Brexit and the waning days of the United Kingdom

[Sheilbh]

16 really was the peak time for them. The migrant crisis had just happened, the eueozone crisis wasn't that long ago, the Eastern nations are still working off their pre entry backlog in terms of emigration and a decade or two off catching up with the west...

I agree on a lot of this - I think it was arguable the best moment from Leavers.

Go back to the 90s and 2000s and a key reason for the tories failures, something that has been actively written out of history, was their obsession with EU stuff that few people in the UK really cared about.

Even in the run up to 2016 not many people really cared all that much. We could have done without the referendum and there'd only be a small chunk of the population who would care.

Except that we had a series of treaty changes. Blair was able to pass Nice and Amsterdam - like Maastricht and the Single Market Act - just through parliament.

Once the constitutional convention starts there is a lot of pressure that results in all three parties saying they'd put it to a referendum. It wasn't a huge issue but there was clearly enough pressure from people that even Blair - probably our most pro-European politician and a very good one - accepted that the next step would require a referendum. Brown knew Lisbon would be rejected and came up with (pretty spurious) justifications to pass it through parliament alone. Cameron said he would have held a referendum but accepted that as it had been ratified it was a fait accompli.

By 2015, Miliband's policy is that any treaty allowing for further European integration would require an in/out referendum; Cameron's obviously was just for the in/out referendum.

I don't think this just came out of nowhere and that all of those politicians were responding to figments of their imagination or newspaper editorials, but to what they were seeing in public opinion. I think from the late 90s and certainly after Lisbon, European integration was pushing at the outer boundaries of popular consent in the UK. Which is why politicians in Labour, Tories and Lib Dems, including pro-European politicians (such as Blair, Kennedy, Clegg, Brown and Miliband) as well as Eurosceptics were looking at ways of re-freshing that consent or having some form of democratic consent for more Europe.

Actually leaving was fringe opinion until voters were asked the question - but that's always the risk with democracy.

As the posted article says, millenials onwards are different. We are European.

Or are millenials just anti-Tory?

Once Labour are in power and there's a government they broadly agree with are they likely to keep agitating for Europe - or is that just one of many signifiers of being anti-Tory as Eurocepticism is for Tories.

[Tamas]

https://www.bbc.co.uk/news/politics/eu_referendum/results

It is worth looking at that little graph for the result to sink in. 2% difference. Little more than half of little more than half of the UK population voted Leave. A different weather that day and we would be still in the EU. Sure we would have Farrage as our own Trump to deal with, but we would be in. Whether that would have been the better result for the EU is up for debate, but it would have been better for the UK.

[Sheilbh]

It is worth looking at that little graph for the result to sink in. 2% difference. Little more than half of little more than half of the UK population voted Leave. A different weather that day and we would be still in the EU. Sure we would have Farrage as our own Trump to deal with, but we would be in. Whether that would have been the better result for the EU is up for debate, but it would have been better for the UK.

Oh I more or less agree. In my view Remain was the right choice. We are experiencing conseuqences of leaving the EU - in particular we are and will be poorer than the EU (assuming no other changes) - that were predictable and predictable. There is a very real "well, well, well if it isn't the consequences of my actions" vibe to all of British politics right now (and not just over Brexit).

[Zanza]

You will not be poorer than the EU, but poorer that a hypothetical UK that remained. Important distinction. 

[Tonitrus]

But I think you're right the thing that was missing was being talked with - maybe TV simply can't do that but I'm not sure of that. Even In Our Time is a (terrifying) form of dialogue

I rather like In Our Time...at least in that it its variety of topics/subjects.  The host is often rather obnoxious, and is really overdue to be out to pasture though.

[Sheilbh]

You will not be poorer than the EU, but poorer that a hypothetical UK that remained. Important distinction. 

Yes - thanks. That's right.

I rather like In Our Time...at least in that it its variety of topics/subjects.  The host is often rather obnoxious, and is really overdue to be out to pasture though.

I love In Our Time in part because of the host

I really like that the only introduction he gives is "hello" before diving right in - "until twenty years ago, dinosaurs were widely assumed to be large, lumpen lizards that became extinct millions of years ago". But also I think he's very good at chivvying (academic) guests along for time or to get to the point - or when you hear him realise someone's not quite right for radio so he quietly cuts them from the show as it goes on. Although given that it's no longer live, it's not really necessary because they can just edit. It must be a terrifying experience for the academics though - especially when it was a live broadcast.

I also personally really like when his personal biases show

[Sheilbh]

I always find articles on the NHS by foreign correspondents quite interesting (I think I've posted one by a Fox News reporter a few times). Particularly thought this one was interesting as it's from a German writer as discourse around health in the UK basically seems to think the only models available are the British or the American, so it's interesting to see a take from a country with a more normal European style social insurance system:

How not to save the NHS
Switching to a European model wouldn't be an easy fix, writes a German journalist whose wife worked as a consultant in the UK health service
By Alexander Menden
 December 8, 2022
January/February 2023

Do European and British patients have different expectations of their healthcare systems? Of course they do. Here is a small but perhaps not entirely unrepresentative example of what happens when expectations shaped by one system encounter the service standards of the other.

