The democratic deficit. Applies to health as well as devolution, and to leaving the EU. The first honest party should get public support.

NHSreality has no doubt that being part of the EU is a “public good”. It’s evolution after the second world war reminds us of it’s “raison detre”. Phil Collins in The Times 5th Feb 2016 opines in a way that appeals to logic. It reinforces NHSreality suggestion that civil unrest is a risk if we continue as we are. ( Backlash against the elite may lead to Brexit ). When we voted for devolution we accepted a small majority on a 20 turn out. When  we rejected PR we did the same. Young people may not be aware of the rhetoric which begins to escalate the risk of war. NHSreality feels health is backed up by peace, security and “jaw jaw”. If this means an expensive top-heavy EU so be it. Far better to change it from within, and be part of a large mutual, than be a small independent fish swimming in an ocean of sharks. Unfortunately the profits from the businesses that trade in the EU do not come through as more equality in our form of democracy. Nevertheless, no club would let less than a 66% majority change it’s constitution. This should be the case for leaving the EU, and any future devolution debates (into a federal system) and even PR. The first honest party should get public support. I hope it’s the Liberals. But the politicians are gagged and in denial….. and there is no leadership.

“The governments from 2010 to 2020 will be seen by history as having avoided difficult questions about the long-term affordability of the NHS and the granting of welfare entitlements to wealthy pensioners.”….

None of which is to say that anti-political sentiment is stupid. Rather, it is a surrogate for other events and a compound cry of anguish. The dissatisfaction with democracy is what the Marxists call an epiphenomenon. It is rooted in the industrial decline of Britain and the rapid disappearance of the skilled manual work that, for my father’s generation, provided household income and self-worth. In those very same places, the once-industrial towns of England, the promise of globalisation has rung hollow. Immigration and open trade are clearly beneficial, in the aggregate, to the nation, but nobody lives in the aggregate.

The best philosopher of English conservatism, Michael Oakeshott, once pointed out that change almost always presents itself as loss. This is how it feels to many people in this country. The political expression of that sentiment is a howl at the system and a brief call to a tin-pot demagogue such as Nigel Farage or Donald Trump or a promise-laden naif such as Jeremy Corbyn or Bernie Sanders.

It is too easy for these fringe characters to stand apart from the established politicians who, as the cliché confirms, “are all the same”. Labour are Tory-lite and Tories are Blair mimics. But there is some truth in this observation. As Michael Caine so profoundly put it in The Times last week, “once you’re left of Blair or right of Cameron I don’t trust you”.

The crucial point here is that millions of British people are, indeed, either left of Blair or right of Cameron but the government isn’t. The quest for victory in electoral politics tends to favour the bland. The largest number of votes can be harvested in Sir Michael’s narrow domain so, until we change the electoral system, professional politicians will concentrate on it. They will look and sound a bit like each other because they win when they do and they lose when they don’t….

..Of course nobody outside the political class will cast a vote on the deal, which is a total irrelevance to the lives of almost everyone in Britain. Woe betide the next person who tries to persuade me that this is a national emergency rather than a game of elite politics within the Tory party. Now that the tedious, fake prelude is over, let us get on with the In-Out referendum that this was always going to be.

The danger for those of us who hope, and think, that Britain will vote for the status quo is not that there is a revolt against the deal, which will disappear more efficiently than Lord Lucan, but a revolt of the people against the elite. This referendum will not catch fire like it did in Scotland. The Scottish referendum was a fierce battle of identity. As Mr Cameron said in his Bloomberg speech in 2013 there is no European demos.

Both sides will pretend the debate pertains to who we are as a people but, as Keir Hardie once said, “the British are a practical people, not given to blowing bubbles”. The building is not burning, at least not the wing of it that we inhabit. There is no reason to get too exercised and, if you can ignore the participants in the campaign, nobody will.

The conditions, though, are gathering for the possibility of a debate that is not In versus Out but Us versus Them. In a more deferential age, the electorate would have taken the guidance of most of the cabinet, the bulk of the opposition and the greater part of organised business. These days, it could work the other way round. If they, the establishment, are all in it together, then it must be a conspiracy against the ordinary people. If Boris Johnson wants to stay In the best thing he could do now is to declare for Out.

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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