Daniel Hannan is in trouble. The young Tory European MP, who
became a YouTube sensation earlier this year for his denunciation
of British Prime Minister Gordon Brown as the "devalued prime
minister of a devalued government," has made what can in politics
be a serious error: he has challenged orthodoxy in a way that is
both substantive and interesting. Boring substantive challenges can
be seen off, and soaring rhetoric that says nothing is the stuff of
politics, but having a point and knowing how to make it will always
raise bellows from the defenders of the gored sacred cow.
The curious thing in this instance is who is doing the
bellowing. Hannan has achieved the impossible: he's brought Gordon
Brown's backers and the Conservative Party into harmony. Health
Secretary Andy Burnham described Hannan as "unpatriotic": it's
curious how dissent is only the highest form of patriotism when it
comes from the left. Lord Peter Mandelson, the First Secretary of
State, claimed that the British people would find Hannan's remarks
"shocking." If so, they must have very short memories or very
low standards: Mandelson, known as the "Prince of Darkness," has
been forced out of the government twice in the past eleven years on
ethics charges. For his part, David Cameron, the Leader of the
Conservative Party, described Hannan as an eccentric, and the
Leader of the Conservative group in the European Parliament,
Timothy Kirkhope told the BBC that Hannan should be disciplined
for his comments.
Hannan's error was to step boldly and simultaneously into two
ongoing battles, with the result that he was hit by the cross-fire.
The battle in the U.S., to which Hannan thought he was
contributing, is the one over health care. Hannan is a vehement
opponent of Britain's National Health Service - which he describes
as a "60-year failure" that he "wouldn't wish on anybody" - and a
supporter of U.S.-style health savings accounts. As the NHS is the
single-payer system to end all single-payer systems, and as it is
one of the two foreign health care systems that Americans have
heard of - the other being Canada's - its deficiencies are potent
fodder for opponents of what President Obama is pleased to call
health care 'reform' in the U.S.
The other battle is the one in Britain between the Tories and
Labour. There, both parties are competing for the title of who can
praise the NHS the loudest. Brown's claim is strong: he has
increased spending on health care since 1999/00 by over 50% in real
terms. The results, charitably, have been modest: much of the
increased spending has been swallowed up by cost pressures and the
advancing bureaucratic legions inside the system. Britain's Office of National Statistics has
found that productivity across government as a whole slumped as
more money was spent: as the NHS got an outsized budget boost, it
turned in a particularly dismal performance. Labour's error was to
believe its own propaganda that the NHS was suffering from
heartless Tory budget cuts, and that the solution was more money
combined with more top-down control. The latter absorbed the
former, and by the end of his tenure in Downing Street, Tony Blair
was returning to Tory-style reforms in an effort to contain the
exploding costs.
It's those costs, and the lingering potency of the claim that
the Tories want to destroy the NHS, that gave the Conservatives
both their political opportunity and their political strategy.
After the Conservatives lost the 2005 election under the leadership
of Michael Howard, Cameron concluded that the Tories had to return
to the legacy of One Nation conservatism that exemplified the
career of Harold Macmillan and, in his post-war tenure, Winston
Churchill. The essence of One Nation conservatism, at least after
1945, was its unwillingness to fundamentally challenge to the
post-war domestic status quo established by Labour.
In the end, that was what destroyed it. The post-war world was
not forever, and many policies that seemed correct - or at least
sustainable - in the two decades after 1945 had become dangerous
irrelevancies by 1979. Appropriately, Macmillan ended his career as
a bitter critic of Margaret Thatcher's denationalizations, as if
the tattered and ineptly run industries the British government
clung to were really the valuable family heirlooms of his
imagination.
The new One Nation vision substitutes New Labour for the Labour
Party of the post-1945 era. The problem is that, so far, it has not
addressed the actual deficiencies in New Labour's agenda, just as
post-war conservatism proved unable to take Labour's program and
make it work. The problem with the nationalized industries, for
example, was simply that they were expected to provide more public
services - in particular, jobs for union members - than their
steadily shrinking productivity could justify. The NHS faced the
same dilemma from the very beginning: the British public then, like
a substantial part of the American public today, wanted to consume
more health than it was willing to pay for. The NHS was launched in
1948 by proposals which estimated it would cost 145 million pounds
per year. By the end of the first eight months, the NHS's annual
cost was 295 million pounds. By mid-1950, experts were anticipating
that the bill for 1950-1 would be 426 million pounds.
From the start, the NHS was thus pulled terribly and constantly
in two directions at once: it had destroyed the variegated system
of charities and insurance schemes that the continent's post-war
systems, by contrast, sought to supplement, so it had to pay for
everything. But somehow it had to constrain costs too. In 1951, the
creator of the NHS, Aneurin Bevan, resigned from his position as
Minister of Labour when the Chancellor of the Exchequer, Hugh
Gaitskell, introduced prescription charges for glasses and dental
care. According to Bevan, this violated the essence of the system,
which was that it was free: "A free health service is pure
Socialism and as such it is opposed to the hedonism of capitalist
society." Or, as he put it in his speech to the Labour Party in
1943, the welfare state was "a social experiment" that would allow
Britain to "assert a moral leadership which will have consequences
in every sphere of her activities."
