POLITICAL COMMENTARY
Mr Crossman's universal queue-plan
AUBERON WAUGH
Your political correspondent probably has few things in common with Mr Harold Wilson, beyond a certain shared interest in politics, but we have both decided, at one time or another, to join BUPA, the health insurance association which enables sub- scribers to secure for themselves those medical and surgical attentions in time of Illness which the Health Service is mani- festly unable to supply. Some time after becoming Prime Minister, Mr Wilson left the scheme, no doubt -reckoning that the Health Service would really exert itself on his behalf thereafter, and the last frail link between us was severed.
Mr Richard Crossman, by contrast has considerable private resources and can easily afford to pay for his own medical expenses, rather than subsidise the ailments of other BUPA members by his own rude health. The four complaints for which the National Health Service is spectacularly inadequate are bad tonsils, hernia, varicose veins and piles. Use of kidney machines, iron lungs and other expensive gadgets is apportioned by consultants in hospital according to whatever system of priorities may tickle their fancy, and even private patients have no guarantee that one will be available. But if Mr Crossman is afflicted by any of the four complaints which I have listed, we shall have to wait and see whether he will put his name on the National Health waiting list, or whether he will jump the queue.
In some parts of England, the queue for hernia and other operations is ten years. Logically, the span must have increased when Mr Crossman's department took upon itself the task of aborting the nation's unwanted babies. This occupation is the greatest growth area of the National Health Service at present, and it is less susceptible to the Crossman queue-plan than most, even if it does reinforce another of the proposi- tions in his Fabian pamphlet (Paying for the Social Services-3s) that 'The service creates the demand'.
However, since 'there is no foreseeable limit on the social services which the nation can reasonably require except the limit that the Government imposes'. then Mr Cross- man's zukiinftige Weltordnung is plainly of a society in which we all queue patiently and eternally for ever more complicated medical services, supervised by a smiling Zugfiihrer of Crossman-type extraction, himself crippled by piles and hernia, but limping bravely on his varicose legs as he exhorts us to further prodigies of patience in broken, adenoidal 'tones. Queue-jumping will be the only grave crime in this brave new world, but when, at the age of ninety, we emerge froth the Crossman welfare factory (or Krankenhaus) we shall have new feet and new bottoms, we shall have lost our tonsils, our toes will be computerised and our hair restored. Every valley shall be exalted, every mountain and hill shall be made low.
But, of course, there is a grave flaw in the logic of Mr Crossman's Weltpolitik. In fact, as he himself acknowledges elsewhere in his pamphlet, there is an absolute limit on the social services which the nation can reason- ably require, and that limit is set by the amount which the nation is prepared to pay for. Among the more thoughtful Labour politicians, there is a dawning awareness that this limit may very well have been reached already, if it has not actually been overreached.
The trouble with Mr Crossman is that he reached his present eminence too old. He tackles the problems of a major spending department of state with the dialectic of an Opposition idealist, to whom government is something strait-laced and wrong, while utopian demagoguery about total welfare is clever and right. Never mind that the original purpose behind those wild, impos- sible promises was to curry favour with the electorate, while nowadays they have the reverse effect. The battle must continue to be fought for its own sake: social insurance must be protected 'against the raids of a greedy Chancellor'; prescription charges 'should be got rid of sooner rather than later'. He is forever playing the role of a naughty boy caught stealing apples who then produces some passage of Holy Scrip- ture to justify the act—on increasing employers' contributions to national insur- ance: 'We might underline the seriousness of our conversion to European ideas by adopting the plan'.
That there is no need for further general expansion (as opposed to rationalisation) of the welfare services on humanitarian grounds is self-evident. But Mr Crossman is too old a dog to learn new tricks—unlike Mr Crosland or Mr Healey, to name but two—and he continues faithful. To protect himself from the realisation of his true position, he resorts to every kind of opiate and hallucinatory drug.
While acknowledging that the working classes react most unfavourably to any in- crease in income tax—even to paying income tax at all—he has managed to convince himself that they do not notice money stopped from their wage packets if the money has been deducted for national insur- ance. It may be that the influence of the communications media—manned exclusively by members of the middle-income groups who pay income tax at the standard rate— has focused greater attention on income tax. But, on inquiry, it emerges that Mr Cross- man's conviction arises out of the fact that practically nobody bothered to turn up in the House of Commons for the third reading of his latest pensions bill, which increased contributions all round and raised more money than the Budget. But if he seriously imagines that the voters didn't notice, he is living in a fool's paradise.
He is living in a fool's paradise, again, if he imagines that there is any electoral mileage in abolishing the private sector in medicine. Under the present system, the private sector is just about the only thing which keeps the National Health Service ticking over. Abolish it, and he would have to pay doctors commensurately more for their national health work, or face an exodus of all our best doctors—and many
of our less good ones—in response to North America's insatiable demand for medicine. The same number of patients would 'lase to be catered for as are covered by the present two systems, except that the Government would pay for • them all. Although a few hernia patients might be spared a week of their ten years in the queue, this ads antage would soon be absorbed in the general increase of demand. All that Mr Crossman would have achieved would be to add enormously to the cost of the health service, without adding any benefit to those who rely on it, and to have put a lot of spending money in the pockets of the middle classes while assuring himself of their bitter and perpetual hostility.
In the field of housing and pensions, says Mr Crossman. there is a strong case for partnership between the private and public sectors, because. without it there can be no consumer satisfaction. In the fields of health and education, on the other hand. there can be no such partnership, because t people's right to equal health facilities and equal education is axiomatic and inalien able. Since there can be no consumer satin• faction in either field at present without a partnership between private and public sectors, why should not equality of housing and pensions be deemed equally as inalien• able and axiomatic rights?. The distinction is not observed in the writings of St Thomas Aquinas, or Plato. or Marx, or Bonhoeffer, or in the Thoughts of Mao Tse-Tung: nor is it reflected in any known sample of public opinion. It is a moral distinction, something cooked up in Mr Crossman's mind as a result of the necessary compromises o political life in the 1940s, and has about as much relevance to modern conditions as th Pragmatic Sanction on the war of th Austrian succession.
To defend his position, Mr Crossma cooks and he fiddles and he stews the figures it- is a sorry spectacle, that of an elderl idealist trying to adjust the entire world t his own model of it. A hospital charge of f per week per person could not possibl bring in more than £45 million, he says. 115 he does not also mention the deterrent eff of such a charge. The present, ludicrousl small and evadeable prescription charg• only brings in £15 million, but the deterren effect is calculated at a further £10 million Plainly, the higher the charge the lower u• return and the higher the deterrent savin: This principle of medical deterrence mu' be the only logical solution to the proble of insatiable demand for free medicine: t less ill a person is, the less he will he Dr pared to pay for corrective medicine. T only alternative I can think of is alon° old-fashioned lines of making the medici nastier and nastier, to make hospitals mot• and more uncomfortable, until only I really ill would wish to venture inside the Instead of calling the patients at six with cup of tea, let them be called at five with glass of cod liver oil and a recorded lecto on contraception by Dr Alex Combo instead of coating pills with sugar, let th be dipped in gall. This may be the solution towards whic Mr Crossman is moving, but it is surely n the best one. The principle of a fre: heal service is so firmly embedded in his se genarian heart that he might well resort desperate measures rather than have it d lodged in an age where social and medi developments have made it inapplica This week, he was suffering from bronch influenza, I am sorry to say; I hope he
through. -
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