Column

Health. Welfare. Internal Markets. Is there a problem here?

Martin is past caring. He’s lived under the bridge for... how long? It seems like forever, it’s still winter and it’s very cold. On his way to where he begs, absorbed in hopelessness, he steps carelessly into the road. A lorry smashes into him, crumpling him against a lamp post. Martin doesn’t hear the sirens, but they come - two ambulances, three police cares, a photographer - and carry him away to weeks of intensive care, months of rehabilitation and, finally, back to the bridge.

Anita’s on her way to fetch her Dad from hospital. Four years it’s been like this. The useless heating, the damp, the leaking windows, Christmas and then his damn cough. Into hospital, a rest, some good food. And now Anita is sitting on the bus, and there’s nothing else for it but to bring him back again. Is there a problem here? Of course there is. There is quite obviously a problem with a society that will spend relatively lavishly on emergency services and medical support for someone to whom it is not prepared to offer a home or a job.

And there is plainly a problem with a society that will provide a cure for diseases while ignoring their causes. In fact, there is so obviously a problem here that it is thoroughly trite to spell it out.

Everyone is aware of such absurdities yet nothing is done to change them. Why not? Why do we persist with such stupid behaviours? One stock explanation is that ‘fundamental change is politically too difficult’, or that ‘the British people don’t want radical policies’. Another - perhaps more credible - interpretation is that it is too risky for politicians to make a stand against established tradition, however crazy it is.

But the most popular excuse is that we are, even now, seeing a ‘failure of the system’. If it worked as it should people would use health services only when there could be no other remedy. It is just that the system is ‘not lean enough’, it is ‘inefficient’, it needs ‘toughening up in certain sectors’. Once we’ve ironed out the technical difficulties then all will be well.

But the system is blameless. It is not the fault of the system that there are parts of life it cannot reach. Market forces can only operate within markets - they are interested only in whom the system defines as buyers or sellers. But if you have nothing to sell and the stalls are offering nothing you want, you are out of the game.

To bring Martin, Anita and countless others properly into the social play someone needs to change the rules. And this is not a decision any market can make - this is for human beings to decide.

Yet the capacity for serious thought seems to have escaped us. In our time we are witnessing a devastating failure of the imagination. Nobody in or seeking power seems to have any idea - never mind the will - how to improve even the most ridiculous social policies. And while these are allowed to continue, nothing we do can truly make sense.

Will this go on forever? It will unless those who have power admit they are incapable of using it for anything other than its own sake. Until our blighted crop of politicians admit they are clueless, we’re stuck. We’ll stay landed with health policies so narrow that cost is the chief measure of success, with planners who seriously believe that the law of the jungle can produce neat flower-beds, and with careerists so afraid that change might be bad for them they might as well all be Conservatives.

There is indeed a problem here. The problem is our culpable inability ever to think beyond the shape of things we have become used to.