The auction is now officially open. Only those who think voters are stupid are allowed to bid.
Election season is in full swing and with it, predictably, the wild promises of how much money each party will pump into the NHS if elected. Labour have taken the money no object approach - anything is worth spending to 'save the NHS' from Tory led destruction. This, combined with their promise to eliminate competition in the provision of services and to pass the costs on to whoever the voters happen to hate today is populist politics at its worst. It makes for a narrative that very few voters will take seriously. The Conservatives are betting that they can navigate the narrow channel between responsible economic management that requires fiscal rectitude while still getting enough people to believe that the NHS is safe in their hands. The Liberal Democrats have, so far, limited their position to increasing the focus on mental health. UKIP vows to dismantle the NHS one day and to protect and defend it the next. Par for the course.
The NHS has become a political minefield that is now largely impossible to manage. Almost no politician dares to tackle seriously some of the real issues that need to be addressed if the service is to be made sustainable. The opprobrium that followed Andrew Lansley's reforms will scare off any other politician who wishes to hang on to his or her job. Instead, the NHS has become nothing more than a political football. Promises galore at election time followed by having to face grim realities on taking office. The result is that policy is made through a series of tactical moves that address the issues in today's headlines (like the ill fated Cancer Drugs Fund) without any time to focus on the overarching issues. For this, it is not just the political class that is to blame. Doctors, NHS managers and unions are also complicit in a game that stokes up any issue that makes the headlines into a crisis that can be used to push their own particular agenda. None of this benefits any of us or the long term sustainability of a national health care service.
There are many issues to be tackled in delivering an effective and sustainable health care service. None of them are easy or obvious. However, one major driver of the political football around the NHS is that most voters want more of it but nobody knows what it costs. The perception that the NHS is somehow 'free' simply fuels demand for more, more, more. If we are to move away from this reduction of the NHS to political football, then voters need to be given the opportunity to understand better the trade-offs between the services provided and the costs they have to pay for those services through their taxes.
The use of co-payments as a way of introducing cost consciousness into the consumption of health services has been widely debated. It is far from a perfect approach riddled as it is with issues of equity and accessibility. An alternative approach is to institute more transparency into how much of our taxes go to the NHS. Ideally, we would have a hypothecated tax to cover all or part of NHS expenditure. That will likely be fought tooth and nail by the Treasury. However, one way or the other, taxpayers should be able to see on their tax bill how much money they are spending on the NHS and they should see that amount increase every time NHS expenditure rises. National Insurance contributions were meant to follow the general principle of a hypothecated tax but have been corrupted into just another payment that goes into the pot for general expenditure managed by the Treasury as it wishes.
Until taxpayers are able to see how much of their taxes go to the NHS and can explicitly see that amount increase every time more is spent on health, then the NHS will remain degraded as a subject of mere political point scoring. Voters will be unable either to make serious judgments as to whether they are getting value for money or hold politicians to account as they throw out whatever numbers they choose in the usual election time silly auction.