I always vowed never to subscribe to The Times when it disappeared behind a pay wall. But then I began to miss some of my favourite columnists such as Giles Coren, Hugo Rifkind, Daniel Finkelstein, David , Rod Liddle and Matthew Parris. But Saturday's column by Matthew Parris hits the nail on the head on the subject of NHS reform.
He imagines a Britain where our agricultural system is run like a Soviet collective. Everything is controlled by the state, everyone involved is employed by the state, all supplies are directed centrally. He then develops this crazy fantasy. The government decides on reform to allow farmers to choose between suppliers. He describes the response to this suggestion as follows...
"Now picture a special conference called by the farmers’ trade union to debate the proposals. Here is an extract from a union leader’s speech to the conference. He is railing against a duty, in the proposed legislation, to promote localised competition . . .
'I want proper controls nationally considered, not locals trying to sort things out . . . I want politicians of every stripe to understand that we do not need competition to run Britain’s food production. It creates duplication that is wasteful — and why give state agriculture’s money to private shareholders? What Britain’s food production needs to improve quality and efficiency is collaboration and co-operation across [all] sectors, [not] different materials being delivered by different providers in order to try to get a cheaper deal — fertilisers in one place, feedstock in another, veterinary services in another and follow-up somewhere else.
'Which brings me to one particularly unacceptable idea in the Bill: performance-related bonuses ... otherwise known as the ‘quality premium’. The idea is that farmers’ groups that ‘purchase well’ — ie, save money — will be given some money to hand out to their members . . . this idea stinks.'"
Only Parris doesn't have to imagine this response. These quotes are taken from a keynote speech by a Doctors leader at a British Medical Association conference in London last week. All Parris did was change references from healthcare to food production.
It highlights the perverse sentimentality we have in this country about maintaining a Marxist style healthcare system despite all the evidence that things could be so much better if a degree of competition, even if it is only in the supply of certain services or supplies, were introduced.
But the main point he makes is how today's Conservative party is failing to champion capitalism. Nothing illustrates this more than the backtracking on the NHS reforms we're seeing now. Many will put this down to the influence of the Lib Dems but the truth is that it is also a symptom of the Tories desire not to re-contaminate their brand. The simplistic messages put about by socialists is far easier to get across in soundbites on the telly and in newspaper headlines than some theory associated with free markets. Free markets that many people associate with selfish pursuit of profit by "fat cats".
A leader must make and keep his party electable. Cameron has gone some way to detoxifying the Tory brand (although not far enough to win a majority, it has to be said). However, sometimes public opinion needs to be led, not followed. Tragically, the case for reform has not been made effectively enough, so a dilution in the proposals was inevitable. But that doesn't mean the case for change shouldn't continue to be made and made strongly, one might say muscularly. A case that, given enough effort, would convince a sceptical public that a free at the point of use health service doesn't have to be totally provided by the state working to some monolithic central plan. That real responsiveness and quality improvements can be achieved through providers competing to be chosen by GPs and patients rather than there being only one option.
It's here David Cameron still has to prove himself. Will he lead a muscular liberal coalition that brings true liberalisation to Britain's public services and with it much improved service and efficiency? Or will he allow the left's preferred definition of the word liberal to prevail, an option that pollsters would tell him would be the best option. In which case we'll miss the greatest opportunity for decades to setup the high quality and high value health service that we need.
UPDATE
This article on the ConservativeHome website by Paul Goodman (@PaulGoodmanCH) covers the liberal/pragmatist debate really well. Definitely worth a read.
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