Some politicians suspected Alan Johnson deliberately chose to make his announcement on top-ups on the same day as Barack Obama's election to the US presidency in the hope that he could 'bury bad news.'

I didn't see it that way at all, myself. But I have to admit that after watching a chunk of the health secretary's statement from my eyrie in the press gallery, I later found MPs unusually agitated about it as I padded around the Commons' legendary Corridors of Impotence.

Tory MP Bill Cash, whose sights are usually set on Europe, warned me that the decision would be good for people rich enough to switch between private and public sectors - "blue lighting to A&E when things go wrong".

Labour's GP-MP Howard Stoate was worried that it would become a "slippery slope" towards a different kind of NHS - the two-tier service Unison and other left critics fear. He also noted some PCTs and trusts ignore existing rules, which is unfair too.

Of course, that fact is part of the existing reality that cancer czar Mike Richards' report was required to address and did so in a level-headed way, says me. Richard Taylor, the Wyre Forest medical guerrilla, told Mr Johnson he was "more confused than I was" by the statement.

Doc Taylor wants ministers to concentrate on the Better Care, Better Value indicators which could - in theory - save£2bn a year on the NHS drugs bill, thereby freeing up more money to pay for the kind of unfunded cancer drugs the National Institute for Health and Clinical Excellence has been rejecting on cost-effectiveness grounds, the nub of this dilemma.

I thought Czar Richards' report (surely worth that knighthood?) caught it well when it said there has been tension between the principles of equity - healthcare free at the point of use - and that of personal choice - the right to spend one's own money - since the NHS's first day in 1948.

Little hypocrisies

The NHS has been tackling it too. We know it involves little hypocrisies and the Richards formula whereby NHS patients who buy those private cancer top-ups (except we don't call them that in Whitehall!) will have to get them administered at home or in a non-NHS ward/hospital is merely the latest in a long line of circle-squaring efforts. We can live with it.

Why do I confidently say that? Partly because getting older makes you realise that little hypocrisies help make the world go round and we sometimes get too hung up on them because the internet and our intrusive media make them easier to spot.

But also because one of the MPs I bumped into was Dennis Skinner. The left wing firebrand has had his own brushes with cancer ("the sky has never looked so blue", he once touchingly confided after an all-clear) and knows the status quo is a bit of a mess too, including trips to French hospitals by those who can afford it.

"This will keep people alive," he told me. Precisely. We can worry about slippery slopes, as some MPs and peers did, also about the cost to the NHS of the new flexible policy and a faster NICE clearance process. We can worry about whether doctors can push patients towards private options in which they may have an interest, as Oxford medic and Liberal Democrat MP Evan Harris did.

Changing NHS

There are all sorts of details we could worry about. By the weekend private health insurers were being reported as gearing up to launch new "top-up products" on the market - ones that could go beyond cancer drugs.

People who want - or fear - that this will drive us towards a core-service NHS plus top-up insurance system, like France's brilliant-but-bust service, will say "told you so". In rectifying what had become an unsustainable chink in the NHS's armour Alan Johnson makes light of such hypothetical anxieties. Rightly, I think.

One further thought, raised in exchanges with Lord Darzi in the unelected chamber by Viscount Bledisloe, is what I call the Ken Clarke fear, that patients' worries will be exploited by doctors and drug firms.

If I were told that spending£20,000 "might keep me alive in some discomfort for another two months I would say no, thank you", the peer observed. Quite so, but as the health minister smoothly replied, it's a free country.

See How are NHS top-ups going to affect your services?

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