Three thoughts:

1) To what extent are the British right beginning to emulate the American right’s peddling of a narrative in which a sinister Liberal Conspiracy (pun intended) secretly rules the world and persecutes the political right, as a way of paradoxically amassing more power to the right? I.e. are they really just whining, or is it cleverer than that?

2) Iain Dale, “This whole row illustrates the problem we have in this country. It is impossible to have a rational debate about the NHS because the moment anyone utters the most mild of criticism (and I accept Hannan’s doesn’t fall into that category!) or dares to suggest that the NHS actually isn’t all that perfect, they are dumped on from a great height.”

Presumably Iain has been living in a box in the ground for the past 20 years. MRSA scandal? Waiting list scandals? Debates on part privatisation? Foundation hospitals?

our recent political history is littered with people criticising the NHS.

3) Given 1 and 2 above, a dilemma for Iain: does he really believe what he says, in which case he appears so totally ignorant of Britain’s recent political history that his status as de facto king blogging authority on uk politics is somewhat undeserved, or is he in fact playing an altogether more sinister and intelligent game?

There are two debates to be had – how the NHS can be improved, and whether we should scrap it and have a completely different system. We have the first debate all the time; we don’t really have the second; if the Right want to have that debate, they need to flag up that they think another system is better. What they don’t get to do is whinge, whilst concealing their actual position.

All this affair has done is smoke out those on the Right who privately think the NHS should be at least partly privatised, but know it’s politically unpalatable.

“All this affair has done is smoke out those on the Right who privately think the NHS should be at least partly privatised, but know it’s politically unpalatable.”

That’s quite an achievement. I’m glad to have DanHannan out in the open where we can better shoot at him.

I think what the likes of Dale and co are referring to are those whose response to Hannan was to hurl abuse at him instead of engage with his arguments. Plenty of people did the latter but there is evidence on both here (calling Hannan an “utter twat”) and LabourHome (calling him a c*** who should be strung up) that some childish people prefer the former. It’s a pity because there’s a worthwhile debate to be had over the NHS and how to improve it.

“Tim Montgomerie of Conservative Home takes it one step further and argues that a journalist (employed by Rupert Murdoch) who criticised Daniel Hannan ought to resign.”

Which again goes to show why Montgomerie should be laughed at all the time. He is a moronic brown shirt fuck who has nothing original to say. He just repeats his American masters bullshit.

As for whinging Dale what he really means is lets have a debate about how we can destroy the NHS. But that is not what the public wants you smarmy oaf. It really is time for the Tory party to tell the truth about where they stand on the health service. And it is not the lires we are getting from call me Dave.

All this goes to show is how the rank and file of the Tory party are becoming more like the crazed wingnuts of the American right wing. Stupid and proud of it should be their motto.

“I think what the likes of Dale and co are referring to ”

Nobody gives a flying toss what what you think troll.

“Plenty of people did the latter but there is evidence on both here (calling Hannan an “utter twat”) and LabourHome (calling him a c*** who should be strung up) that some childish people prefer the former.”

If you read the article on LibCon calling Hannan a twat, you will see that the T-word is followed by a reasoned and sustained critique by Unity, who goes to an extremely detailed and sustained effort to deconstruct what Hannan says about Singapore.

I can’t comment about Labour List, but as for Lib Con, stop putting up strawmen to burn them down again.

Is it not time we looked at the French, German and many other continental Systems for healthcare? PFI construction of hospitals came about because the government does not employ people who can design and supervise construction projects which come in on time and on budget. PFI keeps embarressing budget over- runs off the government books. In France , the government employs engineers who can design structures and bring them in on budget – Normandy Bridge and the centre of he country , cannot remember the name. There was a recent contribution in the Spectator from someone who explained how the French system works. It would appear that in many countries people have an insurance scheme and the money is reimbursed by government. This gives people the power to choose and reduces frivolous use of the health service.

What is important is improving the health of the nation, not preserving the NHS in a 1940s time warp. Just because we invented a national health service it does not mean we have the best one in the World and cannot learn from other countries.
Following this reason, as we started the industrial revolution, football, cricket , rugby and therefore we have the best industry and sports teams in the World .
In manufacturing and sports, those who want to be the best, bench their performance against the best, not the average.

Contribution by Ed Hoskins on French health sysem -well worth a read.

http://www.spectator.co.uk/coffeehouse/5261858/the-nhs-isnt-free.thtml

But – and this is a legitimate question – do they have something to really debate about.

Simply look at the figures per GDP – see what the NHS is giving as a service to the UK populous against what others are giving.

Let’s use the US figure to aim for, practically double the UK’s and what a service that would be!

Is there waste in the NHS – erm, obviously, so let’s eradicate that waste and put it into patient care.