A British friend had recently moved to Germany and had taken out statutory health insurance, as is the law when setting up one's main residence in the country. She needed some work done on her teeth, so called a dentist who had been recommended to her and stressed the urgency of getting an appointment "as soon as possible". The receptionist offered her one on the same day. Being used to week-long waiting times at the very least, the caller was blindsided and had to admit she couldn't make it at such short notice. She then got an appointment for the coming week.

Obviously, not every medical specialist in Germany has such marvellous availability. Appointments with lung doctors, already in demand before the coronavirus pandemic, are now like gold dust; short-notice slots at clinics are usually reserved for privately insured patients. The same is true for psychotherapy. But if the dentistry anecdote shows anything, it's this: if someone uses the same tactics they would deploy in a demand-driven system like the UK's National Health Service—that is, making their request seem urgent in order to get a better shot at partaking of its dwindling resources—they will more often than not be quickly accommodated in the German system.

While living in the UK between 2004 and 2018, I learned quite a lot about how to make my demands for care more urgent. Whether the children had a rash, someone had a cough that would not go away, or my meniscus was flaring up, I would queue outside the GP surgery in north London after the morning school run and try to nab a same-day appointment. If the receptionist told me that nothing was available, I asked again a few times, urging her to ring me immediately if a slot became available after all. Sometimes it worked, sometimes it did not.

The necessity of going through a GP before visiting a hospital or outpatient clinic to see a specialist, if referred, took some getting used to. In Germany, as elsewhere in Europe, specialists have their own surgeries and you can make an appointment with them directly, which indisputably speeds up the process. But I got used to the UK procedure relatively quickly. I accepted it, even embraced it. My wife and I were quite invested in the concept of the NHS: this last remaining great social democratic achievement of the postwar years, founded on egalitarianism and a free-at-the-point-of-delivery approach. We understood why it was one of those British institutions that everyone grumbles about but is still proud of.

It was actually the main reason my wife Melanie and I moved to the UK in 2004. After completing a mission for Médecins Sans Frontières in South Sudan, Melanie wanted to gain more experience abroad instead of going straight back into the German system. She started as a staff grade practitioner in community paediatrics at Camden and Islington Primary Care Trust. I became a UK correspondent for the German broadsheet daily Süddeutsche Zeitung.

In the following years, Melanie worked her way up to consultant level at various London hospitals. By the time we left the UK in 2018, she had become a paediatric consultant and designated doctor for child protection in a north London borough. Melanie remembers the flat hierarchies in the NHS and the generally excellent training—in which senior doctors saw passing on their experience to younger colleagues as an integral part of their work—as second to none.

Our three sons were born in London, in 2004, 2007 and 2010. I will never forget the great care we received at the Whittington Hospital in Archway during a protracted and exhausting labour in October 2004, which lasted 42 hours. The calm and friendly atmosphere, as well as the confident professionalism I encountered, permanently shaped my view of the NHS. During the next two difficult births, the medical teams also did exactly the right thing at the right time.

The fact that my wife could then continue her training in a so-called "flexi post", working part-time, made it much easier for both of us to keep working and share childcare duties. This was another feature of working in the NHS that compared favourably with the rigid German system, which is still not all that accommodating towards health professionals with small children. In short, we got to know the NHS both from the inside and from the patient's perspective.

As such, it was fascinating but not at all surprising to see how many people in Britain reacted to the notorious Vote Leave slogan, "We send the EU £350 million a week—let's fund our NHS instead", emblazoned on the Brexit campaign bus in 2016. The claim was disingenuous, but drew on the fact that the public were willing to invest more money in the health system, a testament to how attached the British people were to the NHS.

Recent figures show that the number of NHS users who doubt the health service's ability to care for them has risen. As the Guardian reported in December 2021, when British residents were asked "how confident are you, if at all, in the NHS's ability to give you the care you need?", 26 per cent said they were not confident; 15 per cent believed the NHS was not coping well with the challenges of the Covid pandemic; and a whopping 41 per cent believed that it was not coping well with providing other services. The reasons given were "long delays for operations and GP appointments, Covid's disruption to normal NHS services and longstanding staff shortages." Recent stories of interminable ambulance response times and emergency care taking place in corridors can only have harmed confidence further.

Conservative voices are again calling for the nationalised service to be replaced wholesale by a different healthcare system. In an article for the Times, journalist Melanie Phillips called the NHS "an institution on its last legs". Although she praised the "magnificent" staff, she cited health professionals who said that patients might have to be charged to cover the cost of medical equipment such as hearing aids and walking devices, or GP services. "These suggestions would destroy the founding principle of the NHS as being free at the point of use," Phillips writes. "Yet such is the grip of the institution, they are couched as proposals to rescue it." She calls the NHS a financial "black hole" and concludes that "the status quo is simply no longer an option".

The solution that Phillips proposes— the systemic sword for this Gordian Knot of an NHS that is, in her words "fundamentally, existentially bust"—is a switch to an insurance-based system. "This is not a US-style private health system but European social insurance. This delivers goals on which the NHS so grievously fails: access to healthcare and higher standards for all," she writes. She also praises market forces being put to good use here: "Competition between healthcare providers drives up standards."

