The medicine manifesto

Last Wednesday I asked for ideas for unpopular policies that (a) Britain needed and (b) might, through their authenticity, cause a paradoxical increase in popularity.  I've repeated my three unpopular policy suggestions in the list below and have added seven ideas from the comments threads to produce what I've dubbed 'The medicine manifesto'.  Swallow the manifesto for five years and it should make Britain healthier...

Illness 1: Britain’s worst debt crisis.
Medicine: Years of public spending restraint including a few years of real cuts in the size of the state.

Illness 2: Hostility towards wealth creation.
Medicine: Opposition to populist measures like higher taxation of the rich that will ultimately damage the economy’s potential to create jobs.

Illness 3: Global terrorism.
Medicine: An increased commitment to Afghanistan so that the Taliban do not have the opportunity to harbour a new generation of al-Qaeda terrorist camps.

Illness 4: A human rights culture that defies common sense.
Medicine: Withdrawal from the ECHR.

Illness 5: A lack of economically-useful skills amongst the British population.
Medicine: Ending the 50% target for the proportion of the population going to university and pouring the savings into high quality apprenticeships and other forms of vocational education.

Illness 6: A police service that has lost the respect of middle England.
Medicine: Wholescale police reform and the direct election of police chiefs.

Illness 7: The lights are about to go out.
Medicine: The construction of twenty new nuclear power stations, in co-operation with France if necessary.

Illness 8: An expensive benefits and tax credit system that has introduced complexity but reduced incentives to work.
Medicine: Abolition of the tax credit system and all savings ploughed into higher income tax thresholds.

Illness 9: The growth of lifestyle illnesses including obesity.
Medicine: The NHS should charge people who call on medical help because of lifestyle choices.  The charge does not need to represent 100% of the cost of treatment.  In some cases the charge would be token.

Illness 10: A generation that doesn’t know anything about British history, can’t cook and doesn’t know what an APR is.
Medicine: Compulsory home economics, history and financial literacy education for all schoolchildren.

Tim Montgomerie

Comments

[Jack Stone]

Illness number nine. The trouble with that is how do you decide people have got there illness by a lifestyle choice.
With illness it is not always clear cut.. People may have lung cancer that they have got from smoking but gave up twenty or so years ago do we charge them?
Someone may have aids who is gay but caught it from a boyfriend who he had been told had never had sex with anyone before do we charge him?
Things are just not as clear cut as people think and I think as soon as you start charging some it is only a matter of time before everyone will face charges and that would be the end of the NHS. Something people will never support.

[John R]

all sound great to me, but can't imagine David Cameron doing more than nudge in the direction of a few of them.

[Guinevere]

Agree with everything except point 9 - the illness with the NHS is far more complex than that, and popular medicine has crept in the current Government policy making us think all illnesses are more or less lifestyle-related, which is not the case.

If Tories are going to get health and NHS right, they should be very careful not to repeat the mistakes of the current Government, which was introducing the culture of non-clinical managers with politically-driven targets. Hand the NHS back to doctors and nurses and the money saved by culling all the non-essential trimmings feeding on the current system will be enough to treat fat people, too.

[Tim Carpenter]

1. Agree, but even more than I suspect the Conservatives would be comfortable with.
2. Yes, but I'd move to end Income Tax altogether so they State realises that it does not own/farm us.
3. Tip of the iceberg. Afghanistan is best fixed as part of drug policy - we become customers, not invaders. Pakistan is now the new problem anyhow.
4. Better to back out of the entire political aspect of the EU. The ECHR is just another tip of an iceberg.
5. Agreed about the first part, though be careful about trying to control apprenticeships. State meddling is very inefficient!
6. Yep. Elected Chief Constables and a return to Peelean Principles.
7. Agree. Germans, Japanese even - we might get to use the Westinghouse skills sold for a song to Japan by one G Brown. Make sure we do what China does - absorb all the skills and re-grow our skill base.
8. As said, abolish Income tax and the credits and allowances that go with it.
9. Disagree. This is damnable Authoritarianism. The problem is that the State thinks it "pays" for the NHS. End that illusion and move to a more European insurance based system so people pay for their healthcare (shock! horror!) with a safety net.
10. Get the State out of Education and allow Schools to decide their own exam boards. No need for central meddling!

