It’s Time for an Honest Debate About the Provision of Healthcare

By MARCUS STEAD

We need to face up to reality about the National Health Service. For too long, it has been politically taboo to question whether the current model is either the best way of providing healthcare, or its sustainability in the long term.

William Beveridge
William Beveridge, the true founder of the NHS.

The Labour Party likes to portray Aneurin Bevan as the founder of the NHS. This is not the case. In fact, it was a key recommendation of the Beveridge Report of 1942, in which William Beveridge, a Liberal economist, outlined social reforms that were to be brought in at the end of World War II.

Both the Conservative and Labour parties agreed in principle to implement the report’s recommendations, regardless of which party won the first general election after the war (it came in 1945, and was won by Labour).

Beveridge’s vision was of a National Health Service run through local health centres and regional hospital administrations. In other words, they were to be non-political and free from government interference. But in the years immediately after 1945, Labour’s Minister of Health, Aneurin Bevan, had other ideas.

Aneurin Bevan
Aneurin Bevan, whose role in the creation of the NHS continues to be absurdly overstated.

Bevan, a temperamental, undiplomatic, extreme left winger, loathed by many inside the Labour Party, fought hard in Cabinet to abandon Beveridge’s vision in favour of a centralised structure of 14 regional boards appointed by the Minister of Health and local management committees.

From that moment onwards, the NHS became a political football, and it has remained so ever since. Bevan, knowing full well the implications of the seed he was sowing, didn’t allow facts and evidence to get in the way of his ideological dogma. Sir Harold Webbe, the Conservative leader on London County Council, was unhappy about local government’s role in the NHS being removed, and said of Bevan, “He is so full of his own importance that he is prepared to pit his knowledge against the accumulated experience of this council, which is to be butchered to make a Welshman’s holiday.”

Yet even Beveridge’s vision for an NHS contained three major assumptions that sounded quite reasonable at the time, but subsequently turned out to be utterly incorrect:

  1. As people became healthier, demand on the NHS would decrease.
  2. The demographics of society would remain roughly the same.
  3. The NHS could be paid for from ‘the stamp’, now known as National Insurance.

The reality has been utterly different. Huge medical advances in the last 60 years have resulted in significantly increased life expectancy, albeit with the assistance of ongoing care and drugs, which come at a price.

With the exception of the Callaghan government of 1976-79, all administrations have overseen vast increases in real-terms spending on the NHS, as demographics shifted, demand increased, and medical advances continued. By the late 1980s, National Insurance could just about cover pensions and contributory benefits, with the occasional bit of help from general taxation, but it was certainly no longer in a position to fund the NHS.

There is some evidence that Margaret Thatcher understood the magnitude of the problem as long ago as the early 1980s, but she was advised not to handle the ‘hot potato’.

The time has come to end the mawkish obsession with the NHS model, which was epitomised at the 2012 Olympic opening ceremony by the sight of nurses jumping up and down on beds. Britain’s cancer and stroke survival rates are significantly down on where they should be for an apparently rich country, and there is a lack of choice on the part of the patient.

It is easy to see why the Labour Party is so ideologically attached to the NHS. It frequently misleads people into believing it is a Labour creation, and is one of very few things in this country that can in any way, shape or form be described as a Labour success story.

The quasi-religious reverence with which the Labour Party treats the NHS, and the way in which it tries to make bogeymen of anyone who questions it in any way, is holding back a full, honest and frank debate about how we provide sustainable healthcare for the next 50 years.

When they hear any form of criticism of the NHS, their default position is always to make crude comparisons with the system in the USA, one they rarely know very much about, and are quick to point to horror stories within, while conveniently ignoring the numerous deaths in the NHS due to poor hygiene, lengthy waiting times and medical negligence. Doctors and nurses themselves are treated as saints to be revered, rather than tax-funded employees who deserve praise and respect when they do well, but should not be above criticism when they fall short of certain standards.

It is as though no other countries or healthcare systems exist elsewhere in the world. Why can’t we try to learn lessons from Singapore, which from a very low starting point in the 1960s, has managed to create and sustain one of the very best health systems anywhere on earth? Or what about continental Europe, where many countries operate with a mix of public and private healthcare, with compulsory insurance schemes using various models?

This debate should have begun at least 20 years ago, but there are signs that we are approaching the point where the current NHS system is unsustainable. Sooner or later, we will have to face up to this impending reality. Is it not better to do so while the hospitals and GP surgeries are just about working?