Former Conservative party chairman and Brexit secretary David Davis took the same line in a recent article for the Daily Telegraph. He praised the "professionalism" of NHS staff but wrote that "the ramshackle nature of the organisation is clear for all to see." He criticised the NHS's "ineffective bureaucracy", "huge" budget that is "eating up a staggering 12 per cent of GDP", and poor health outcomes in relation to comparable European countries for people suffering from cancer or heart attacks. For Davis, the only option is to replace the NHS with something akin to "the social insurance systems of Europe" that "offer universal coverage, are often funded by annual premiums that resemble ring-fenced taxes, and, crucially, provide care that is free at the point of use."

All of this sounds wonderful, like an enhanced version of the still-beloved  NHS—but the devil is in the detail. The claim that the European insurance model also offers care free at the point of delivery, for example, may technically be correct: to access care, you hand your health card to the receptionist, who scans it and thus passes the cost of everything covered by your health insurance policy on to the company who issued you the card. But the way statutory health insurance is funded is quite different from the NHS model; it is also quite complex because, like many institutions in a federally structured state like Germany, it is less centralised than the NHS.

Germany is the birthplace of social insurance: the "Iron Chancellor" Otto von Bismarck introduced a system of statutory social insurance in 1883, and it has remained one of the few constants in Germany's eventful history since. It is the bedrock of social security in the country, regulated by law and organised by self-governing insurance institutions. It covers statutory health insurance, long-term social care, pensions, unemployment and statutory accident insurance. It is therefore a useful benchmark against which the NHS can be compared, because it was the blueprint for many similar insurance systems around the world.

Their fundamental principle—and here the similarities with the NHS are in fact strong—is solidarity: those paying into insurance schemes can claim financial benefits in the event of an accident, illness or loss of job, while providing for other contributors, too. Social insurance is compulsory for anyone in gainful employment, though exceptions apply to civil servants and people in part-time work with low incomes, among others.

The cost of someone's social security contributions depends on their income, with a portion of their monthly gross salary reserved for each kind of insurance— currently 18.6 per cent for pension insurance and 14.6 per cent for health insurance. One half of this total contribution is paid by the employer, the other by the employee; contributions are automatically deducted from the monthly pay packet. It works largely as a "pay-as-you-go system": contributions that are paid in are paid out again directly as benefits to others, so that nothing is saved apart from a reserve.

All contributions for statutory health insurance (SHI) are collected by one of the approximately 550 SHI providers. They act as corporations under public law, so although they are under state supervision, they are organisationally and financially independent. Contributions flow into a large pot called the health fund, before being redistributed proportionately to all SHI providers in Germany. Each uses its share to cover the health provisions of customers, including their dependent partners and their underage children. The federal government pays a tax-financed subsidy into the health fund, which has been fixed since 2017 at €14.5bn (£12.6bn) per year, only a fraction of the whole pot.

In 2021, German health expenditure was higher than ever before, partly because of coronavirus, totalling €466bn. That is the equivalent of £403bn, £126bn more than the UK's healthcare expenditure in the same year, and adds up to around £500 more per year per person.

The tendency in Germany goes towards oversupply: when in doubt, many doctors will prescribe an X-ray, antibiotics or a tonsillectomy when these might not be necessary or even helpful. In the NHS, GPs are gatekeepers and so tend to delay expensive screenings or treatments unless they are urgent. For example, when I had trouble with my knee in Germany a while ago, I saw an orthopaedic specialist who swiftly referred me to a radiologist for an MRI scan; no need to check with my SHI provider.

When we still lived in London, the father of my son's schoolmates had terrible back pain. His GP saw him several times and prescribed painkillers that didn't really help, but never referred him. In the end, he paid privately for an MRI scan, which revealed that he had a slipped disc. Turning up at the GP surgery with the scan, he was immediately referred to a neurosurgeon and had back surgery within a couple of days. NHS patients are used to having to kickstart the system in this way. In Germany, the sense of being entitled to "optimal care", which often means treatment when none might be required, is much stronger, leading to unnecessary treatments that drive up costs. Neither is ideal.

Since 1996, people with statutory health insurance have been able to choose which provider they want. In order to compete with one another—an element of the German system praised by Melanie Phillips—each SHI provider offers a different package of voluntary supplementary benefits beyond the legally prescribed catalogue. However, such competition is reined in by a compensation system (the so-called Risikostrukturausgleich), through which SHI providers receive extra money, on top of a flat rate, for every old or ill customer they cover. They are therefore incentivised not to vie only for ones who are young, healthy and cheap to insure. This is not quite the kind of market-driven system that Phillips seems to envisage.

Someone's health and youth are much more decisive if they opt for private health insurance (PHI). As mentioned earlier, the system is not as egalitarian as it may appear: the German language even has its own compound, Zweiklassenmedizin, to describe the two tiers into which healthcare is often divided.

Civil servants and others who can afford it opt for private health insurance. PHI providers do not participate in the health fund and don't get a share of the contributions citizens pay through social security. Instead, the decisive factor they use to calculate someone's premium is not their income, but their age, health and which services they require when they join. The younger you are when joining, the cheaper your premiums.

If you have private insurance, you pay bills directly with the doctor and then claim your money back from the insurance company. This option is particularly attractive for civil servants because their employer, the state, pays 50 to 70 per cent of the costs and they then only have to settle the remaining amount with the insurance provider. PHI offers many privileges, including an appointment at short notice when a specialist's surgery appears fully booked, or guaranteed consultant treatment and a single room if you need to go to hospital. Doctors can charge two-and-a-half times as much for privately insured patients as they do for SHI ones.