Take away the PFi rip offs, and see how much that saves, reduce the administration and see how much that means we can hand back to doctors and nurses and patient care?

Now, what is it they want to debate? Reduction of cost? Again, we must point to the little the NHS actually costs in terms of GDP. Very little in comparisons to others – including France.

The Singapore method? Well that means we have to become Singapore for that to work, and hand everything over to private insurance – oh wait a frigging second, did we have this kind of debate 60 odd years ago where it was stated that people get healthcare according to need and not the ability to pay?

Why don’t these people – who we are told do not speak for the Tory party, only that they spread Tory spin – come out and say what their alternative is – then, as it seems reasonable, we have something to actually debate!

What planet are Dizzy, Iain D & Jimmy F on?

The NHS has been subject to profound changes and yet we have heard very little about the far reaching implications of these developments.

NuLab have busied themselves with a form of marketisation that few Tories (back in the day- 1997) would dare dream about – although I daresay Dave C & Co can barely believe their luck that the dirty work has already been initiated by Tony B (remember him, the war mongering former NuLab head boy).

Anybody interested in just how far the NHS has been given over to the private sector can do no better than cast an eye over Allyson Pollock’s stuff
http://www.guardian.co.uk/commentisfree/2008/jun/11/nhs.health1

This from her article;
Today 90 NHS foundation hospitals operate outside direct government control in an increasingly commercial environment. At the same time, the government has continued to divert NHS funds to the private sector. Since 1997, its private finance initiative programme has been used to sell and liquidate hundreds of NHS hospitals and clinics. But the 76 planned and 33 operational PFI hospital schemes are not under public control – they are leased back from the private sector under 30-year to 60-year commercial contracts.

Then we have the Independent Sector Treatment Centres – this in the BMJ
http://www.bmj.com/cgi/content/full/338/apr30_2/b1421
Pollock notes;
Since 2000, the Department of Health has had an explicit policy of using NHS funds to contract out some elective surgery and associated clinical services to the private for profit sector. This policy of commercialisation is known in England as the Independent Sector Treatment Centre (ISTC) programme, under which the government intends that the private health care industry will provide elective surgery and other clinical services at a projected total cost to the NHS of over £5bn.

GP services are being privatised too;
http://www.healthcarerepublic.com//news/index.cfm?fuseaction=HCR.News.GP.LatestNews.Article&nNewsID=922481&sHashCode=#AddComment

I would be surprised if Cameron did not push on now the NHS privatisation agenda has gathered so much momentum.

Anyway, what is it Dizzy & Co want? ……. to be able to BUY paracetamol from A&E staff so as to appease the likes of Danny Hannan?
I really do despair that there are those who would hand the health of our nation over to this type of politician.

Is there anything more tedious than right-wingers banging on ad infinitum in the media and on blogs about how their views are being censored?

You’re being censored? So how come you won’t shut up?

Hannan is not “very right wing”, he’s simply a mired in neo-liberal doctrine. It’s funny when lefties seriously disagree with someone; their opponents become extremists. Reminds me of when Ken quipped that Trevor Philips would soon be joining the BNP. Political opponents become the legitimately hated enemy.

If you happen to think that Hannan is “very right wing” then you yourself are either very left wing or simply are not that au fiat with political analysis.

Nobody gives a flying toss what what you think troll.

Ah Lib-Con, the place for the highest quality liberal discourse

#tories4thenhs

[13] Marvin can you supply a list of those on the right of Hannan – personally I think we should be very scared of them?

Just as I thought [see 11]
http://www.guardian.co.uk/politics/2009/aug/16/tory-mps-back-nhs-dismantling

I imagine that an open and honest debate would be easier if we didn’t all suspect that any debate at all would be used as a means by the right to slowly dismantle and privatise the NHS.

Of course it’s not perfect, but the right take every imperfection and use it as a weapon in their fight to have the whole thing pulled down.

Spot on. It’s the classic tactic of the lunatic culture warriors of the American right: (1) poison debate with hysterical half-truths and horror stories; (2) wait for the inevitable backlash; (c) paint your critics as freedom-hating, debate-stifling commies/nazis/fascists/all of the above. As far as I can tell, Daniel Hannan is pretty much Sarah Palin in bad drag.

A&E nurse you needn’t worry, Cameron is a massive fan of NHS, and a majority of conservatives in this country in general support the NHS concept. Scrapping the NHS or privatisation is a not on the agenda.

Remember it’s ONE Conservative MEP whom wields no power over national policy who has praised the American private healthcare system whilst deriding our NHS. There’s a debate to be had about quality of care, perhaps, but the panic over ‘privatisation of the NHS is secret Tory policy’ is without foundation…

Reform is, surely. The mind boggles at the amount of money wasted on middle management, consultancy, and terrible decisions within the NHS. We need more nurses, more doctors, better and fewer middle management, dropping of consultancy and PR, and investment in buildings and equipment.