Jeremy Corbyn Wants Your Future to be Decided by 16-year-olds. Do You?

By MARCUS STEAD

THIS has been a dull, lacklustre, uninspiring election campaign. In recent weeks, for entirely understandable reasons, the emphasis has been firmly on national security and the party leaders. As a result, details of the party manifestos have been under-reported and under-scrutinised.

One substantial Labour policy that has ‘slipped through the net’ is the pledge to reduce the voting age to 16.  It’s worth providing a brief history of the voting franchise and how we ended up with ‘equal votes for everybody’.

In 1918, all men aged 21 and over, and all women aged 30 and over, were given the vote. The role of the suffragettes was far more controversial than is generally taught in schools today (not that it is taught in much depth in most schools).

Suffragette Poster
A Suffragette Poster

Closer examination reveals that their violence, arson and vandalism alienated more people than they inspired, and it was the conscription of women into the workforce as a result of World War I in 1914 that led to votes for all women over 30, along with other social changes.

There were some interesting quirks to the arguments, many of which are no longer widely recognised. Many women were opposed to the suffragettes, and many in the Liberal Party feared that women voters would tend to be Conservatives, and did their best to delay the reforms.

It wasn’t until 1928 that the voting age for women was reduced to 21, bringing it into line with men. You will have to look elsewhere for a more detailed account of how the franchise was extended in the 19th and early 20th centuries, for I have more pressing matters to attend to here.

The next major changes occurred in 1948, when University seats were abolished. University seats resulted in a number of distinguished and exceptional individuals from entering Parliament who could not realistically have done so by any other means.

Screaming_Lord_Sutch
Screaming Lord Sutch

In the mid-1960s, Screaming Lord Sutch called for the voting age to be lowered to 18. He was probably joking, but, like several of the causes he championed, they were eventually to be taken seriously by the political establishment (the others being the launch of local and commercial radio, all-day pub opening, passports for pets, and knighthoods for the Beatles).

Just four years later, Harold Wilson’s Labour government reduced the voting age to 18 in a cynical but unsuccessful attempt to rig the 1970 general election in their favour. This piece of legislation had the frightening side-effect of putting 18-year-olds on juries.

Jeremy Corbyn’s attempt to lower the age further to 16 is being proposed for similarly cynical reasons, not dissimilar to those which motivated Alex Salmond to do the same thing in the 2014 Scottish independence referendum.

Ask yourself this simple question: Do you want your future decided by 16-year-olds? Think very carefully.

16-year-olds are not wise. You were not wise at 16, and neither was I. Most people of that age will either still be in, or have just left comprehensive schools, where most of their teachers will have been Labour voters, and theories such as man-made climate change will have been taught as absolute fact, and the EU as an absolutely good thing.

Most 16-year-olds are idealistic, especially on matters such as environmental issues and foreign policy. Most will believe that the world is a far nicer place than it is.

Many will be easy to manipulate as a consequence of dire, egalitarian comprehensive education, and due to the tremendous peer pressure they feel at that age to conform. Quite a number idolise celebrities of the day and will follow whatever they are told to do by them.

Brand
The alleged ‘comedian’, Russell Brand

For example, around the time of the 2015 election, Russell Brand was the ‘in’ celebrity with a lot of young people (a phase that has thankfully now passed). It’s hard to know exactly why he was so popular for quite a long time, but I put it down to a mix of his use of obscure words, which the easily-manipulated are flattered by and confuse with intelligence, and his fashionable opinions on drug use.

Around that time, a considerable number of 16-year-olds would have voted whichever way Brand told them to. 15 years earlier, the American rapper, Eminem, had a similar hold on many young people’s minds. In the 1960s and 70s, John Lennon and Yoko Ono assumed such power. You get the idea.

With age comes wisdom and responsibilities. It is a gradual process. I was fortunate in that I realised that the EU was a very bad thing and that Anthony Blair’s New Labour project was doing immense damage to this country several years before I turned 16. But even so, I had no experience of paying taxes, a superficial understanding of foreign policy, and no comprehension of my now-absolute belief that the man-made climate change theory is disastrous, very expensive and fundamentally flawed.

I began my journey to political maturity while still at school, and I was very much the exception to the rule, but I wouldn’t for one second conclude that it was anywhere near complete at 16.

