'The government wants us to believe that the only way to achieve good-cost effective healthcare is by privatisation.' Photograph: Paul Davey/Paul Davey/Demotix/Corbis
Imagine you are feeling a bit groggy, maybe a bit fed up with life. You go to your doctor. Or telephone them, or Skype them, or whatever hoop it is now necessary to jump through. You explain your symptoms – the headaches, the insomnia, the reluctance to get out of bed in the morning. The doctor looks increasingly grave. They add in some questions of their own. Yes, you have lost your appetite, and yes, you have rather given up taking any exercise. Suddenly, the doctor brightens. "I think I have the answer!" they exclaim. "You are depressed. But I can make you better at once! Full of energy, positive, back to the party person you used to be. We will amputate your left leg!"
This is roughly the logic of the government's determination to privatise the NHS. It doesn't have enough money, therefore it should be given less. It is a type of political manoeuvre that the Tories (and sometimes Labour too) have been practising for a while – an ideological sleight of hand that is worth deconstructing this bright July morning, the day that it is revealed that the first £1bn NHS contracts are going out to tender to the private sector.
The rhetorical trick they play goes something like this. You love the NHS. (Once it was the railways and in the future it might be schools, but the NHS stands alone as the absolute essence of the public provision of a public good.) We love the NHS too. We so get where you are coming from. But …
Then the chiselling starts. Across a broad front. The scale of the service:proudly employing more people than the Chinese People's Liberation Army. The budget: spending £97bn in England alone. And then the statistics. All those people, all that money and it still isn't infallible. Shame. Its competence: is it really all that good? Is it sometimes, in some areas, less good at, for example, innovation than healthcare in the US, or at detecting cancers than some hospitals in France or Germany? And finally, its affordability. Never mind that study after study shows it is the most cost-effective health service in the world, Britain is on its uppers. We can't afford it.
And after that, the amputation moment, the moment of total disconnect. There is only one answer. It must be broken up and sold into the private sector. The discipline of the market – that will be the same market that has brought you the most expensive train tickets in the world along with a direct transfer of public subsidy into shareholders' pockets. The market that so efficiently delivers complexity like, say, banking services and insurance policies. This is the market that will sort out delivery and somehow cost less and make a profit all at the same time.
And when it doesn't – the way rail privatisation hasn't delivered the advertised benefits of cost-effectiveness even if the trains are more comfortable – it won't be that you arrive four hours late into Crewe. You won't arrive at all.
The government wants us to believe that the only way to achieve good cost-effective healthcare is by privatisation. That has nothing to do with an objective truth. It is because many Conservatives truly believe that the state is incapable of doing anything better than the private sector could. This is sometimes so taken for granted that it is overlooked.
There is a danger that the campaign against the Tory health reforms will look like a battle between two tribes fought in incomprehensible acronyms over the organisational detail of a system that is properly understood by about five people, most of whom work for the Kings Fund. But really, we should fight on the most basic points.
Jeremy Hunt must explain exactly why and how the private sector will be better. Better outcomes or just new paint? Shorter waiting times, but at what cost? And why, when OECD projections show that every developed country will be spending a growing share of GDP on health, does he believe that the private sector – invariably more expensive – will be the answer? And who will pay, with what, if he's wrong?