[19] Sorry, Marvin, I disagree.
This again from Pollock …….
Labour’s 1997 manifesto promised – “Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working cooperatively for patients, not a commercial business driven by competition.”
But from the outset, New Labour had four targets in its sights:
[1] ending public ownership and control of the NHS.
[2] developing a large for-profit private sector using Treasury and NHS funds.
[3] creating a flexible workforce for that sector.
[4] changing the public’s resistance to markets in healthcare.

If we look at the £5 billion spent on ISTCs and god knows how much (in the end) on PFIs then we are already well down the covert privatisation road.

Factor in the outsourcing of ancillary hospital services and the shift in primary care from state to private providers and it becomes impossible not to conclude that NuLabs stewardship of the NHS has resulted in huge structural changes some of which even Danny Hannan might approve off?

As an ancient, I can recall from 50 years or so ago the regular (academic as well as populist) rationale for the NHS was to say how awful the American way of healthcare is. The current public debate in America just plays this back in reverse. The curious aspect in the debate is that few protagonists pause to compare the performance of the social insurance schemes for healthcare in other west European countries.

“Defenders of Britain’s system point out that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain’s healthcare as 18th in the world, while the US is in 37th place.”
http://www.guardian.co.uk/world/2009/aug/11/nhs-united-states-republican-health

Other independent assessments have reached similar conclusions – in comparison with healthcare in other west European countries, the NHS rates as fairly mediocre:
http://www.healthpowerhouse.com/files/canadaIndex03.pdf

Try also the graphics here in a BBC report:
http://news.bbc.co.uk/1/hi/health/8201711.stm

One of the little discussed aspects of the NHS being “free at the point of need” is that the nature of medical need is very much left to the individual to define.

With symptoms of repeated headaches, for example, person A will take a proprietary pain killer whilst person B will go to their GP and insist on a brain scan (to rule out a tumour as the cause). This is not to criticise person B- when there is no cost associated with his course of action, it might be argued that it is the more rational.

And from the point of view of the NHS employees, there is no downside to sending B for the scan- their own future employment prospects are dependent on people like B needing such tests and, potentially, getting some treatment. If you decide not to agree to the tests and it transpires he has a tumour, you will be sued.

But the problem is that, at a macro level, we have an ageing population and recent and future advances in medical technology mean that we can all be kept alive almost indefinitely. So future demand for medical services will be increasingly exponential and the cost will, undoubtedly, become unsustainable for everyone. The challenge for developed countries, faced with this demand, is how they will decide to ration the resources they can afford.

In the case of the US, it is and will be rationed according to the ability and willingness of the individual to pay. But this factor also controls and potentially limits the size of the US health industry in total- the danger for the UK is that, faced with unlimited demand and political oblivion for anyone unwilling to satisfy that demand in full, rationing will only begin when we become bankrupt.

My confidence is not high that this will be avoided when it seems we are currently prepared to pay GPs six figure salaries to prescribe antibiotics and the same again to the pharmacist to put the pills in a box.

“If you read the article on LibCon calling Hannan a twat, you will see that the T-word is followed by a reasoned and sustained critique by Unity,”

So why ruin what was an excellent article by kicking off with a playground insult? I don’t agree that there’s been some sort of attempt to censor critics of the NHS (it gets criticised non-stop in the press) but the virtriol poured on Hannan from some quarters doesn’t do the Left any favours. I sometimes wonder if it’s partly to do with the Youtube attack on Brown and the fact that he has a “posh” accent.

“Which again goes to show why Montgomerie should be laughed at all the time. He is a moronic brown shirt fuck who has nothing original to say. He just repeats his American masters bullshit.”

I think you secretly fancy him.

@23

why ruin what was an excellent article by kicking off with a playground insult?

Ok. No playground insults right?

I think you secretly fancy him.

Hmm.

@25

Took the words right out of my keyboard…

Sally’s back.

Excellent.

I’m all for people having the freedom to spout their views, no matetr how backward or rubbish they are, just as Hannan did but then everyone else has a right to attack them or agree with them as they see fit.

I get the feeling that some want the right to spiel their stuff but not have to be challenged on it, or challenged on it in a way they find acceptable.

And as they keep moving the goalposts the idea remains unchallenged.

[27] The challenge for developed countries, faced with this demand, is how they will decide to ration the resources they can afford.

For Danny H and his ilk the resource issue is simply dealt with by basing provision on ability to pay for it.

Oh, I know the Hannonites probably pay lip service to protecting the needs of certain vulnerable groups – a system that might resemble a US style medicare?