Most problems are caused by State hand, so the answer is not different poisons but an end to the poison. The less the State does the less it costs to run!

[YMT]

"Illness 9: The growth of lifestyle illnesses including obesity.
Medicine: The NHS should charge people who call on medical help because of lifestyle choices. The charge does not need to represent 100% of the cost of treatment. In some cases the charge would be token."

Or instead, increase the NI contribution by all, but at the end of the year rebate a percentage based on a persons usage. That way the NHS isn't caught short of funds, and those who barely use it get to get a nice present in time for Christmas or something in cash back.

[Meritocrat]

Illness 11: Collapsing social mobility.
Medicine: Restoration of 11 plus and grammar schools.

[Sally Roberts]

On number 9 I agree with Tim Carpenter. I think compulsory healthcare insurance is the way forward - as they have in Germany. It is totally wrong to penalise people for a "lifestyle choice" - after all, where does it end? Do you charge extra or refuse to treat someone who has chosen to go rock climbing and has fallen?

[Dr Obesity]

Sally: You treat them without questions asked and charge them later (through the courts if necessary).

[Liberanos]

Number nine cannot stand a moment's examination...despite its superficially populist appeal.

It's not simply a matter of the obese or heavy smokers or drinkers. Those who eat red meat are far more suceptible to colon and other cancers than those who don't. Who will levy a charge on all non-vegetarians or non-chicken eaters?

There are many such examples of lifestyle choices which are almost impossible to avoid in a modern Western society.

Let's hope the other manifesto points are rather more thoroughly thought through.

[Sally Roberts]

Dr Obesity (oh dear what a frightful name!) I am not entirely sure what you mean - perhaps I am being a little obtuse?
My point is that where does the "lifestyle choice" bit end? Yes, we include alcoholics, the morbidly obese and drug addicts but what about (as I say) people who choose to indulge in high-risk sports? What about someone who was knocked off their bicycle by a car or lorry? Would we say that they should not have been riding their bike on a busy London thoroughfare? Where do we draw the line?

[Cleethorpes Rock]

Agree with those. Nice to see my "20 nuke stations" suggestion came up. Energy security is crucial to so many other areas of the economy- just look at how Eskom's inability to power South Africa is harming investment in that country.

The proposals also make a bold statement about the sort of country we want- where people are not removed from the consequences of their actions.

On Afghanistan, I agree we need to do more, but this cannot happen as long as we have so many servicemen in Iraq or on shortened leave while our European "allies" and Muslim countries refuse to contribute.

[Annabel Herriott]

Illness 12.
Dislike of success, either academic or work based. Children bullying bright children. Cult of the Lowest Common Denominator.
Medicine. Bring back competition in school, classroom, sports field. Someone HAS to win! Everyone cant have a prize, but all can strive for success.

[Sally Roberts]

Hear Hear, Annabel!!

[William Blake's Ghost]

Tim Montgomerie:

On 9 - only if those discriminated against have the option to opt out of NHS completely and get their taxes refunded and reallocated to personal medical insurance

Personally I consider it statist interfering bigotry but if they will give us our right to choose and our money back then fine!

Incidentally, it could be argued that conceiving a child is a 'lifestyle choice' should that be charged for too?

All in all it is a nasty idea but as I say if it allows us to be excluded from the NHS altogether so much the better

[Denis Cooper]

OK, so we directly elect police chiefs.

Please explain, precisely, using Thames Valley Police

http://www.thamesvalley.police.uk/

as an example:

1. How that election would work.

2. What the successful candidate would be expected to do.

3. Why having that person would be better than having the present Chief Constable, who was appointed by the Police Authority:

http://tvpa.thamesvalley.police.uk/

[Peter]

Illness number one has to be that 75% of our laws come from the EU, and this will be close to 100% with the Lisbon Treaty (EU Parliament President said so).

With that illness we aren't really in a position to cure the others.

[William Blake's Ghost]

As a general comment, I would point out that the Conservatives Health policy is along with it's 'Democracy' proposals the worst part of it's manifesto (and it is bad) and as the Health budget makes up 20% of Government spending unless it comes up with something radically better it will fail to get public spending under control.