So, if the UK took on the SHI model, ideally without watering it down by adding a private element, would this solve the current crisis?

The challenges of replacing the NHS—a system directly financed through taxes with no additional direct levies for health provision—with an insurance system like the one in Germany would be immense. If nothing else, it would require a complete mentality shift for employers and employees to agree to pay into something like the health fund. How likely is it that all employers, from the biggest companies down to small traders, would be convinced to stump up for these extra costs? The same goes for workers, who would effectively see a loss in their direct earnings unless employers were willing to supplement wages by an amount equal to their employees' healthcare costs.

These extra costs would not be perceived as "ring-fenced taxes", as David Davis would have it, but as compulsory levies on top, not instead, of normal tax payments. Alternatively, the government of the day could reduce the overall tax burden by the amount of health insurance costs, but this would mean that all governments, irrespective of their political hue, would have to agree to a reduction in tax revenue in perpetuity. Considering the wildly varying approaches to tax policy, this would be a big ask of a party system that is far less willing to compromise than the German one, in which parties are used to working together in coalitions.

Even if such a switch could be implemented, the German insurance model does not solve the underlying challenges facing healthcare providers around Europe. Doom-laden predictions of imminent health system collapse aren't an exclusively British phenomenon: there is a marked shortage of specialist staff in Germany, as in the UK; an increasing percentage of Germany's €1.28bn (£1.1bn) daily healthcare costs must now be borne by private households; and some SHI providers have been cutting their benefits, which means that insured people have to pay for many services out of their own pocket. This then drives up their expectations as they feel entitled to get value for the extra money they are asked to pay.

The demographic changes of the country's ageing population put some pressure on services, though to a lesser degree than is often assumed. Instead, new, expensive products are the biggest cost driver. A study by the Bertelsmann Foundation estimated in 2019, before the pandemic, that the increase in quantity and price of medical services could contribute to a deficit of up to €50bn (£43bn) for SHI providers by 2040. The only way to counteract this would be a significant rise in contribution rates.

For the sake of argument, let's assume that all these caveats would not deter the UK from changing to an insurance system: is it likely that the result would actually be a "European" model? Wouldn't the more likely outcome be the gradual privatisation of the NHS until it ended up resembling the dreaded American model far more than the German one?

The agenda that the Conservative party has been pursuing for at least a decade seems to indicate that it would. One big step in this direction was former health secretary Andrew Lansley's decision in 2012 to force health bodies in England to put contracts for services out to tender. As a result, billions of pounds of taxpayers' money flowed to private companies for the treatment of NHS patients.

According to an analysis by the University of Oxford published in the Lancet last year, "the privatisation of the NHS in England, through the outsourcing of services to for-profit companies, consistently increased" after Lansley's intervention. This corresponded with significantly increased rates of treatable mortality—people dying when they could have been helped—potentially as a result of a decline in the quality of healthcare services.

In other words, the shift towards a different health provision in the UK has already begun, by stealth. Politicians who declare that the NHS is flatlining will incentivise ever more people who can afford to opt out to do so, and pay for private treatment instead. If support for the NHS dwindles further, the government would see it as licence to further cut spending, citing "value for money", rather than investing to revive it.

Rather than continuing to pay private health providers with tax money, such as financing privatised GP surgeries through NHS funds, the government will no doubt eventually make a proposition to cut taxes, "freeing" the resulting taxpayers' savings for private, customised direct health expenditure. Cutting taxes and letting the market regulate everything is what the Conservatives are about, after all. This would leave those patients who cannot afford to pay for private alternatives to settle for a massively scaled-down NHS service and receive minimal to no care. In short, the UK would end up with a very bad case of Zweiklassenmedizin.

It is true that I sometimes yearned for more efficiency and a swifter, more streamlined treatment when I was an NHS patient. However, I never thought that replacing a fundamentally egalitarian, nationalised healthcare system with a German-style insurance system would be a panacea. Neither, incidentally, did many of the fellow Europeans living in the UK and working in the NHS that I discussed this with after the referendum. We were all invested in this system. A major factor in the staff shortages presently ravaging the NHS is a marked downturn in the levels of recruitment from the EU after Brexit, especially for nurses. Both the NHS Confederation and Simon Stevens, then the chief executive of NHS England, raised concerns during the referendum campaign that this would almost certainly happen in the event of a Leave vote, but to no avail.

The NHS's greatest asset is still its staff, whom even its greatest detractors dare not denigrate. The state should pay them properly, in particular nurses. But instead of replacing the whole system to achieve this, as some seem so keen to do, the government should pursue a long-term reform of NHS management and administration structures.

As part of those reforms, the health system should be robustly shielded by regulation, preventing party-political meddling. Centralisation and the guidelines set out by the National Institute for Health and Care Excellence, which make the system slow and cumbersome, should be reduced and relaxed. Care should be better integrated, with GPs working more closely with specialists so that patients get quicker access to specialist treatment. This could be achieved within a system of polyclinics, for example, where doctors from different specialisms come together in a joint surgery that includes diagnostics and a pharmacy, taking the pressure off hospitals.

