Shaming politicians for using private healthcare is facile

A former Minister once explained to me, in the simplest terms, the basic choices in democratic politics as he saw them. “You’ve got a spectrum with total equality at one end”, he theorised, “and absolute liberty at the other extreme. We just have to decide where to be along that line.”

The trade-offs between fairness and the freedom of the individual are the essence of much derided “centrism”. “Centrist Dad” is currently thrown around as an affectionately dismissive slur. It is the political equivalent of “dad dancing”, not quite in tune with the spirit of the times. 

All the same the centre ground is close to where the British electorate has often ended up. “You only win elections by playing to the middle”, is another maxim favoured by veteran campaigners. It worked for New Labour. It worked for Boris Johnson in 2019 when Jeremy Corbyn was painted as the extremist. 

In most areas of policy debate, the freedom/fairness balance is seldom dwelt on. But there are two areas, vital to us all, where it is obsessed over, usually without being mentioned explicitly: health and education and, more particularly, the exposing of those who use, or have used “private” health care or private schools for themselves or their families. 

“Were you registered with a private GP and are you still?” was the gotcha question, Senator McCarthy style, in Laura Kuenssberg’s New Year interview with the Prime Minister on BBC1. Claiming “huge public interest”, she pressed on: “Why won’t you tell us whether or not you use private healthcare?”. She didn’t get an answer as Rishi Sunak evaded, claiming it was a private matter. 

The BBC tends to self-identify institutionally with the NHS, but the rest of the media were certainly interested, picking up the story in their headlines.  By Wednesday, it underpinned the first question the Prime Minister faced in the Commons. “How long did the Prime Minister have to wait for his last NHS dentist appointment?” probed Cat Smith, the Labour MP for Lancaster and Fleetwood. The game was up. It was time for Sunak to confess: “I have used independent health care in the past”, pleading in mitigation: “I am registered with an NHS” and “I am proud to come from a NHS family”, a reference to his parents’ jobs in healthcare. 

Sir Keir Starmer, who has marked centrist dad tendencies, stayed off personal matters in his challenges about “the greatest crisis in the NHS” until his penultimate question. “I heard the Prime Minister say that he is now registered with an NHS doctor”, he jeered, “so he will soon enjoy the experience of waiting on hold every morning at 8am to get a GP appointment.” 

This is a peculiarly British obsession. As Reaction’s editor Maggie Pagano commented: “Can you imagine Macron or Scholz or Biden or any other world leader having to defend using private healthcare ?”  France and Germany both have universal health care but the public/private name calling does not arise because their systems incorporate personal insurance and some co-payment at point of use. For all the criticism directed at the US by Europeans, the majority of Americans emphasise personal responsibility for healthcare and abominate what they consider to be our inferior “socialized medicine”. 

Other countries have their problems with strained healthcare. For example, French family doctors have recently been on strike. But only in the UK is the NHS treated as a sacred cow which it is heresy to disrespect. Even if it means putting up with misery when it can be avoided, public devotion to the fairness principle has made it is a moral duty for everyone to suffer together. President Trump was fast-tracked to the best available treatment when he tested positive for Covid, while Prime Minister Boris Johnson hid away in his flat until emergency treatment at St Thomas’ hospital rescued him from near death. Does the leader of the opposition seriously think it is a good idea for the Prime Minister to spend his time hanging on the phone to his local surgery?

The political row over private provision has raged at least since 1948 when, largely free at the point of use, the NHS was established “as the closest thing the English people have to a national religion” in Nigel Lawson’s famous words. There is a standing inquisition against apostasy from the NHS or even asking if it could be improved by any method other than more money extracted from other people. Politicians beware of the question! 

During her third, final, and successful general election campaign in 1987, Prime Minister Margaret Thatcher defended her use of private health insurance: “…to enable me to go into hospital on the day I want; at the time I want, and with a doctor I want. For me, that is absolutely vital. I do that along with five million others. Like most people, I pay my dues to the National Health Service; I do not add to the queue… I exercise my right as a free citizen to spend my own money in my own way…”. 

That same year, the Shadow Foreign Secretary, Labour’s Dennis Healey, lost his temper live on television when Anne Diamond asked him, without Kuenssberg’s prosecutorial relish, about the front page headline in The Sun that his wife had had a private hip replacement. I had set up the interview that morning and had delivered a pile of newspapers to him beforehand. Healey stood up bellowing that it was a “TV-am dirty trick” and calling each of us out as “a shit”. The channel cut to a commercial break. As we were leaving the studio Healey thumped me in the chest, unfortunately in front of the next guest Nigel Dempster, then Britain’s leading gossip columnist. So there were more newspaper headlines. We subsequently made up and the late Healey remains one of the politicians I most respected. 

Neither the Thatcher nor the Healey tactic would work today. Sunak palely imitated Thatcher by suggesting weakly that going private helped take the pressure off services, but he did not dare trumpet his rights as a free citizen. 

Angela Rayner, Labour’s savvy deputy leader, was upfront. She cleared a potential liability out of the way by volunteering to the straight-laced Financial Times during a profile interview that she paid £5,600 for a “boob job” because “my boobs just looked like two boiled eggs in socks, you know like basset hound ears.” Subsequently talking to Beth Rigby on Sky News she suggested that private cosmetic surgery was acceptable because it was an optional item rather than essential to health.

The strongest argument against politicians who use private health and “independent” schools is that they will care less about services which do not affect them personally. This is based on the logical premises that all politicians have no sense of public service and act entirely selfishly and in their own interests. Though fashionable, these assumptions are false in my experience. Even if self-interest were the prime motive, in order to get re-elected, any sensible candidate would commit to improving the public services used by voters. Only about 10% of children attend a private school, and between 10% and 20% use some aspect of private health care; neither is enough for a majority.

Shaming politicians for going private is facile. It plays to two great British hypocrisies: that we ourselves are never queue jumpers and that the state should always look after us all for free even when we can look after ourselves. Centrists know that both of these propositions are fallacies. Government and opposition politicians should ignore the easy hits and concentrate instead on the middle of the spectrum looking for ways to improve public services. 

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