Putting a former civil servant and bureacrat(Lansley) in charge of the Health remit was a really dumb idea..........

[William Blake's Ghost]

Oh and on 10. Home economics - ROFLMAO. More nanny state nonsense. Keep education OUT OF THE HOME. Having kids telling their parents what to eat and what not to eat is only going to further destroy the relationship between the state and the people.

If you want to do something about people's diet then address the problem. The Fast food corporates, the supermarkets and the advertising and marketing industry! Stop them manipulating food in ways that are bad for the health of the consumer.

Stop the social eginerring and begin reform the corrupt aspects of the corporate world!

I really beginning to think that Tim is a corporatist of the immoral kind!

[Iain]

Shouldn't the first dose of medicne go to our political establishment to rid them of some of their beloved policies that have precious little support beyond the Westminster village?

[Mark M]

"The NHS should charge people who call on medical help because of lifestyle choices"

Only if you also allow people to opt out of the NHS. If the NHS is going to charge people who make lifestyle choices, a person should also be able to make a lifestyle choice to not be in the NHS.

What we actually need is an increase in private sector healthcare. The NHS should operate in general as it does with regards to glasses. The NHS does provide options for people with poor eyesight who cannot afford e.g. SpecSavers, but in general people will buy their spectacles from a private enterprise. This works very well (if you need new glasses you just pop in and buy some. Imagine if glasses were 100% run by the NHS, how long would you have to wait for your new glasses then?)

[Mark M]

Denis Cooper:

1. It works as a normal election does. Each candidate puts forward their views, what their aims for the police force are etc

2. The elected candidate would be expected to do what they set out in 1). When the next election comes, the public (who, if you hadn't noticed, are affected by police actions more than the police authority) decide whether to keep the current guy or change.

3. It is better because the police chief will concentrate more time on policing the things people want policed rather than the box-ticking and targets of the police authority.

Thankyou for the police authority link, it's interesting to see the most recent information.

- Council Tax rise to fund extra front line police officers
- Decision to drop elected police authorities welcomed
- Trial of new uniform

Yes, the chairman of the TVPA welcomes the decision to keep the police authorities undemocratic, presumably so they can spend that extra council tax money wearing new uniforms rather than having to do what the people want.

[Cleethorpes Rock]

My health insurance costs £27 per month. How can only 10% of people have something that is so valuable yet so cheap?

Surely, if everyone took similar steps the pressures on the NHS would be reduced, especially in areas such as mental health, physiotherapy and lifestyle illnesses. Many Insurers offer healthchecks to members and incentives for adopting healthy lifestyles and taking exercise.

[Robert Eve]

Tim - all ten sound good to me.

[DCMX]

There's probably a 5% boost in the polls for a politician who tells uncomfortable truths but David Cameron has probably left it too late to be the truth teller. He's seen as Mister Spin and if he starts telling the truth now it will be like the boy who shouted wolf.

[James Cullis]

TIm you forgot reversing the poly upgrade and reintroduction of grammar schools

[Malcolm Dunn]

Agree with many of your ideas Tim but not 9, I simply don't think it's workable.
10 is also a bit dodgy in my opinion. I'm not in favour of an ever increasing national curriculum. I would prefer Heads and their staff to be given more discretion.
Also interested to know what you mean by 6.Elected police chiefs would be great but more explanation needed.

[THE BISHOP SWINE]

