To reform the NHS, use the politics of envy

‘Let’s make the rich pay more.’ Does that sound so right-wing? To me it has a positively socialist ring. It should appeal to egalitarians: to those who call themselves socially concerned and seek new ways to redistribute wealth. So why not apply it for the NHS? Let’s make the rich pay more for health care. I’m no health policy wonk. I chip in with just this one small suggestion, which is not really about market-based reform of our health service, but about how to sell the idea to a deeply reactionary electorate. The British are positively neuralgic on health. They shudder at the use of words like ‘profit’. Expressions such as ‘privatise’, ‘charge’ or ‘insurance’ are incendiary in our health politics. As a result, both major parties are paralysed. The Tories are paralysed by fear of being thought to threaten the NHS; Labour’s paralysis is born of the stupefying knowledge that all they need do to show they care is promise to protect the institution from change. How, then, to break this political stasis? We need a populist argument — something that will appeal to the masses — for charging some people for access to our health service. What better approach than the cry that the rich are hitching a free ride on an already overcrowded wagon? Instead of talking about how to protect the poor, why don’t we talk about how to sting the rich? In a public service for which swelling demand exceeds supply, the richer among us (who tend to be older) are hogging scarce resources, crowding out younger, poorer patients while demanding that we the better-off should carry on getting our health care ‘free at the point of use’. Why should it be seen flintily right-wing to find this objectionable? Whatever else may be its demerits, the proposal for a ‘mansion tax’ is hardly thought to be an assault on the poor.