Prompted by the story of how (not) to reward effort, a reader tells us another story:

This is a truly massive failure called the American healthcare system. Dreamt up by laissez faire Capitalists over sixty years ago, the American healthcare system costs twice as much as the NHS whilst leaving 16% of Americans uninsured …

Roughly 22,000 Americans die annually because they do not have health insurance and approximately 50% of personal bankruptcies there have healthcare costs at their root.

Horrible, nightmarish stuff.

Yet we too have problems in that sector:

There are 10 times more deaths across the UK from the superbug Clostridium difficile among over 65-year-olds than in any other country in the world, figures suggest …

Professor Brendan Wren, of the London School of Hygiene and Tropical Medicine, told Panorama: "The deaths of 6,500 people a year is the equivalent of one person dying every hour in our hospitals."

Since the USA is more than four times our population, it appears that they have 22,000 people a year dying for lack of health insurance, whereas we have 26,000 dying by illnesses caused by entering our comprehensive state-dominated system.

And now this. Following that.

Another sad story.

The moral of all of them? That (as in the financial sector) organisations/systems which grow to become too complex to be managed become unmanageable.

And then, sooner or later, they crash.

So reforms aimed at simplification are more likely to work in the long run than changes which add yet more control and complexity.