Sir Lynton Crosby, the elections strategist, is fond of reminding his clients that: ‘In politics, when reason and emotion collide, emotion invariably wins.’ Sir Lynton is well paid for his advice and I’m sure he makes a shrewd point. It often means that politicians favouring the free market approach are at a disadvantage. They can often provide plenty of statistics and case studies on public sector inefficiency or the benefits of trade, competition and incentives. But the socialists respond with an emotional appeal for solidarity, equality and fair shares for all.
The argument, that has been going on for decades, about the morality of using private healthcare offers a good example. Those who ‘go private’ are accused of selfishness and ‘jumping the queue’. As with paying school fees, the subject is best avoided at Islington dinner parties. Even conservatives can sound apologetic about exercising such a choice.
It is a curious source of guilt. They are paying for healthcare twice. Through their taxes for the NHS, and then through fees or premiums for private services. So the ‘jumping the queue’ analogy is false. They are getting out of the queue and making it shorter for the rest of us. It is not a ‘zero-sum game’ with a fixed supply of healthcare. They are financing even more of it.
That is what reason would indicate. But emotion sees disloyalty to ‘our NHS’ as a source of shame. Few emotions are stronger than envy, which Churchill termed ‘the most barren of all vices’. How natural for those waiting in pain for months for an NHS operation to envy others who can afford to pay for treatment in days.
The irony is that political sensitivity to such attitudes has prevented reforms that could have made private health care much more affordable.
But the climate of opinion is changing at last. Wes Streeting, the Shadow Health Secretary, recently claimed that ‘Just as only Nixon could go to China, only Labour can reform the NHS’. Part of that reform involves greater use of the private sector by the NHS. If the NHS can send us for private health treatment why should we not be encouraged to reach the same destination by individual choice?
This week there was a report in The Times of a ‘generational shift’ that is ‘leading thousands of young people to seek private healthcare’.
It continued:
‘Younger adults are more positive than their parents and grandparents about the private sector, according to a poll by the Independent Healthcare Providers Network (IHPN). Forty-one per cent of respondents aged 18 to 24 said they had used private healthcare, the highest proportion of any age group. They were particularly likely to have used private GPs, with 45 per cent going private for a GP appointment, compared with 6 per cent of over-65s. The poll found young people were willing to forgo socialising, holidays and new clothes to pay for healthcare.’
The young were also more likely to have taken out private health insurance, according to the poll.
Thea Stein, the chief executive of the Nuffield Trust, a health think tank, felt that, ‘younger people’s increased willingness to use private GPs could reflect an increase in app-based and digital services.’
Plenty of other polling has shown support for the Conservatives among 18-25-year-olds to be vanishingly small. Yet their enthusiasm for private healthcare scarcely suggests a deep allegiance to socialism from the next generation. No doubt they don’t regard such spending as controversial. It is driven by impatience rather than ideology. They are using Amazon, Uber and Deliveroo to instantly cater for relatively minor wants. Why put up with delay for the more important matter of one’s health?
That young people have no qualms about going private has presented the government with a political opportunity.
The government should respond with a bold message of gratitude to those using private healthcare and thus easing the pressure on the NHS. But it should go further with policies to encourage more to do so.
In January, Rishi Sunak gave as one of his five pledges that ‘NHS waiting lists will fall and people will get the care they need more quickly.’ But since then the waiting lists have gone up, and 7.7m are waiting for routine treatment. The other pledges might well be achieved. If the flights to Rwanda start, the deterrent to those making small boat crossings could be very significant. It is likely that we will see inflation halved from where it was and the economy may well grow.
But waiting lists? The last, best hope is to widen choice. Spending on private healthcare should be made tax deductible. That should not just be for spending on your own treatment but also for your family and friends. Suppose you are highly paid but you have a less affluent relative who does not have £13,000 for a knee replacement. Or £11,000 for a hip replacement. Or £3,000 for cataract surgery. If you stump up the cost then you should be rewarded for that generosity. You should have that set off against taxation.
There should also be a basic protection for all of us that if the NHS can not provide treatment for specific treatments by specific deadlines then we have a right to have that treatment carried out by the private sector with the cost met by the taxpayer.
No doubt such radicalism would cause disquiet. However, the very boldness of it would make the opportunities widely available – including to the poorest who were in greatest need. Thus it would overcome some of the emotional resentment that Sir Lynton warns against.
I wonder if the Labour Party would oppose such measures. My guess is that they would not. After all, they don’t want to risk the youth vote.
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