Labour is a lost cause it will be shown up to be the brew of dishonest wicked catholic plotters. Some of the political crimes that Blair was party too are so gross they grossed out Ruth Kelly. That prebbi Brown is playing us for suckers he hopes that we will put him straight which we of course will. So its only a matter of pebbles on the beach. We will be back to sail boats in ten years time, the way back from the brink is quite a straightforward path. It may even be some improvement to downsize. do the down side sizzle? We could even burn coal before we had need of any fuel. e all are going to take a whopping cut but it will be a strong recovery. Those who recovery will astonish those who will struggle, It will be important to keep all of details relevant we should not feed them outright lies and we need very much to work together. We can no longer allow a minority of worthys to stomp on a majority of one. Those who election is transparent need bow to no other man. So when they come with their Tory Wigs and their snooty Pitt, we say as a man...RA RA god save the queen. An when they stamp down with Anger we stamp down in unison. This is what D.C. must grasp, if he fails to reach out we might have too. Authority is a concept that George grasps far better than D.C. George is balanced not bonkers, and we are sliding towards a national emergency. In to this mess with added inflation, that is were we will find ourselves. Crack down hard and mean it, make an example of somebody if needed..here and there show the teeth of power. Don't be afraid to act in the best interest of the state, but be very afraid to step outside of that commitment. In short believe your cause is right and act accordingly. Of Goldstein and of Judea remain open minded. Quantative easy ?? I don't think so we already know exactly where it gets us. Are we really going to cut back from Europe as of old and in accordance with National , Royal and Church tradition. Control the press impose restriction alter the playing field. UN do the mess the socialists have made. Is it any wonder our system doesn't work and cannot deliver the goods. We have enough wealth and enough people to produce absolutely everything we need inside this country. we have a market we have the people and frankly shop rents are having to fall a great deal yet. We have to make the reforms that force those properties to cost less and which encourage small business to flourish. We have to set the new realism. There is a way out of our mess and as always it involves production. Government should be in the business of setting up business's. 10% of the best of the Civil Service should be encouraged to start new business. Are there rules against that? in that case make it a Crown declaration and have done with it. We have every reason to favour Britain and no reason to favour Europe in the placing of the production and our national means. Why would we British act in another way? We have the Market why shouldn't we work our market in our national favour. For Europe to work it needs a centralising figurehead que Tony Blair and his awful sincere act of aggression. We are not going to fall back into the grasp of Rome are we? Seriously?

[Thatcherite88]

I agree with most points, particularly with regards to scrapping the unrealistic unversity target. A great post, highly true, but sadly not going to happen under Cameron.

[Conand]

'Illness 8: An expensive benefits and tax credit system that has introduced complexity but reduced incentives to work.'

I have a different prescription:

My Medicine: Simplify Tax & Credits and use money to cut taxes on Low Income earners and on Small Businesses. Encourage saving. Encourage work. Encourage enterprise. Encourage simplicity. Reduce nonsense.

[Denis Cooper]

MarkM @ 18:08 - Thanks, but just stopping you at 1.

Who would be eligible to be a candidate?

What would be the nomination process?

How would their campaigns be run across the Thames Valley?

How would those campaigns be financed?

Would any party or non-party organisation be permitted any involvement in the process?

Would it be first past the post, STV, or what?

And, on a personal note, how would I decide who to vote for?

[Alex Swanson]

Sorry, but I cannot support the building of new nuclear power stations.

We talk glibly about renewable and non-renewable resources, but the truth is that some resources really, genuinely, can only be used once and are then lost to mankind forever. The two prime substances to which this applies are helium and uranium, and it is just wrong to use either for anything for which some other alternative is available.

[Mahatma Coat]

On Doctors Orders, number 9: Yes, the health of the nation is a common good, ie we all have an interest in the health of our fellow citizens. But defenders of the NHS have to answer the question of why, if it is so wonderful, not a single other country has followed that model. They, unlike our wonderful post-war political elite, saw the trap: if something is free at the point of use the users cannot put a value on it and so it will be treated as if it is valueless. Added to which if the political class are such cowards that they refuse to tell the public exactly what they will get for their money, the public will expect to get everything that is available at no extra cost. So there will never be sufficient funding and the service will always be regarded as inadequate. The answer, as many have noted, is to follow the example of other countries and have an insurance based system. Those who cannot pay can be supported by social security. At the moment the NHS is simply another department of social security one way or another.

[John Anslow]

After the NHS was established, working men no longer had their lives blighted for want of a simple operation to fix a hernia, women did not have to bear the indignity of having to wear some medieval appliance to deal with a prolapsed uterus, and infants born with a cleft palate were not hidden away by their parents. So I am grateful for the NHS: perhaps it’s an attitude common among people of my generation who did not come from privileged backgrounds.

Those who set up the NHS genuinely believed that its budget would decrease over time, as the population became healthier. They could not have foreseen procedures such as organ transplants, joint replacements, in vitro fertilization and even gender reassignment would eventually be included in the population’s expectations: expected as a right, even.

