Do you remember the debate over the future of the US healthcare system that dominated the last Presidential election?

With talk of the “death panels” supposedly organised by the National Institute for Health and Clinical Excellence we mocked the ignorance of Americans and reassured ourselves that the health debate here was of a higher quality.

However, the current furore over the role of competition in the NHS is likely to have those on the other side of the Atlantic who understand health policy laughing just as loudly at us.

Mark Britnell identifies some risks, but we should also listen to Carol Propper, professor of economics at Imperial College business school and the leading expert in the field. She says there is robust evidence that, where prices are fixed, competition improves quality and, at least, does not increase cost.

Uncontrolled price competition can undermine quality, as the UK found in the 1990s. But when it is properly regulated, as with choose and book, it does make care better.

What’s more, as HSJ has often remarked, better management drives quality and, the evidence suggests, competition improves management standards.

These nuances are largely lost in the debate over Monitor’s transformation into an economic regulator. It is sensible to consider what regard Monitor should give to the role of cooperation between providers. It is dangerous, however, not to take into account what impact those tweaks might have on allowing the positive aspects of competition to improve patient care.