Excellent pieces by David Green in the Telegraph and Stephen Pollard in the Times about David Cameron’s decision to stick with the failed NHS. As Pollard points out, Cameron has missed a crucial opportunity. The NHS is beyond repair and most people now know it. Yet purely for reasons of political positioning, he has chosen not only to support a failed institution but to foreclose debate about alternatives:

David Cameron’s response to the disappearance of billions of pounds into the NHS black hole is to argue for improved management and more fiddling with structures, but to run a mile from questioning the system itself. The Conservative solution is: we’d do it better than they would.

But he is walking away from real reform at the moment when its need is at last becoming understood by voters. In a poll for the think tank Reform in February 2004, 69 per cent agreed that: “The NHS was the right idea when it was introduced in the 1940s, but Britain has changed and we need a different healthcare system now.” Only 40 per cent agreed that: “The Government is right to rule out alternatives to the taxpayer-funded NHS.” In nailing his colours so firmly to an exclusively tax-funded NHS mast, Mr Cameron is making a huge mistake, both politically and for the good of the country. Labour’s policy of spending as much money as possible and fiddling with the system is a form of controlled experiment to discover if that is indeed all that is needed. The answer is now becoming clear: it isn’t.

For years, those of us who have argued that it is the very notion of an entirely tax-funded system that is the real problem were dismissed as ideologues and lunatics. Now, with the evidence showing that the NHS cannot deliver even with massive funding, real reform has at last entered the realms of acceptable debate. That is a huge transformation in the political landscape. Yet just at this moment, Mr Cameron has chosen to cut off all such talk, neutering his attacks on Labour with his “me too” policy, and destroying any prospect of the reforms that might actually give us a system to deliver the best healthcare.

Cameron was right to ditch the last Tory health policy – which he helped create – which was to subsidise private health care. But he remains stuck in the old paradigm, that the only alternative to a US-style private insurance system is Britain’s Stalinist command-and-control NHS. He has ruled out the third and most attractive option, a European-style system of social insurance, which combines personal leverage for potential patients with responsibility for the poor.

Cameron appears to be resting his claim to radical change on proposals, yet to be unveiled, to give hospitals and doctors ‘independence’ within the NHS system. This sounds horribly like a re-run of the health policies of the last Tory government which promised ‘independence’ for hospital trusts in an ‘internal market’, a policy which brought the NHS to its knees and caused chaos and suffering for countless patients. Independence for professionals cannot be spatchcocked onto a public service funded by the Treasury. Such funding requires national politicians to be accountable for that money, which inescapably creates political control which, over an issue so politically explosive as health care, inevitably means the kind of micro-interference which destroys the service.

This is a major decision to have got wrong so early in Cameron’s leadership. It not only cements British health care into a guaranteed spiral of decline and crisis, but knocks a big hole in his claim to be launching a new politics based on ‘trusting the people’ and ‘sharing responsibility’ with them. The way to trust people and make them responsible for health care or education is to give them financial leverage over those services. That is the only way to make these services accountable to the public rather than to Whitehall. As David Green, an apostle of social health insurance, observes:

There are two main Tory traditions: patricians, who see society as made up of leaders and followers, and themselves as a kindly elite destined to rule, and radicals, who inherited the mantle of J S Mill's liberalism when the old Liberal Party collapsed in the 20th century. They picture society as a self-governing community reliant on the qualities of its individual members.

David Cameron, it now seems, is a patrician Tory. Although some have likened him to Tony Blair, in truth his emerging policies reveal a person more like Gordon Brown, who combines disdain for the masses with a belief that they need most things done for them by a kindly state, run by people of superior insight.

Tony Blair has fought to liberalise Labour. His early slogan ‘education, education, education’ reflected the importance attached by radicals - in all parties - to the strengths of individual men and women, that can be nurtured and deepened through good schools. Mr Blair has failed to win over his party to support anything like the necessary changes, but he tried. By ruling out education vouchers, social health insurance, and radical welfare reform, Mr Cameron has revealed himself as a paternalist. His wish to help the poor is no doubt sincere, but it is the assistance of Lady Bountiful, not the help of an equal partner acting in a spirit of reciprocity.

Brutal, but true.