Fraser Nelson

Why we need a proper debate about healthcare

Why we need a proper debate about healthcare
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What we've seen in the last few days cannot be described as a debate about healthcare. It was a session of transatlantic insult slinging – and damned lies. This raises two questions: is the future of the NHS a subject that can be discussed rationally? And is the internet taking to British politics to the inane extremes that we see in certain sections of the American media?

Let’s take this #welovethenhs Twitter campaign. Contrary to several British press reports, Sarah Palin did not describe the NHS as Orwellian or evil (she didn’t even mention Britain in her Facebook entry, here). But suggestions to the contrary have helped stoke this image of the NHS being under attack by a group which Gordon Brown has called “right wing in the United States” (a phrase I note he didn’t use when Bush was in power) and “their friends in the British Conservative Party” (booo!). People are condemning Dan Hannan without reading what he has been writing (for months). Brown is trying to claim ownership of the Twitterers, saying he has “been profoundly moved,” as if it has the slightest thing to do with him. The Health Secretary’s contribution is to inform us that he loves the NHS “2nd only to Everton FC”.

Mark Halperin calls this “The Freak Show” – political debate being reduced to two extremes hurling abuse at each other. In America, this takes the form of “Michael Moore, meet Ann Coulter.” The extremes tend to provoke a mass reaction (as per Twitter). Cynical politicians can stoke the hysteria. Cowardly politcians attempt to ride it, joining the debate on its inane terms.

In my News of the World column today, I say an opportunity to properly debate the NHS has been missed. And this Twitter intifada seems to see a very worried David Cameron boxing himself into a corner. He has told us that commitment does not mean protecting the budget – but he was talking about defence. In health, he does seem to define commitment as keeping the budget “safe”. Why? This is pure Twitter logic. Cuts = bad. Cash = caring Tories. That really is the limit of the argument.

Thatcher was fond of saying that she never confused the leader page of The Guardian with the vox populi. Cameron should remember that the same is true of Twitter. Mass opinion on the health service can be sampled by proper opinion polls. OECD Health Data 2009 refers to a poll taken in 2007, which I thought is worth reprinting here:

The first columm, minor change, is what Cameron is now offering. Fundamental change is what Blair and Alan Milburn tried to accomplish. Complete restructuring is what Dan Hannan advocates in his book The Plan. Cameron called Hannan “eccentric” but the poll shows his views are shared by about one in six of the public – and, I suspect, about half of Tory MPs. Britain loves the NHS, which is why the majority want fundamental reform. There is no contradiction here. Just because the reformers aren't dropping one-liners on Twitter, it would be most unwise to ignore them.

I’d like to finish off by saying a word of praise for Blair and Milburn. CoffeeHousers will, I suspect, baulk at that. But Blair realised the Dobson era was an error, spent his second term rebuilding the internal market - complete with a tariff system, foundation hospitals, independent players, far more than anyone had dared attempt since 1948. In doing so, he took on Brown, faced down his party and picked a fight with the unions. Of course, Blair's motives would not be questioned by the public in the same way that Cameron feels his might be. And - terrifying thought - those Milburn reforms may be the high water mark of healthcare liberalisation in England. This issue does arouse high passions, it is hugely difficult. Health reform is second only to welfare reform in toughness. But if you love the NHS, as I believe Blair and Milburn both did, you get on with it and take the knocks.

If Cameron really believes the NHS is his top priority, it deserves more from him than “here’s £104 billion, don’t spend it all at once, and I promise it'll go up next year” It means getting one’s hands dirty with reform, taking radical steps to reverse the declining productivity. It means redefining NHS to mean a method of paying for, not necessarily providing, healthcare. This was Milburn’s misison when he was Health Secretary. This comes under the category of radical reform. And this, not the Tories' proposed guarantee of independence to the NHS bureaucratic overlords, is what Britain’s health service needs. Cameron will have decided that health is too dangerous a battle to fight. The Tweets are too many, he'll have decided. NHS reform will be judged a bridge too far. But Cameron will discover, as Blair did, that it’s a bridge he will have to cross at some point.

P.S. If any CoffeeHousers are hungry for a proper spirited debate about healthcare - as a remedy to this "Isn't Hannan Evil" summer panto - I can recommend this Intelligence Squared debate: "The NHS is Broken, It Needs Fixing." I actually paid for this via iTunes, but I'm sure you clever folk can think of a way of getting it for free.

UPDATE: I thought I’d respond here rather than as a comment...

Simonhb, I was referring not so much to that twitter feed, but the political discourse and hysterical columns in the UK press. There is also this suggestion that the whole American right is attacking the NHS. We flatter ourselves to think we feature so highly on the American radar. A handful of people in a country of 300m have made invalid criticisms of the NHS – ie, that Stephen Hawking would have died, etc. They have been magnified by our press, who make out as if everyone in America is saying the NHS is evil. There are plenty more level-headed criticisms of the NHS and I would humbly refer you to a recent piece in the Weekly Standard by yours truly and Irwin Stelzer.

John B Sheffield, I can’t agree that Hannan is “eccentric” as Cameron claimed. I note with alarm this tendency to play the man and not the ball. Hannan is not insult slinging – he has written a book about his views on the NHS and other things. I’d respect his critics a lot more if they found flaws in his oft-expressed logic rather than say “he’s a nutter”. Thank God for mavericks – on left and right. Churchill and Galloway. How dull our politics would be without them. (And TGF, writers don’t do headlines.)

Gawain, I make no complaint of the US media. It’s the British press in the last few days that drives me to despair. Americans seem plenty capable of having an intelligent and detailed debate. But all our media seems to pick up on is the extreme fringes of this debate because it conforms to the stereotype of “mad right-wing Americans.” It reminds me of when I was a Scotland correspondent for a national newspaper, and the only stories I could enthuse the London-based editors about were to do with seaweed farming, crofts and hairy-arsed men in kilts. That’s why Halperin’s point about the Freak Show (made in his excellent book Way to Win - £2 on Amazon) sprang to mind. It explains the Freak Show as a new event in US political discourse – which may well be coming here. My concern is that it may supplant rather than augment normal debate.

Written byFraser Nelson

Fraser Nelson is the editor of The Spectator. He is also a columnist with The Daily Telegraph, a member of the advisory board of the Centre for Social Justice and the Centre for Policy Studies.

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