Wednesday 16 June 2010

Visiting the Doctor

There are those who argue periodically that the days of ideology in politics are dead and gone. In much of what passes for political debate, that often seems to be true. But I'm not convinced; there are plenty of issues where the underlying disagreement is really an ideological one; it just isn't presented in those terms.

Yesterday's news about a Labour-leaning think tank suggesting a £20 charge every time anyone visits the doctor is a case in point. It's presented as though it's merely a suggestion, an option, for addressing the budget deficit, but there really is an ideological disagreement underneath that.

There are, in practice, three ways in which we can pay for health care:
• We can pay for what we use at point of use;
• We can pay through an insurance scheme; or
• We can pay through taxation.

There is no necessary reason why the total cost of delivery or the total amount paid should be any different under those three potential models, but there is a huge difference in the impact on who pays, and how much they pay. Under the first, those who are ill most often pay the most, under the second, we all pay broadly the same, and under the third, payment is based on the ability to pay.

Whilst people can and do put forward practical arguments why one is better than another, or why we should mix and match elements of two or three of them, the argument at root is not a pragmatic one. Positions are taken on the basis of a belief about what is right and what is wrong – and if that isn't, ultimately, an ideological argument what is it?

I'm in no doubt that my own commitment to free health care – including prescriptions and visits to the doctor – stems from my view that health care should be universally available as needed without cost at point of use, with contributions being based on ability to pay. And I shall continue to make that argument.


Anonymous said...

hmmm, so how do you cope with an ageing population with increase needs, expectation and sophistication of practice?

Should we increase the retirement age to, say 70 to try and increase the money taken from taxation to pay for health? Would you argue against those unions who've argued against increasing the retirement age for their members?

What will you do when, despite arguing intelligently for higher taxation to fund healthcare, you and your party doesn't win enough votes to implement it? What should any party do in this situation? Carry on saying the same thing and hope the public change their minds? What if the public don't change their minds? Should we offer them less for the money they are willing to pay in taxation?

Where does 'free' healthcare stop? What about expensive cancer drugs or treatment which we all know will only prolong the frail life of someone in their 90s for a few more months?

Should there be a 'contract' of some sort where people know that most things are 'free' but others are not available at all. But what if someone is willing to pay for something which is not available for 'free'? Is that banned?

I'm not sure of the answers, but I find myself switching the radio off when politicians say everything should be free. I just guess they'll change their tune if they get into power. I've been on local councils where councillors (including Plaid ones) have argued against an extra 20pence a month on the council tax.


John Dixon said...


The gulf between our viewpoints seems to be pretty wide to me, and I'm not sure that it can be bridged.

You seem to be suggesting that if we fail to convince the public that we are right, we should simply change our minds and offer the public what they want. It was Marx (Groucho, not Karl) who said "Those are my principles, and if you don't like them I've got some other ones".

I've always believed that politics is about offering people a choice of different views of the world and trying to lead. I accept that there are others - even in Plaid these days - who seem to think that it's about saying whatever will win an election, but I'm afraid that just isn't my position.

I suppose I should be more careful about the way I use the word 'free' though. Prescriptions aren't free; they're just paid for collectively rather than individually. A debate framed in terms of which things we believe should be paid for collectively and which should be paid for collectively might be more helpful.

Anonymous said...

"I accept that there are others - even in Plaid these days - who seem to think that it's about saying whatever will win an election, but I'm afraid that just isn't my position."

... John, but I'd contend that 'syaing whatever will win an election' is what you're doing by saying everything should be free. That, to me seems the easy route and it's one Plaid seem to take in the expectation that people will vote for them. I don't think people are as gulable as Plaid think. As Plaid always talk of 'free' people think Plaid have a simplistic and unthought and dogmatic view of policy which may be one reason they're not voting for Plaid.

It's not a case of changing every policy to win votes but maybe of listening and seeing what is about and realising that saying we want 'free' this and that just doesn't wash any more. People think Plaid haven't costed their policies. Plaid won't be able to raise (nor lower) taxes in the Assembly and more money to health means less to other departments.

Up to you, but if Plaid want to win seats in 2011 it may need to listen to what people are saying and not what they should be saying. Some may be ready to vote Tory especially as they can vote on constitutional issues in the referendum so the 'vote Plaid for more power to the Assembly' type sentiment, won't play any more.

As a candidate in Carmarthen West you'll know that every vote counts and going into 2011 with more 'free this and that' will be seen as wasteful by many.

In any case, sad to hear you're not standing again. I think you're a solid and good candidate.


John Dixon said...


I know that I have, at times, used the phrase 'free prescriptions' as a form of shorthand. In reality, of course, there is no such thing as 'free'. And that was the point of my original post - everything has to be paid for, the question is, 'who pays, and how?'

It might be better, even if making for rather more laborious language, if I stopped saying that things should be 'free'.

What I really mean is that there are some things which I believe we should pay for collectively on the basis of ability to pay, and then use them on the basis of need. Healthcare, for me, comes into that category.

That conclusion is based on the way that I view the world, and on my sense of what is right - my ideological perspective, in short - and not on what I think will necessarily win votes.

My view of politics is that it is for politicians to lay out their view of the world - both as it is and as they think it should be - and seek to explain to people why that is the right way forward. And that's what I try to do.

I accept that other people have a different view, and think that politics is simply about who gets elected to carry out a broadly similar programme.