When reading or listening to calls for an "overstretched, outdated system" to be replaced wholesale, one must always consider what the agenda behind them is. Transplanting other systems is extremely difficult and in no way guarantees success. The NHS is under strain, but its existence is still an achievement; people still value the care it provides. The solution is not to replace it, but to maintain and improve it.

There's lots to think about in there - I've always been a fan of European social insurance models for things. I think, for example, we should be looking at a form of mandatory social insurance for social care.

My one caution is that I think a lot of his recommendations sound very much like the recommendations you'd expect from someone who is married to an NHS doctor which I'm not sure would help (and is part of the reason why governments have introduced market reforms, external regulators, league tables, targets etc). I think it misses that motivation around market reforms over the last 30 years since Major's NHS internal market.

It also doesn't mention what I think is a bigger cause of problems in the last 12 years is the standard British story of under-investment. So while spending on the NHS has kept rising, the capital investment budget was slashed. And I can never find it but I remember reading that the NHS is spectacularly under-managed compared to most healthcare systems. Under-investment plus bad management is more or less the common theme of Britain's post-war history post-war

I also think the point on the NHS as the great social democratic post-war achievement is true, but a little bit more complicated because I think in many ways (and this may be part of why it's still so popular) it's also the last great remnant of the war. Partly because to an extent health was nationalised during the war, also the principle which is accepted in the UK of, in effect, a form of rationing so everyone has equal access. But also ideologically one of the things Labour did as part of the wartime coalition was really push the idea that the government needed to set out "what we are fighting for" as well as against and Churchill basically let Labour define that "reconstruction".

The NHS came out of the Beveridge Report which was a surprising bestseller but also part of British propaganda - a copy was sent to all British service personnel and by that point we had conscription so it was part of motivating a conscript military in a democratic state. I don't think it's true but the story has always been that it was the armed forces vote that swung the 1945 election to Labour and I suspect part of it is that social democratic vision of reconstructed/post-war Britain with the NHS at the heart of it.

[Sheilbh]

50th anniversary of the UK entering the EU. Interesting thread of the various reactions and events to mark entry by Sunder Katwala:
https://twitter.com/sundersays/status/1609534359878475776?s=20&t=IECff6L0P9pzTRx8gVOL5Q

Attitudes towards membership over the first forty or so years - looking at the numbers in the first decade it feels like 75 was also possibly the perfect moment from a remain perspective. Maybe just another sign that Harold Wilson was a better politician and PM than Cameron


Particularly interesting the Guardian article reporting on it. Reading Robert Saunders work on the 1975 referendum it's really striking how many echoes there are which you can slightly see here too:

We're in - but without the fireworks
By David McKie and Dennis Barker
Monday 1 January 1973
guardian.co.uk

Britain passed peacefully into Europe at midnight last night without any special celebration. It was difficult to tell that anything of importance had occurred, and a date which will be entered in the history books as long as histories of Britain are written, was taken by most people as a matter of course.

The principal party political figures maintained their familiar postures of hope and optimism or head-shaking despair. Mr Heath was starting back from Ottawa, where he had gone for the funeral of Mr Lester Pearson, at about the time that Britain, along with Denmark and Ireland, officially became members of the European Community.

In a spate of pre-recorded interviews, he expressed his own hope and satisfaction at the successful outcome of the long march towards Europe with which he had himself been so closely associated for so long.

Yesterday the latest opinion poll on the Market, by Opinion Research Centre for the BBC, suggested that 38 per cent were happy about embarking on what Mr Heath depicted as an exciting adventure, while 39 per cent would prefer to get off. Twenty three per cent had no opinion at all.

But the worry on the effect on prices continues. The Consumer's Union announced it will hold a regular weekly check on food prices, and the Farmers' Union said that during the last five years while the price review procedure lasts the major preoccupation of farmers would be commercial organisation.

Pragmatism

Mr Heath believed that enthusiasm for the market existed predominantly among the young. Elsewhere he detected no more than good old British pragmatism. He had been impressed by people he had met who did not expect immediate benefit for themselves but looked forward to a better life for their children and grandchildren.

"I think in their phlegmatic and pragmatic way the British are now waiting for action and as we in the Community together take action, then I think more and more they will respond to it. "Of course whenever there is change people have fears and it may be particularly characteristic of the British that they are conservative by nature which has stood us very well in many difficult times, and so they fear change particularly. But they are also very practical and when they see the need for it they face up to it.

"If you allow yourself to be bedevilled by your fears, you are paralyzed by them. The only future lies in energetically seizing opportunities."

Mr Wilson, however, saw nothing to celebrate when we were going in without that fullhearted consent of the British people, which Mr Heath had made a condition of entry and when the price of admission was "utterly crippling." He defended the Labour decision not to attend the European Assembly. The real power lay not there but with the Council of Ministers and the only place to try to exert influence on them was through the British Parliament.

The Market would be an issue in the next election, but only one of several others would be prices, housing, jobs, "and very conceivably big aspects of foreign policy, like Vietnam, if this tragedy continues." Labour would be pledged to renegotiation and this would be followed by consultation with the people, either through a referendum or a further election.

