Both Sajid Javid and Wes Streeting – the ghosts of the Health Department’s past and (potential) future – have made recent headlines by floating radical reform to the NHS. Streeting may claim his criticism of the health service’s monopoly status makes him ‘some sort of heretic’. But so far his boldness has only extended to some habitual non-dom bashing, and a pledge to nationalise GPs, which hardly seems the best way to reduce state influence.
Javid has gone further. He has nodded towards the Eldorado of healthcare reform: the introduction of a social insurance system. He argues that if the NHS does not move towards a more European-style model, it will not “survive many more years”. A discussion is needed about moving to a form of “co-payment”, with the better-off contributing towards some of their care. He pointed to France and Germany as examples we could emulate.
Naturally, with Britain currently celebrating its annual NHS winter crisis, ConservativeHome could not let this blue-sky thinking go by without asking our survey for their thoughts. The results suggest Javid can count on the tentative sympathy of party members.
Given the choice 36.86 per cent support the NHS model, with the state providing most healthcare free at the point of use. By contrast, 45.13 per cent support a social insurance model under which employers and employees fund their own healthcare. Another 14.48 per cent plumped for neither, and the remaining 3.53 per cent suggested they did not know enough to choose.
What should we make of this? Think-tanks and commentators have been fighting the good social insurance fight for a long-time, so one might have expected the figures to be higher. But we did not specify a particular alternative model, and there is a great deal of variation between the systems established in different countries.
The cliché is that most Brits get their understanding of healthcare models from either Casualty or E.R, and assume the choice is between the depressing uniformity of the NHS or the expensive dystopia of the United States. So they – quite literally – cling to nurse for fear of something worse, rather than considering other systems.
But one should not forget that a Tory case can also be made for the NHS. Enoch Powell’s free-market credentials were dented by his fondness for the health service for which delivered the 1962 Hospital Plan. Peter Lilley earnt himself a sacking from the Shadow Cabinet in 1999 by arguing “the free market has only a limited role in improving public services”. Boris Johnson owed the service his life – and, arguably, a victory in both the 2016 referendum and the 2019 election.
Their reasoning? That the grass is not always greener on the other side – check out the current crises in both the German and Canadian healthcare systems – and that the NHS is the most equitable system available. That may mean, Soviet-style, it is equally miserable for most that use it. But that does not mean there is mass enthusiasm, even on the right, for ripping it up and starting again.