, the DoH told The Times .

It is a recurring NHS story, but I remain unconvinced by what I read that it is a major issue. Whatever the problem (racial sensitivity? ) and the solution (smartcards? ), the underlying problem is that the NHS is (rightly) not geared up to collecting money off people.

Should we offset the cost of health tourism against the cost of training those Chinese nurses whose imminent arrival in the NHS so alarmed The Telegraph , I wondered? In this swirl of 'silly seasonry' much more interesting was the story buried on the inside pages of The Times.'NHS reforms will privatise care of elderly, ' as the paper put it.

I would have missed this but for Philip Hammond, assiduous deputy to Tory health spokesman Dr Liam Fox, who went off the radar after denouncing health tourism.

Was I aware that Professor Allyson Pollock of the health services and health policy research unit at University College London, is arguing that the NHS plan will 'fundamentally change the principle under which English citizens receive healthcare. The NHS will cease to be a universal, comprehensive service. . .'

No, I wasn't and the DoH claims that Professor Pollock's article in the BMJ is misleading. Intermediate care, mainly for rehabilitative post-hospital care - and the focus of her article - will remain free at the point of delivery. The principle of free care for clinical need remains intact, it says.

I logged onto the Internet and read the prof's article.

As you may know, she argues that new combined care trusts, delivering primary, community and social care under capped unified budgets will, under the Blair Milburn plan, be able to levy charges for personal care (however that turns out to be defined).

The core point is that they will have an incentive 'to shift intermediate care into non-NHS settings', the same private sector path that long-term care was propelled down in the Tory '80s, except that the expansion of private intermediate care will be funded by user charges (ie charges on your income or home) rather than income support.

Ministers insist that they are determined to use regulation (CHI and the new Care Standards Commission for the private sector) to protect patients.

They still have time to set up the funding mechanism to spread the financial risk to ensure that private homes don't minimise their own risk by taking the least risky (or wealthiest) patients. It's still up to Alan.

Mr Hammond predicts that we will find out this winter. Health managers, he says, are being told there must be no winter bed crisis this year because the election is looming. Therefore bed managers will kick elderly patients out of the ward into intermediate care as soon as they decently dare .

All the options are full of 'perverse incentives'. In Madonna's native land, the new system encourages the private sector to take on the most dependent patients, but not to spend the extra money on actually caring for them. But then, Madonna's 41 and famously fit. What does she know?