Labour's most notable dissenter, Mr Roy Jenkins, wanted to see Britain pressing for greater changes in the Community, especially changes to improve the distribution of wealth, the amenities of life, Community aid to the Third World and the democratisation of European institutions. Mr Enoch Powell, the Conservative's best known rebel, said: 'The new year merely marks the commencement of a further and more vigorous phase of the campaign to ensure that in the matter of Britain and the European Community, the preponderant wish of the British people that Britain should not be a member on present terms is heeded.' The TUC, long dubious about entry, said that 'the one conspicuous omission from the celebrations was any real attempt to answer the serious questions raised about British entry. The safeguards they had called for had not been obtained. The official pageantry was not launched in time for the hour of destiny. The Government's Fanfare for Europe, in which among other attractions, an Irish folk group will perform in Lincoln's Inn and Lord Montagu's motor cars go to Brussels, does not begin until Wednesday.

Fulsome

But praise from friends of the Market reached new heights of fulsomeness. Mr George Thomson, one of Britain's two Common Market Commissioners, said: "This is a unique new year. What dictators have failed to do by force, democracies are undertaking by peaceful consent. Twenty-five years from now, if we build the right foundations in 1973, our children will enjoy a richer quality of life than could have been conceivable had we remained separate. And the voice of European civilisation, so muted since the Second World War, will be able to speak in a united way that can contribute decisively to a more peaceful and prosperous world."

The other Commissioner, Sir Christopher Soames, added to this Gladstonian note by talking of "a great adventure" and a European union which, with its own "personality, strength, and sense of purpose", would have a major impact on world affairs. On the other side, Mr Richard Briginshaw general secretary of NATSOPA, the print worker's union, was confident that the British people would long remember January 1, 1973 as "the blackest day in the calendar of their history." Wars and international conflict had at least left us with our basic national sovereignty and independence but that had now gone.

The Campaign For British Freedom said in a pamphlet that it was all a "shameful betrayal" and (in heavy type) that the British were not going to accept it. The Union Movement, child of Sir Oswald Mosley and supporter of European unity discovered in a statement that the terms were the wrong ones. The European movement staged a torchlight procession through London to Mr George Thomson in Whitehall Place, who was handed a new year's message to take to Brussels civic leaders of nine capital cities of the EEC began girding their loins for their conference in London in the new year on the problems of urban government: Westminster Abbey prepared itself for a Day of Prayer to the New Europe today and at the Royal Opera House Covent Garden, an estimated 10 million flowers were being put up in the auditorium for the Fanfare for Europe programme.

Mr Henry Plumb, president of the National Farmers' Union said that British farmers would be welcomed into Europe because they would take with them experience in how to look after their interests. The procedure of the price review would last another five years and the "major preoccupation" of farmers during that time would commercial organisation, and the development of production and marketing potential. Tactfully, he did not mention horticulture. Fishermen were not so much celebrating the new year as drowning their sorrows. South Coast fishermen took the opportunity of sending telegrams to their MPs asking for restriction on the size and numbers of Continental boats - especially French ones - because overfishing by Continental boats, especially the French, had already led to a shortage of fish.

Today thousands of balloons will be set off in Snowdonia by young people, and there will certainly be special postage stamps with the interlocking hands motif on sale later in the week. Girls from each of the Nine will compete for the Miss TV Europe title on Thursday. But it will take perhaps rather more than this to tip the British public into making up its mind decisively on whether the EEC is really a rising sun or only an amalgam of extinct volcanoes. As the Opinion Research Centre poll shows, opinion is well in line with the ambiguity of the whole proceedings so far - almost exactly fifty-fifty.

Also some echoes in the Guardian's editorial:

Editorial: Into Europe, andante
1 January 1973

"If the trumpet give an uncertain sound, who shall prepare himself to the battle?" Well, it's a pity that the Fanfare for Europe is not more harmonious, but in politics as in music dissonance has always been inevitable if the Second Fiddles play a different tune. In this case it must be acknowledged that a large part of the country is not ecstatic about the score. The journey into Europe will be bumpy and discordant.

That is sad, but not disastrous. What will be disastrous is if Britain devotes the next two, three, or four years to introspective champing over the issue: "Who went wrong when?" Among the most human and least attractive phrases in the English language is "I told you so." There will be much scope for such a Great Recriminative Debate. The transition period will not be all Beaujolais and boules. Change is always painful, and although the change arising from membership of the European Community will not be as sudden or all-pervasive as either its zealots or its most fiery critics believe, there will be enough change to cause trouble if people are determined.

Surely enough inconclusive balance sheets have now been drawn up, worried over, and discarded. If every change in prices, costs, wages, taxation, growth, and unemployment is to be put under the microscope to separate its European from its non-European elements, the effect on British politics and possibly on Britain's role in Europe and the world will be corrosive. Can we remember in the next few years that in the past few years prices have been rising sharply, unemployment has been worse than at any time since the war, and the balance of payments has recently showed signs of dipping into the same old trough from which only Labour's painful post-devaluation squeeze temporarily rescued it? And can we remember that all this happened before we entered Europe?

Can we remember also that it was partly in the hope of rescuing Britain from growing political aimlessness and economic lassitude that governments of the two parties have in turn sought membership of the Community? Labour is entitled, if it regains power, to seek changes, particularly with the benefit of experience. The Community is, and needs to be, an evolving institution. Even the Common Agricultural Policy may not be written on tablets of stone.

