In an address given to an aptly awful audience of venture capitalists a few months ago, Tony Blair adopted the modish confessional style and told the world that his struggle to manage the public sector had left 'scars on my back'. The National Health Service was not a home for the many under-resourced and over-worked people who run the most efficient medical service in the developed world, but a swamp of vested interests. Nurses, doctors and cleaners were the &eacute;lite forces of conservatism. The Prime Minister was their proletarian victim. Only the unreliable protection of an enormous Parliamentary majority and a Cabinet which will let him do anything he wants, prevented a martyrdom to rival Saint Di's.  After his performance, no one had the right to be surprised when he announced that henceforth the NHS would buy operations from private hospitals. A 'concordat' had been reached with corporate medicine. 'I have always made clear that it is not a question of ideology,' he said in July when asked if further treaties were likely.   Admittedly, this particular policy without ideology was the wheeze of New Labour's most influential think tank - the Conservative Party, which once was considered to be an ideologically motivated organisation. But all Third Wayers of good will and sound judgment could be relied upon to forget intellectual origins in this instance and agree that it is nothing more than plain common sense to cut waiting lists by snapping up private services. Who wouldn't prefer to be treated on demand by suddenly deferential consultants in a room of one's own, luxuriously appointed with pot plants the size of triffids, soft carpets and cable television? How many  Observer readers have forgotten their loud defences of the NHS when worrying pains afflict them or their loved ones and gone private? What matters is what works. Only a weirdo and probable paedophile would sacrifice the health of a child on the alter of an exhausted ideology. The private sector delivers.   It can deliver your child at the Portland Hospital, where Sarah Ferguson, Patsy Kensit, and Posh Spice were relieved of various sprogs. Those with other requirements can be sent to the Harley Street, Princess Grace or Wellington hospitals in central London. All four were brought by a company called HCA on 19 May. The US health conglomerate, which used to be called Columbia/HCA, but was forced to dance the old Windscale-Sellafield name shuffle for reasons we'll get to in a moment, added the Devonshire, Lister and London Bridge hospitals to its portfolio in June. The company intends to nab 'new facilities in markets outside the London area' as soon as possible.   Commercial rivals at the London Heart Hospital are so worried by the   Americans' predatory intent they are trying to excite a media campaign to persuade the Department of Trade and Industry to stop HCA creating a private monopoly in London. Sir Richard Needham, a former Conservative Health Minister who now runs the Heart, complained to me at length that HCA's associates, the PPP insurance company, had insisted their patients - sorry, customers - should be diverted from his beds to the rooms of HCA hospitals. Needham's colleagues say the loss of income may force him to sell to the Americans.   You may not care about Needham's problems - I won't pretend to have been sobbing myself - when HCA seems the better product. The company's PRs boast it is 'one of London's leading healthcare providers... committed to excellence and quality through the provision of specialised healthcare services. We have established an international reputation for offering the highest quality of service in private healthcare'.   They forgot to add that HCA's international reputation is somewhat tarnished. On 19 May it agreed to pay $745 million (500m) to the US Justice Department for the greatest fraud in American medical history, without admitting liability, after two executives had been jailed. When other alleged scams are resolved the final fine will be about a billion dollars.   By purchasing private beds for public patients, New Labour is imitating American health care. The US government uses the Medicare and Medicaid national insurance schemes to pay 'independent' hospitals to treat working-class and elderly Americans. (The poor are left to suffer and die without health cover.) Charitable institutions with a rudimentary grasp of medical ethics are being taken over by medical conglomerates which seek to maximise profits. The US authorities cannot have officials on the spot to check that treatment is necessary and bills are accurate - if they did, they might as well go for the full Soviet terror of a 'socialistic' national health service administered by the state.   The result of a freeish market is pervasive fraud. June Gibbs Brown, Inspector General of the US Department of Health, estimated that private hospitals were overpaid by $23 billion (15bn) a year. Fourteen cents in every dollar spent on health were stolen from the government by accident or design. Tales of scams fill the US press. There were the psychiatric hospitals which refused to release cash-earning patients even when they had recovered their wits; the psychologists who billed for 24 hours of therapy a day; and the health-company owners who claimed their son's first BMW was a medical expense.   The FBI investigation into HCA showed corruption went beyond the odd rotten apple. 'Columbia's fraudulent cost-reporting practices have infected the cost reports of virtually every health care facility,' the US government said in its affidavit.   As in Britain, HCA had engaged in the vigorous buying of beds and built a network of 340 hospitals. It was then able to add new euphemisms to the dictionary of fraud. Its executives tried 'upcoding': the exaggeration of the seriousness of an illness to receive higher fees; 'gaming': the double billing of the state; and 'physician partnerships': the practice of offering doctors shares, subsidised offices and directorships in return to steering patients to HCA hospitals.   Mark Gardner, who worked in three Columbia hospitals, testified: 'I committed felonies every day. Let me tell you this a ruthless greedy company. Employees are the largest operating expense. Cut that to the bone. Cut nursing to the bone.' The instructions were obeyed to   the letter. One nurse told how she was left to watch 80 heart monitors by herself. John W. Schilling, another whistleblower, said the company was confident it could avoid detection. Advertising and marketing costs were passed off as medical necessities and when the danger of a government auditor getting too close to the truth grew, he was told to buy her off with a job offer.   Their testimony sounds strange to British ears. Yet Action for Proper Regulation of Private Hospitals (whose website at www.homeusers.prestel.co.uk I urge you to read before paying for treatment) suggests that many American vices are here in embryo.   Private hospitals are dangerous places. They don't have the emergency teams of the NHS and their lovely single rooms are not the safest places to be when you need to attract attention urgently. For all the pampering on offer at HCA's Portland Hospital, the death rate of pregnant women is five times above the national average, as we reported last week.   Their parasitic nature is well known - they rely on the NHS to train their staff and to take their patients when an operation goes wrong or an insurance company refuses to pay for complicated treatment - but their imitation of US practices deserves a wider audience. The  British Medical Journal claimed in 1993 that at least one-third of all private 'hysterectomies... are unnecessary', while the growth in the number of 'therapeutically useless' removals of tonsils was an 'epidemic'.   The NHS, by contrast, has no interest in overcharging or performing pointless operations, quite the reverse. The largest employer in Europe is remarkably free of fiddles in all areas except one: consultants skipping NHS commitments to work in the private sector. There is a perverse incentive: unscrupulous consultants benefit if they persuade patients to pay to see them privately. Invariably, the consultants with the longest waiting lists are those with the largest private practices.   Instead of buying out consultants and giving them the generous salaries they deserve - for these are skilled men and women - to work exclusively for the NHS, the Government is making the perverse incentive more attractive still by pumping public funds to the likes of HCA. It claims that it will ensure that health authorities get value for money. If you were to point out that the US Government which has decades of experience of auditing private hospitals still cannot prevent fraud which would dazzle a mafioso, you would be dismissed as an ideological dinosaur. HCA has the advertising slogan 'You've Never Seen Health Care Like This Before'. Indeed you have not. But soon you may.