At university, I witnessed how most 18-21-year-old politics students held similar views. They nearly always voted Labour or Lib Dem, believed the EU to be a good thing, and assumed man-made climate change to be absolute fact. I usually fought back in seminars to provide alternative arguments, though there were occasions where I concluded that it was more trouble than it was worth (especially on occasions when I was in a seminar with a Blairite tutor and a group of students I didn’t really know).

During last year’s referendum on Britain’s membership of the EU, politically-engaged university students voted Remain in large numbers, in stark contrast to continental countries, where grass roots movements against the EU are fuelled by the energy and enthusiasm of the young. It is therefore quite reasonable to ask questions as to what is going on with the teaching in British universities.

The journey of political maturity continues throughout one’s 20s. The idealism fades as people settle into jobs, careers and start families. They realise that the world can be a very nasty place, that solutions to problems are often far from simple, finding the complete truth is not always straightforward, and that, if they’re honest, priority number one is the wellbeing of themselves and their family.

Other realities also gradually dawn, such as the fact you are not indestructible, some people don’t live to old age, binge drinking is dangerous and has consequences, night clubs are overrated and that fitting in with your friends isn’t so important after all.

The ages from 21 until about 30 usually see the gradual drift away from idealism into a reality of paying taxes and adult responsibilities. The idealism of youth comes at somebody else’s expense. When you become the taxpayer, you become more concerned about how that money is spent, and you may conclude that you are often a better judge of how to spend your money than the government.

A deeper understanding of financial reality also develops through one’s 20s. You are either paying rent, or a mortgage, and prioritise how your pay packet is spent. You grasp that money that is borrowed eventually has to be paid back, and that it is a bad idea to get into too much debt.

Corbyn Economics
Jeremy Corbyn’s ‘back of a fag packet’ economic calculations, which bear no resemblance to reality.

The individual in his or her late 20s is therefore far more likely to see through Jeremy Corbyn’s teen-like idealism and the ‘back of a fag packet’ economic calculations.

Yes, there are problems with the current voting system, but not for the reasons Corbyn is advocating. The notion of ‘equal votes for everybody’ is broadly assumed to be a good thing, but few people bother to question it.

Fortunately, attempts by the EU to bully the UK into giving votes to prisoners have been thwarted. Those who are in prison have forfeited their right to participate in wider society, and that should remain the case.

Before 1914, there was a rule that nobody who received a public salary or welfare payment could vote, thereby preventing parties from bribing voters by giving them jobs or handouts, something that works strongly to Labour’s advantage.

Let us not forget that during the New Labour era, one million more public sector jobs were created. Let us also not forget the absurdity of the jobs pages in the Guardian every Wednesday during that era, with its ‘diversity officers’ and ‘five-a-day co-ordinators’. Such frivolity is, of course, a useful way for governments to buy votes and to keep the unemployment figures down.

Public sector workers often think (rightly) that their jobs will be better-protected by a Labour government than a Conservative one, and therefore jump to the conclusion that it is in the country’s interests to elect a Labour government. They very often neither know nor care much about the difference between ‘debt’ and ‘deficit’, or the balance of trade, or productivity rates. All these matters, and generating the money to pay their salaries is somebody else’s problem, and they’re quite prepared to let the Labour Party get on with it without bothering to look at the sums.

Realistically, we cannot withdraw the vote from those who already have it. Some ideas of how it can be reformed for the better can be found in Nevil Shute’s novel, ‘In the Wet’, where he devises a scheme for additional votes. Every person has one vote, with some having as many as seven, based on the criteria such as academic achievement, successful raising of children, having a trade, living abroad and other experiences that make you a wiser person.

This is obviously a pipe dream, and one that cannot be realised in the Britain of 2017. For now, it remains a ‘joke’ in the way Screaming Lord Sutch’s policy ideas of the mid-1960s were a joke, but in time, they became a reality (he didn’t live to see some of them come to fruition, so we cannot be sure of what he would make of the Britain of 2017). But if the wisdom of ‘equal votes for everybody’ is publicly discussed and challenged, it may not be so far-fetched in the long term.

Yes, it is desirable to reform the electoral system, but in favour of wisdom, experience and achievement, rather than by exploiting the naivety of youth for political gain.

The prospect of votes for 16-year-olds is just one more reason not to vote for Jeremy Corbyn’s Labour Party on Thursday.