One temptation should be avoided, however; to prepare a future Labour Government's negotiating position by seeking, month after month, to prove that membership of the Community has created all Britain's ills. We enter Europe with the reputation of being a nation of shopkeepers; we would be unwise to present ourselves as a nation of second-hand-car dealers. Above all we should avoid creating a new, semi-permanent rift in British society, between pro and anti Europeans Britain has much to contribute to the new Europe's main need – for effective democratic control of a bureaucracy that grows in power all the time. In making that contribution we may even give our own parliamentary institutions a new injection of vigour and some relief from the staleness that long unsolved problems have created at Westminster.

[Tamas]

I eagerly await Sheilbh's explanation on how this is not Brexit's fault.

https://www.theguardian.com/uk-news/2023/jan/04/disaster-response-charity-enlisted-to-aid-drivers-stuck-in-uk-queues-for-channel

The government has signed a £200,000-a-year contract with a disaster response charity established by the former head of Britain's armed forces to help drivers stuck in lorry queues in Kent.

The Department for Transport has enlisted RE:ACT, which uses military veterans to distribute humanitarian aid in war zones and following natural disasters, amid concerns over driver welfare.

The year-long contract, which started in November, means that food and water will be supplied to queues of vehicles on approach roads to Dover and the Channel tunnel if drivers are at a standstill for two days.

The DfT summary says the welfare plan was needed because of "regular disruptions" to the road network in the area during previous national events which had severely overstretched local responses.

[Josquius]

There's lots to think about in there - I've always been a fan of European social insurance models for things. I think, for example, we should be looking at a form of mandatory social insurance for social care.

My one caution is that I think a lot of his recommendations sound very much like the recommendations you'd expect from someone who is married to an NHS doctor which I'm not sure would help (and is part of the reason why governments have introduced market reforms, external regulators, league tables, targets etc). I think it misses that motivation around market reforms over the last 30 years since Major's NHS internal market.

It also doesn't mention what I think is a bigger cause of problems in the last 12 years is the standard British story of under-investment. So while spending on the NHS has kept rising, the capital investment budget was slashed. And I can never find it but I remember reading that the NHS is spectacularly under-managed compared to most healthcare systems. Under-investment plus bad management is more or less the common theme of Britain's post-war history post-war

I also think the point on the NHS as the great social democratic post-war achievement is true, but a little bit more complicated because I think in many ways (and this may be part of why it's still so popular) it's also the last great remnant of the war. Partly because to an extent health was nationalised during the war, also the principle which is accepted in the UK of, in effect, a form of rationing so everyone has equal access. But also ideologically one of the things Labour did as part of the wartime coalition was really push the idea that the government needed to set out "what we are fighting for" as well as against and Churchill basically let Labour define that "reconstruction".

The NHS came out of the Beveridge Report which was a surprising bestseller but also part of British propaganda - a copy was sent to all British service personnel and by that point we had conscription so it was part of motivating a conscript military in a democratic state. I don't think it's true but the story has always been that it was the armed forces vote that swung the 1945 election to Labour and I suspect part of it is that social democratic vision of reconstructed/post-war Britain with the NHS at the heart of it.

This sounds like a key difference to the Swiss system I'm used to

The cost of someone's social security contributions depends on their income, with a portion of their monthly gross salary reserved for each kind of insurance— currently 18.6 per cent for pension insurance and 14.6 per cent for health insurance. One half of this total contribution is paid by the employer, the other by the employee; contributions are automatically deducted from the monthly pay packet. It works largely as a "pay-as-you-go system": contributions that are paid in are paid out again directly as benefits to others, so that nothing is saved apart from a reserve.

Which might make it workable.
The way it works in Switzerland like the US has no scaling for income. Which makes it great if you're rich but awful if you're not.

I'm not seeing how any of what this article says shows funding is the problem.
How is having a few hundred private company middle men any better than publicly owned trusts?
It really sounds like the way the NHS works and is organised needs improving- the statistic about how we spend so much more on treatment and nothing on prevention for instance.

Then theres this.

When we still lived in London, the father of my son's schoolmates had terrible back pain. His GP saw him several times and prescribed painkillers that didn't really help, but never referred him. In the end, he paid privately for an MRI scan, which revealed that he had a slipped disc. Turning up at the GP surgery with the scan, he was immediately referred to a neurosurgeon and had back surgery within a couple of days. NHS patients are used to having to kickstart the system in this way. In Germany, the sense of being entitled to "optimal care", which often means treatment when none might be required, is much stronger, leading to unnecessary treatments that drive up costs. Neither is ideal.

Yep.
This kind of shit in the NHS really feeds a Thatcherite 'I want mine' sort of mentality where people will seek to play the system. Which is really damaging.
There really should be a trial setup to try out a less penny smart, pound foolish approach and see how the numbers work out.

Attitudes towards membership over the first forty or so years - looking at the numbers in the first decade it feels like 75 was also possibly the perfect moment from a remain perspective. Maybe just another sign that Harold Wilson was a better politician and PM than Cameron


Particularly interesting the Guardian article reporting on it. Reading Robert Saunders work on the 1975 referendum it's really striking how many echoes there are which you can slightly see here too:

Very 'curious' that it isn't until 2008 hits that the idiocy takes hold, with the supposed horrors of the early noughties seeing a high point...
Almost like the EU is just a convenient scapegoat when things are bad.

