In which I wonder if we’ve got it wrong about… coalition building

So, Ed Miliband won’t do deals with the SNP. Nick Clegg has ruled out deals with any party also doing deals with UKIP or the SNP. Politicians are ruling out all sorts of possible post-election coalition permutations. It’s sort of the precise opposite of what happened last time, and in a way, suggests that politicians have matured a bit in their approach to coalitionbuilding. Unfortunately they haven’t really matured enough. Last time Nick Clegg was like a toddler in the playground, and David Cameron bounded up to him and showed him some gravel he’d found. Fifteen seconds later they were bestest bestest friends and running up and down Downing Street playing aeroplanes. This time around our politicians are more like teenagers. They’ve got their little friendship groups and the risk of looking stupid by getting rejected by anyone else is just like totes beyond horrendous, so they’re all making very clear that they’re the ones doing the rejecting.

So they’ve grown-up a bit, but not so much that any of them are prepared to talk about what they would do in a hung parliament, and the only thing any of the polls in this election are predicting with any confidence is that it will be a hung parliament. The Conservatives seem to have just about nearly sort of inched ahead in terms of number of votes, but the vagaries of our electoral system means that there’s no guarantee that that will equate to winning the most seats.

It’s looking increasingly likely that, in addition to no single party being able to form a majority government, it’s going to need more than two parties to form a majority coalition. So that probably means either the Tories plus UKIP plus the Ulster Unionists plus the Lib Dems, or Labour plus the SNP plus the Lib Dems, but both of those options include alliances that have already been ruled out.

So why are politicians so keen to rule out what could be workable coalition options? Well some of them relate to points of policy – it’s difficult to imagine the uber pro-European Lib Dems as natural bedfellows of Nigel Farage, and that’s clearly also a stumbling block for pro-United Kingdom parties when it comes to doing deals with Scottish or Welsh Nationalists, but there can’t be very many people who genuinely think that Labour can make it into government without support from the SNP. The numbers simply don’t add up. The Tories position isn’t much better; if they can’t get both the Lib Dems and UKIP on board their numbers look equally unlikely to get them to the magic 326.

Even if Labour attempt to form a minority government they’ll only be able to do anything if the SNP vote with them, and that’s where we get to the problem with all this ruling out, because it’s a very specific form of ruling out. Announcing that you won’t do any ‘formal deals’ is very specific, and in no way rules out only attempting to pass legislation that you already know other parties definitely agree with.

Realistically as soon as the polls close on Thursday every party will be running around desperately trying to do deals with every other. And that’s not a good or a bad thing. It’s just the reality of the fact that the two parties who’ve dominated UK politics for the last century are increasingly under pressure from smaller parties. First past the post, like most electoral systems, only consistently gives you single-party majority governments if you only have two significant parties in the race. Multi-party politics creates coalitions, and minority governments who need to negotiate with opponents and make concessions and compromises to get legislation approved.

That’s not a bad thing. It’s just true. What is a bad thing is politicians pointing each other and using the fact that deals will be brokered and compromises made as a stick to beat the other with. What is a bad thing is the media printing pictures of party leaders as the whipping boys of their coalition allies. Because that just suggests that we all need to grow up a bit more – past the teenage stage and into the elusive functioning adult stage. Hung parliaments look to be here to stay; it’s probably time we all got over that and got used to the idea that compromise and talking to people you disagree with might not actually be the end of the world.

So that’s it. The election campaign is all over bar the voting, so tomorrow will be all books and loveliness on the blog with my (slightly belated) 52 Weeks: 52 Books update for April.

In which I struggle to muster the energy to get annoyed with Ian Duncan Smith

So Ian Duncan Smith, Minister for Work and Pensions, thinks he could live on £53 per week. In fact he’s sure he could because he’s been unemployed before and is therefore very much down with the common man. If you’ve missed out on this little news titbit, it’s worth reading the Guardian’s version of the story, not least for the supreme piece of editing that butts IDS’s claim to have experienced poverty right up next to the additional detail that he’s married to the daughter of the 5th Baron Cottesloe.

And clearly, he probably could live on £53 for a week or even a couple of weeks, but that’s not really the point. You can probably get through the first week without needing to go to the launderette and eating only value beans on value toast. The second week is more difficult. By the third week you smell bad, you’ve run out of stuff like soap and toilet roll and you’re starting to want to throw value beans at passersby.