Of course, the service was not genuinely free: nothing of value
is. Free, in this context, was just a synonym for a grant from the
Exchequer paid out of general taxation. But for Bevan, using the
power of the state to tax money away from the men and women who had
earned it had a morality that actually earning money in the first
place could never possess. The crucial consideration to him was
that, once the NHS was in place, the old shame inherent in
accepting public handouts would be abolished, because everyone -
bared from the hedonistic pleasure inherent in writing a check to
the doctor - would now be a client of the state.
But Bevan's belief that free service at the point of delivery
was a matter not so much of bodily health but of moral purity
exercised a continuing and malevolent influence. By turning the NHS
into something resembling a religion for milk and water Marxists -
which is not an unfair description of Bevan's political
sensibilities - and by crushing the old system beneath the iron but
faltering wheels of progress, Bevan at once committed Britain to a
single payer system and made criticizing it a form of political
heresy. All Gordon Brown did was to take advantage of what appeared
to be one of the most prosperous periods in modern British history
to remedy the deficiency that had vexed Bevan: the system could
never get enough money.
As it turned out, it still can't: even as Brown blew the doors
of the Treasury to pump money into the NHS, private spending on
health care in Britain - there is some, in spite of the existence
of the NHS - has remained steady at 1.4% of GDP. No amount of
public spending appears to be sufficient to meet all needs, or to
satiate the public's demand for better health, a lesson that the
U.S. might take usefully to heart. The idea that instituting a
British-style system in the U.S. will save money relies on the
premise that Americans could be restrained from spending their own
money on their own health, and would be willing to accept British
levels of government-provided care. Any politician who really
believes this is welcome to test the validity of their belief at
the ballot box.
Indeed, Britain spends less on health than the U.S. precisely
because, like any basically single payer system, the NHS ultimately
has to ration what it provides to take account of the public's
unwillingness to pay higher taxes, a reality that accounts for many
of the NHS's failures and horror stories. The NHS's defenders have
the difficult job of protecting it from the reality that Britain is
no longer dominated by the old cloth-cap class system that made it
so appealing in 1948: the NHS is a top-down system trying to get by
in a bottom-up age. But that has not prevented British politicians
on all sides from promising to try even harder and attacking the
littleness of their opponents' vision. That is why Brown delights
in Hannan's remarks, which give him the opportunity to demand that
even meeting with foreign critics of the NHS be ruled out of bounds
by all parties, and to play the old 'Tory spending cuts' card. This
blissfully ignores the reality that his own Treasury has forecast
massive spending cuts after he wins the next election - however
unlikely that eventuality now appears - which implies that even a
future Labour Prime Minister would have to continue the ceaseless
struggle to reduce the cost pressures in the NHS.
The Conservatives, for their part, worry that Hannan's words
will hurt them politically because, as part of their effort to
compete with Brown, they have promised to ring-fence the NHS's
budget when they win. This creates a tricky dilemma, because in
2007/8 spending on health (at 92.2 billion pounds) was almost 30%
of the budget. It will not be easy to come close to balancing the
budget - never mind achieving the surplus that Brown used to aspire
to in good times - after declaring a third of spending off limits.
The Conservatives are following the strategy that Blair pioneered
in the mid-1990s: seize the opportunity of the recession to talk
about the budget cuts that the government plans to inflict,
emphasize the danger to public services, look askance at tax
increases, and remain vague about how that circle can be squared.
The difference is that Blair benefited from sound Tory stewardship
of the economy before 1997: Cameron is not going to be so lucky. He
has achieved a virtual political miracle in bringing the Tory Party
back from the brink: now he will need to follow that up with a
fiscal hole in one.
What does all this have to do with the health of ordinary
Britons and Americans? Not much. Life expectancies in Britain keep
on rising, just as they did before Brown's spending spree. The
majority of uninsured Americans, whose numbers are usually
exaggerated, have either decided that health insurance is a waste
of their money, or rely on free emergency room care. The former
strikes me, personally, as insane, and the latter is undeniably
inefficient, but the supposed money-saving alternative of
preventive care usually leads, the Director
of the Congressional Budget Office testified last week, to
higher, not lower, spending. By moving the U.S. towards a
single-payer system under the guise of the public option, Obama is
heading in the direction of the British system, at precisely the
moment when that system, after an unprecedented injection of
taxpayer money, has failed to deliver the promised results.
But then the left's demand for the single-payer system in the
U.S. is not about health. It is, as it was for Bevan in 1948, about
a vision of social morality, which accounts for the eagerness with
which its supporters stigmatize their opponents as unpatriotic and
evil. That's a curious basis, even an unhealthy one, on which to
build a health care system, which one might suppose should be
judged on its results. But it's an even unhealthier basis for a
political system. There is no surer guarantee of fossilization, and
eventual irrelevancy, than mistaking particular policies, which
need to change, for immutable principles, which need not. If the
British people cannot grasp the difference, Dan Hannan will be the
least of their troubles.
Ted
Bromund is a senior research fellow in The Margaret Thatcher
Centre for Freedom at the Washington-based Heritage
Foundation.