There is a pattern emerging in policy-making in Britain. We Conservatives propose a policy. The Labour government ridicules and vilifies it. They question our motives and our sanity. Then, soon afterwards, they adopt essentially the same policy themselves, although often in a bowdlerised and vitiated version. The most striking recent example was the issue of the Death Tax last October.
Now Alan Johnson emerges to tell us of his plan for “patient health budgets” which will enable patients to take the NHS funding available for their treatment, and to shop around in the public and private sectors for the best deal. We Conservatives have been talking about this idea for a long time. Call it a patient’s budget, call it health passports, call it education vouchers. The only way to introduce market disciplines into public service provision is to make the citizen a customer, not merely in the rhetorical sense (doctors now seem to call patients “clients”), but in the real sense that they have money (or its equivalent) in their hands, and they spend it as they choose.
This year, Adam Smith would have been 285 years old, if he’d lived. Yet many of us still don’t quite believe in his invisible hand. In our heads we know that free markets are the best and most efficient way to allocate resources, and to drive innovation and quality, but our hearts haven’t quite come to terms with it yet. For many in the soft centre of British politics (including some Conservatives) vouchers are a step too far. We are so accustomed to the state’s social security comfort blanket, to the Beveridge dispensation that has been in place for most of our lives, that we are reluctant to abandon it even when it has failed consistently for decades. Education vouchers? Patient passports? Surely these are wild-eyed neo-con ideas espoused by free market ideologues, not the nostrums of practical men?
We still hear people (usually Lib-Dems) saying that they don’t want choice for the individual patient or pupil. They want every hospital, every school to offer uniformly excellent service. They haven’t grasped that that’s what we all want, and that consumer choice and patient power are the way to achieve it.
It is nonetheless an astonishing volte-face that this Labour government is coming up with such proposals. At the next general Election, the choice will not be between left and right. It will be between a Conservative Party wedded to market-based reforms because it understands them, which adopts them out of commitment, and a Labour Party that hates them, but holds its nose and adopts them out of desperation.
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- My final speech in Strasbourg - Two-seat parliament a perfect metaphor for the hubris and futility of EU project
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