All of that is so utterly self-evident and not really worth the energy it took to type, that it’s making me wonder if I’ve actually reached the point of anger-fatigue with the current state of British politics. I used to get mad about this stuff. There are sufficient ranty blog posts on this very site to show my ability to get a tad worked up about major and minor policy issues. But today I’m struggling to work up a good head of rant. Maybe the triple whammy of Legal Aid cuts, welfare cuts and NHS “reform” is just a bit overwhelming for my poor liberal bleeding heart, but I feel tired. Tired of complaining. Tired of virtuously keeping myself informed, writing letters to my MP, signing petitions, retweeting links to campaign sites, and actually turning up to exercise my democratic whatnot at every election from local council to Westminster to Europe, without it really seeming to make a blind bit of difference.

I feel confused by a political landscape in which poor people and immigrants are unquestioningly talking about as scroungers right across the political spectrum. I feel confused by a set up where jobseekers’ benefit rate is experiencing a real-terms drop, but large companies are allowed to negotiate how much tax they feel like paying. I feel confused by an Education Secretary who talks about the importance of evidence-based education policy only after he’s announced a whole set of major education policies. And I feel like, in voting terms, there’s nowhere for tired confused liberals to go and have out metaphorical wounds licked. Maybe we need a new political party, born out of disenfranchisement, like the early labour movement. A party peopled by slightly over-anxious liberals who’s main contribution to parliamentary debate would be to suggest that it might be a bit more complicated than that. Or maybe I just need to take a break from reading the papers and come back when I’ve got the energy to get properly wound up again. Ho-hum.

Where I explain why the Health & Social Care Bill is a Bad Thing in five easy to understand numbered points.

The Health and Social Care Bill is currently at the report stage in the House of Lords. The Lords’ amendments are going to bounce the bill back to the House of Commons and the bill will find itself in a game of Parliamentary ping-pong between the two houses as further amendments are debated and agreed (or not).

This means that both MPs and peers are likely to have further chances to amend or vote out this bill, and if you’re a Liberal Democrat parliamentarian (which I’m assuming most of you are) you really should be making use of those chances. Here’s why:

1. It ain’t broke…

Sometimes we need to take a step back and remind ourselves what an incredible achievement the NHS is. Comprehensive healthcare, free at the point of access, provided to everyone dependent on clinical need with no regard to ability to pay. That’s an impressive goal and one which the service largely delivers. It’s not perfect – outcomes are better for some areas of disease than others, and as a country we could still do more in the area of preventative medicine (particularly relating to alcohol and obesity), but actually it’s pretty damn good.

Looking at the OECD‘s figures on health we can see that our health system stands up pretty well to comparison to other countries. We spend approximately half as much per head of population on healthcare as America, and, on average, live for two years longer. Taking a couple of examples from within Europe, we also spend less than Ireland and Denmark, and enjoy higher life expectancies. The only country that enjoys significantly higher average life expectancy (83 compared to our 80.4) whilst also spending less per head on healthcare is Japan. That’s not all down to healthcare – Japan has very low rates of obesity and places a high cultural importance on health and wellbeing. There’s a quick overview of how the Japanese health system works here. What’s interesting is that, although the Japanese system includes some private funding,  all the competition has been removed from the market – more on that point later.

So, our health system isn’t perfect, but neither is it fundamentally broken. This bill proposes high level change to the way the system is organised and delivered – to put through that level of change I’d suggest you need to be pretty sure that what you’re doing at the moment isn’t working. Actually, the evidence we have suggests that it works pretty well.

2. …and this won’t fix it.

The list of groups who actively support this bill is tiny-wee. The against list is almost overwheming. The Health Select Committee, for example, think the change will be too disruptive on top of the current tightening of funding. The BMA, who initially supported the idea of health care being commissioned by clinicians, now say that “the positive vision of clinician-led, patient-focused, locally sensitive and accountable commissioning is being lost in the huge amount of often chaotic change taking place.”

The key elements to the bill that create this feeling of chaos are the shift towards healthcare being commissoned by local groups of GPs and the introduction of a requirement for competition in the provision of some services. For me, it’s this competition that’s the real problem. Competition is a market concept – it works where there is a clear market and a consumer that can choose between different products or services based on quality, price, convenience etc. A good way of thinking about how competition will work in a given situation is to ask yourself two questions. “Who’s the customer?” and “What’s the product?”