[Josquius]

I eagerly await Sheilbh's explanation on how this is not Brexit's fault.

https://www.theguardian.com/uk-news/2023/jan/04/disaster-response-charity-enlisted-to-aid-drivers-stuck-in-uk-queues-for-channel

The government has signed a £200,000-a-year contract with a disaster response charity established by the former head of Britain's armed forces to help drivers stuck in lorry queues in Kent.

The Department for Transport has enlisted RE:ACT, which uses military veterans to distribute humanitarian aid in war zones and following natural disasters, amid concerns over driver welfare.

The year-long contract, which started in November, means that food and water will be supplied to queues of vehicles on approach roads to Dover and the Channel tunnel if drivers are at a standstill for two days.

The DfT summary says the welfare plan was needed because of "regular disruptions" to the road network in the area during previous national events which had severely overstretched local responses.

Thats not brexit. Its the EU trying to punish us for daring to leave innit. 

[Sheilbh]

This sounds like a key difference to the Swiss system I'm used to

Which might make it workable.
The way it works in Switzerland like the US has no scaling for income. Which makes it great if you're rich but awful if you're not.

I'm not seeing how any of what this article says shows funding is the problem.
How is having a few hundred private company middle men any better than publicly owned trusts?
It really sounds like the way the NHS works and is organised needs improving- the statistic about how we spend so much more on treatment and nothing on prevention for instance.

Well I think Switzerland is an outlier in Europe generally in how much it spends on healthcare, but also has a more private system (them and the Dutch) rather than the more normal European social insurance model. They don't have be private companies, often in social insurance they are non-profits.

Yeah I don't think funding is the problem and I think a lot of his comments on that area are a bit weird to be honest. I don't think you can easily wholly switch the way the NHS works, but I think having a genuine National Insurance system wouldn't be absolutely impossible.

Yep.
This kind of shit in the NHS really feeds a Thatcherite 'I want mine' sort of mentality where people will seek to play the system. Which is really damaging.
There really should be a trial setup to try out a less penny smart, pound foolish approach and see how the numbers work out.

Not sure what it's got to do with Thatcherism

Very 'curious' that it isn't until 2008 hits that the idiocy takes hold, with the supposed horrors of the early noughties seeing a high point...
Almost like the EU is just a convenient scapegoat when things are bad.

The peak of support is the late 80s, early 90s. It's from the early 00s on that it looks like the seventies again with both good and bad being at pretty similar levels.

I eagerly await Sheilbh's explanation on how this is not Brexit's fault.

[The Minsky Moment]

There's lots to think about in there - I've always been a fan of European social insurance models for things. I think, for example, we should be looking at a form of mandatory social insurance for social care.

From your article:

Someone's health and youth are much more decisive if they opt for private health insurance (PHI). As mentioned earlier, the system is not as egalitarian as it may appear: the German language even has its own compound, Zweiklassenmedizin, to describe the two tiers into which healthcare is often divided.

This is significant element of the German system.  Many of those who can afford it go "privat" which lowers some demand (burden) on the publicly-funded system but does result in the two tier system.  Whether that is a feature or a bug depends on one's view of these things.

[Sheilbh]

This is significant element of the German system.  Many of those who can afford it go "privat" which lowers some demand (burden) on the publicly-funded system but does result in the two tier system.  Whether that is a feature or a bug depends on one's view of these things.

There is significant private health insurance in the UK too - largely through employers in nice office jobs. But around 8 million people have the option to go private through their insurance. I don't know about numbers but the % of spending on private healthcare is about the same in the UK and Germany which is at the lower end internationally but higher than the Nordics.

I've used them for physio which is quite common and I think they are good for those more elective courses of treatment where the NHS is less well-resourced - so physio, non-emergency mental health care etc. Speaking to a friend who works in health the other area that is worth going private is cancer care. But the stuff you apparently absolutely shouldn't go private for is trauma, emergencies and pregnancies.

I think more spending on the NHS is necessary - particularly investing in the infrastructure of healthcare which the UK does not do. But I always remember a King's Fund - which is a health policy thinktank - did a study during the well-funded Blair years of different healthcare systems and there was lots of reporting about the fact that the NHS came top in loads of categories. But you looked into the detail and basically all of those categories were measures of efficiency and the category the NHS came close to last in was keeping people alive which I think outweights the other categories

I've always thought our health policy debate is trapped in a perception that the two models are British and American (not the only are where that's our discourse), so I'm always interested when someone actually looks at a European model. But also - and this is starting to shift with Labour's Shadow Health Secretary - our debate in recent years has basically just focused on funding and spending levels. I think the bit that has been missing is any sense of reform (again Labour's Shadow Health Secretary starting to talk about public sector reform again).

The reason I think mandatory social insurance would work for care is that it's an area where I think insurance is genuinely the right model. The costs are calamitously high for an individual/family and they're really not equally distributed or predictable on an individual level. So I think a social insurance model makes sense in funding care while making sure everyone who needs it is able to access it.

[Zanza]

The German system just has other problems than the British system, but probably not more or less...