And there might be a certain amount of bluster from Danny-boy about the benefits of an ‘insurance’ approach, bearing in mind the American conglomerates are already circling the lucrative UK health market – but I find it impossible to believe that these market orientated mechanisms would lead to an improvement in services (for the MAJORITY of patients) although I dare say one or two shareholders might do OK out of it?

28 “but I find it impossible to believe that these market orientated mechanisms would lead to an improvement in services (for the MAJORITY of patients) although I dare say one or two shareholders might do OK out of it?”

Nails it!!

The idea that this is being done for the little guy is bullshit. It will be fine for the rich and the well of middle class, but not for everyone else. It is also been done for the American heath corporations who want to take over both the Britsish and Canda health systems.

And we all know that Tory MPS and many New labour scum like Blair are just servants to American corporate interests.

“The idea that this is being done for the little guy is bullshit.”

C’mon. The question is why do various independent assessments rate national healthcare systems in many west European countries as better than the NHS in Britain and even more so than the US healthcare system? In such comparisons, the NHS rates as fairly mediocre, a conclusion supported by the published data for comparative life expectancy, infant mortality, cancer survival rates etc etc.

The combination of universal social insurance with a verging-on state monopoly over the provision of healthcare services – the characteristic feature of the NHS – was avoided in other west European countries which, instead, focus on social insurance schemes that, on the evidence, yield better results in independent performance league tables.

Put my obsession with empirical findings over political prejudice down to the dreadful habits of a career economist.

30 – “The question is why do various independent assessments rate national healthcare systems in many west European countries as better than the NHS in Britain and even more so than the US healthcare system?”

Part of the answer is much higher levels of spending on healthcare + lower levels of economic inequality, right?

Different structures can make a difference, but it is not like there is a social insurance system which costs a similar amount to the amount which has been spent on the NHS over the past 30 years, and which performs a lot better.

This is also part of the answer to pagar’s point that “the danger for the UK is that, faced with unlimited demand and political oblivion for anyone unwilling to satisfy that demand in full, rationing will only begin when we become bankrupt”

The evidence suggests almost exactly the opposite – one of the features of the NHS compared to Western Europe or the USA over the past 50 years is how much less the UK has spent on healthcare. Even after the spending increases of the past few years, we spend a lot less than the best performing countries.

“Part of the answer is much higher levels of spending on healthcare + lower levels of economic inequality, right?”

That’s certainly (an important) part of a comprehensive answer but there are other important contributing elements too.

Looking over various official, regular OECD Surveys of national economies, I was surprised to note in the standard stats annexes a few years back that the UK rated poorly compared with other OECD countries in the numbers of physicians per head of population. In one of the worst comparisons, c. 1997 the French had nearly twice as many physicians per head as we had. How come?

This relative scarcity of physicians in Britain connects with the current high pay of GPs – several Primary Care Trusts are reporting top earning GPs as getting over £300,000 a year – and also with several reports that higher pay for NHS staff has absorbed some 70% of the extra financial support put into the NHS by the government since 1999. I believe this is a major factor explaining why NHS productivity is calculated by ONS as having declined in recent years.

Another significant factor IMO is that – unlike other west European countries – the NHS in Britain is a verging-on state monopoly in the supply of healthcare services. In France, I could walk into any GP *without registration* for a consultation which I pay for and then recover all or most of the costs from the state and whatever additional occupational or private cover I have. Competition between suppliers of healthcare services was and is regarded a natural part of healthcare provision in other west European countries but not in Britain. The government has only recently restored hospital choice in the NHS.

The monopoly factor also features in reasons for the relative scarcity of physicians and what was the relatively poor pay of nurses and NHS support staff. The monopoly element also probably means that some prescription pharmaceuticals are cheaper compared with elsewhere in Europe.

Btw some of us have been saying for many years that Americans are getting a rotten deal out of their healthcare system.

The government has only recently restored hospital choice in the NHS.

But only so far, see John Crippen.

“Ok. No playground insults right?”

My apologies, I thought that would have come across as some harmless banter in responding to a blatant Tory troll. If I had said “Sally you complete twat” or something similar then I would admit the charge of hypocrisy.

Sally is a Tory troll.

One day she’ll understand irony doesn’t work on the Internet.

Sally’s a legend!

So was Cyclops.

Yeah but cyclops wasn’t as good as getting Tories on their toes…

Sorry, but I don’t think throwing one eyed insults at people is likely to bother them much.

Sally’s avowed politics are of the type that used to be parodied on early 1980’s sit coms and have about as much relevance to the 21st century as eight track music players.

Up the workers, evil bosses, class envy.

I suspect it’s a parody but, if not, she needs to move on quick.

Actually, I think cyclops, just be the very nature of his size and temper would have kept the Tories on their toes, but then he would have to kept on a tight leash so as not to attack it’s NU LABOUR owner.