If you go to a store to buy a loaf of bread it’s easy. You’re the customer. The bread is the product. You choose the type of bread you want – white, granary etc. – you might also look at the size and price of the loaves, and then you buy your selected product. It looks simple in a healthcare situation as well, but actually it’s not. At face value, you might think that the patient is the customer and the medical care is the product, but that’s not quite right. The medical care is the product, but the customer is whoever is paying for/commissoning that medical care, whether that’s central government, local Primary Care Trusts or groups of GPs. The seller of the healthcare, whether that’s an NHS hospital or a private provider, has to make their offering the most attractive to the commissoning group, not the most beneficial to the patient. The market is skewed, so that the individual receiving the product isn’t the person it’s been tailored towards. Going back to the shop analogy, the patient isn’t the product or the seller or the customer. The patient is the carrier bag.

3. … and the arguments in favour of the bill are stupid

Now I know that this isn’t actually how parliamentary democracy works, but in principle the group that make the best arguments and provide the strongest evidence should win the debate. I understand that actually the party (or parties) that hold a parliamentary majority and whose Whips’ office work most effectively win the day, but let’s just pretend that the debates might influence someone.

Firstly, the fact that the Health Select Committee oppose the Bill should be a fairly big reason to vote against it. Otherwise what’s the point of the committee stage in the passage of any bill? The idea is that, at the committee stage, a smaller group of MPs examine bills more closely, identify any major problems and iron out the kinks. In this case the relevant committee has come back and essentially advised that this bill just won’t work at the moment. That’s strike 1.

Secondly, your own deputy leader wants the Health Secretary to move on. Simon Hughes suggested that Andrew Lansley should move on after the bill was passed on the Andrew Marr Show. This is a very odd thing to suggest. Hughes isn’t saying that the bill shoudn’t be passed, but he’s suggesting that the architect of the bill should lose his job. I don’t see any other way of interpreting this other than that Hughes is saying, “Yes. It’s a terrible idea, but we have to put up with it, and then do everything we can to try to forget…” Well, you don’t have to put up with it. There is no inevitability about the passage of this bill. You could vote against it. Then Andrew Lansley would almost certainly lose his job as Health Secretary. It’s a win:win. That’s strike 2.

Thirdly, the government’s main argument in favour of the bill is now that the changes just need to be voted through as soon as possible to give people as long as possible to forget before the next general election. It’s not really a position marked by huge idealogical commitment to a vision. “Let’s just get it over with…” is a legitimate position if you’re talking about ripping off a band aid, but not if you’re planning to pull out the underpinnings of one of the most effective public healthcare systems in the world. Strike 3.

4. It’s technically the right thing to do

Ok, so you’re a Lib Dem MP. You might not like this bill, but you are in coalition with the Tories and part of coalition is accepting things that might not have been your first preference for the greater good. Well, you don’t have to accept this.  It wasn’t in the Tory manifesto at the last general election. It’s not in the coalition agreement. In fact the coalition agreement says that the government will “stop the top-down reorganisations of the NHS that have got in the way of patient care.” So there you go. It’s not that you personally want to scupper this bill. It’s that you have to. It’s in the coalition agreement. Voting against this bill is what you signed up for. Technically, you have no choice.

5. It’s politically the right thing to do.

Now, you do understand that the Liberal Democrat vote is going to evaporate at the next election, don’t you? Those of us to the left of the party are going to follow the boy wizard over to Labour in punishment for your buddying up with Dave and his massive shiny forehead. Anyone towards the right of the party has got a Conservative government anyway, so they might as well actually vote for them next time.

You need to set yourself apart from your coalition peers, and this is the issue to do it on. Nigel Lawson viewed the NHS as the closest thing the British have to a religion, and he wasn’t far wrong. We moan about it but suggest that we might change it, suggest, horror of horrors, that we might have to pay directly for health care, and all of a sudden we are unquestioning believers in the one true way.  Positioning your party as the protectors of the NHS might be your best bet to stave off electoral ruin next time around.

So there we go, five reasons for any Lib Dem parliamentarians to get behind the opposition to the Health and Social Care Bill. You can pick whatever reason works for you – ethical, intellectual, technical or self-interested. I don’t really care why you vote against it, just make sure you do.

And that’s me done getting my politics on for this week. Apologies for the lack of recent bloggage – my work life went a bit manic for a while, but normal(ish) service should now be resumed, so, as ever, if you like please subscribe and you’ll get a lovely email letting you know when there’s something new to read. The plan is that if you come back at the end of the week there should be some lovely crime fiction reviews here waiting for you all. Happy days.