So it is of no use tinkering, as in number 9 above. The nasty medicine is going to be telling people that they cannot expect a whole range of procedures to be funded from general taxation: we simply cannot afford it; we’re bust. Some unthinkable thoughts need to be thunk.

[rcs]

The major problem is the EU that distorts our economy, laws, energy policy and way of life.

I fear that there is no politician who will stand up for Britain any longer - we are just doomed to go down an increasingly statist, authoritarian path dictated by the EU.

[Anthony Scholefield]

I dont think there is any point in following this discussion until you clarify your thinking-you have to define'unpopular 'with who?This elementary logical point was observed by several posters in your previous posting comments but you have not taken it on board so thee list you give is illogical-who are you supposed to be unpopular with?

[John Prendergast]

On nuclear, we must back all 20 stations with alternative Thorium technology to uranium so we will not get blackmailed by future Uranium barons, we must also sort our fast breeder reactore, and include an offer to rest of world to decommission nuclear weapons in order we can use the plutonium or sell it back to them. Ths we coud have electricity for 3,000 years or at least until fusion is made to work. This must be embarked on ASAP.

As for clause 9 NHS should e replaced by compulsory health insurance with premiums affected by lifestyle.

[Stephen]

You want to withdraw from the ECHR, just when this government is dismantling our civil liberties as fast as it can? Please tell me in what way the Tories hate freedom any less that the Labourites?

[Stephen]

The NHS should charge people who call on medical help because of lifestyle choices

So what's a 'life style choice'? Having a BMI > 25? Tweisting your ankle whilst on a hiking holiday? Breaking your leg because you were thrown from your horse? Did the cretin who wrote this have any idea how difficult it would be to administer such a system?

[Stephen]

So how do we square

Opposition to populist measures like higher taxation of the rich that will ultimately damage the economy’s potential to create jobs

with

The NHS should charge people who call on medical help because of lifestyle choices

which rather sounds like a tax on 'life style choices' if anyone can define what they hell those are.

I wouldn't put these golden ideas in your manifesto. You might actually cause this crappy government to win the next election.

[Stephen]

The nasty medicine is going to be telling people that they cannot expect a whole range of procedures to be funded from general taxation: we simply cannot afford it; we’re bust

So we can afford to leave alone the taxes of the richest part of our population but effctively increase the taxes on the poorest by obliging them to pay upfront for medical care that they would have received from the NHS? Yeah, I can see that as an election winning formula.

[Steve Tierney]

I disagree with no.9 and would be careful with no.3 Other than that, nice work!

[John Anslow]

Those anonymous contributors for whom sarcasm serves as reason might consider the following.

As long as medical technology progresses, the expectations of the population will never be met, no matter if you tax the rich till “the pips squeak” (and with all the adverse consequences that policy would bring). This was not foreseen by the founders of the NHS.

There have always been procedures that have not been available on the NHS. Plastic surgery for a child born with a hare lip? Of course. Cosmetic surgery for someone who thinks his nose too large? You must be joking … mustn’t you? Gender reassignment? Someone has to make a decision.

From a different field, how many cycles of IVF should be available? There was a discussion about that in 2004.

Bury your head in the sand if you don’t want to think about it, or continue with the mantra of “tax the rich more”. Clearly, even thinking about these issues has proved too nasty a medicine for some.

[Stephen]

As long as medical technology progresses, the expectations of the population will never be met, no matter if you tax the rich till “the pips squeak” (and with all the adverse consequences that policy would bring). This was not foreseen by the founders of the NHS

I don't know how that remark is intended to advance the debate. Since the amount of GDP that can be spent on the NHS is ultimately limited, quite obviously there must be limits to what can be done and that prioritisations must be made. However such prioritisation should be made on the basis of clinical judgement and must be transparent. It must be transparent because clinical judgement must ultimately be subservient to the will of the people, who pay for it.

I must say that I wasn't aware that posting under my real name was being 'anonymous' but there you go. I make no apologies for sarcasm when attacking Point 9. What is a 'lifestyle choice' and how could you construct a fair and transparent system of sliding charges that reflected a person's alleged culpability for their medical problems? It's unimplementable populist drivel that would create a layer of expensive bureaucracy to adjudicate charges. Thinking that it represents realistic policy is 'burying your head in the sand'.