"Is this math you do as a Republican to make yourself feel better?"

NHS debate - Daniel Hannan has not been clear enough

Well as usual when I go away for a few days there is a big story that I have come back to and have had to properly catch up with. This time it is the whole NHS debate kicked off by Obama's attempts to get healthcare reform proposals on the table in the US and brought into sharp focus in the UK by Daniel Hannan's disparaging comments about the NHS on Sean Hannity's show on Fox News (see below for embedded version) combined with the "#WeLoveTheNHS" Twitter campaign.

Allied to this and coincidentally, as part of my holiday reading I read "The Plan" by Douglas Carswell and Daniel Hannan, one chapter of which is devoted to the NHS and how it could be reformed so I have detailed insight into Mr Hannan's thoughts in this area.

As far as I can tell there has been much more heat than light in the "debate" on this so far. As Fraser Nelson points out on the Spectator blog today it has largely been mud slinging. It seems like the left is using this as an opportunity to bash the Tories supposed "real views" about the NHS, despite David Cameron's many on the record pledges to the contrary.

I have to say though, having this morning watched Daniel Hannan's appearance on Hannity's Fox News programme he largely has himself to blame. He spends much of the interview decrying the NHS and urging the US not to go down the "socialist" route that the UK has done. He also spends time pointing out (quite legitimately) some of the failings of the NHS. The problem is that at no point during the interview are any of the shortcomings of the US system even discussed. This is partly due to the ridiculous bias of Fox News in general and Hannity in particular who does not frame his questions like this or even play devil's advocate in order to test Hannan's views. But it is also Hannan's own fault for not taking the opportunity in an almost 7 minute interview to spell out what he thinks should happen.

Douglas Carswell has been complaining on his blog about how Hannan's views are not being represented correctly but he did not do so himself!

I will have a crack at briefly outlining the position described in "The Plan" which I presume is what Daniel Hannan thinks in detail is what should happen with the NHS. The chapter explains the shortcomings of the NHS but it also points out some of the failings of the US system, specifically that it is "burdened by too much litigation, regulation and producer capture. We can do better". It then goes on to describe how Singapore's health system works which revolves around a system of health savings accounts. Apparently they have better health outcomes than many European nations but it costs less than half (in GDP terms) what we pay in the UK. There is discussion of how this leads to Singaporeans generally making healthier life choices because it is ultimately their money they have saved that will be spent (or not and hence available for other things or once a threshold is reached no more payments needed). Also, catastrophic health care insurance is used to cover major problems that cannot be covered by the savings. There is then discussion of how a safety net could be applied in the UK to ensure that health care is available to all in a similar way to the NHS currently.

Hannan could have summed this up using his prodigious rhetorical skills in less than a minute on Fox if he had wished. He chose not to instead giving the impression that the US system is the one he favours when he manifestly does not. For the Tories to now complain that the left are misrepresenting him is to miss the point that Hannan has made it very easy for them to do just that and a great opportunity for the interesting ideas in "The Plan" to be more widely debated has been missed.

From my perspective, I think there is merit in "The Plan" idea for health care reform. As Charlotte has pointed out, it does not sound a million miles from what was proposed in the Orange Book a few years back by David Laws where an insurance based system would be used and the patient chooses the provider. That achieves similar ends (proper patient choice) through a slightly different mechanism. I know the contents of that book are the subject of debate within and outside the Lib Dems but my view is that alternatives need to be sensibly considered and I cannot see how the NHS in its current form can continue for the next 60 years. We have to properly debate reform.

Sadly it looks like it aint going to happen this time around. Advocates of reform need however to be much more clear in future to make it harder for their opponents to misrepresent their real views.

Perhaps Mr Hannan could bear this in mind the next time Mr Hannity invites him onto his show as he doubtless will. It may not be exactly what Fox News wants to hear but he should be unafraid to fully state his position.