MPs often forget what the real purpose of prime minister's questions is.
It's not as most seem to think, an opportunity to scream slightly louder than the other side for thirty minutes. Nor is it a chance to crowbar as many totally unrelated barbs about unions into every answer, as the prime minister seems to think.
At its best, PMQs is an opportunity to ask genuinely important questions and expose serious flaws in government policy. A well researched and concise question can be a show-stopper. Ed Miliband failed to come up with any of these today.
It's not that the 'A+E crisis' wasn't the right issue. Having to wait hours for often poor emergency care is a big issue for millions of people. The Conservatives have long been vulnerable on health, with concern over the NHS a big factor in Labour's landslide victory in 1997.
It's just that Ed Miliband failed to find Cameron's weak spot today. By focusing on NHS management pay-offs and waiting times, the Labour leader allowed Cameron to reel off a long list of Soviet-style tractor production figures and to repeatedly refer to Labour's management of the NHS in Wales.
And after a week in which several A&E closures were announced and the health secretary was humiliated in his attempts to close Lewisham Hospital A&E in London, Miliband failed to mention closures at all. In fact it was left to Labour backbencher and Lewisham MP Heidi Alexander to raise the issue, in which was the best question of the whole session.
"Page 47 of the Tory party manifesto says and I quote: 'We will stop the forced closure of A&E and maternity services…' How's that going prime minister?" she asked.
It was a brilliant question that left Cameron utterly lost for a reasonable answer.
Heidi Alexander had raised a hugely important issue both to her constituents and the wider public, left the prime minister vulnerable and exposed, and all within the space of just one simple question.
Miliband failed to achieve any of that despite devoting six far longer questions to the same topic. The Labour leader has had several decent weeks at PMQs. Today he was most definitely upstaged.
Verdict - Cameron: 1, Miliband: 1, Heidi Alexander: 2