A protest in support of the NHS at last year's Labour conference. Source: Getty
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NHS funding is a taboo topic for all parties

The Tories blew their chance to be trusted on health and Labour doesn't want to talk about where the money will come from.

It is hard to think of a policy that Labour is less likely to adopt for its 2015 manifesto than the flat rate £10-per-month “membership fee” for the NHS proposed by Lord Warner, a Blair-era health minister now sitting in the Lords. Jamie Reed MP, shadow health minister has said “this is not something Labour would ever consider.” He might have added re-introduction of small pox as a health policy  closer to Ed Miliband’s preferred general election offer.

When Labour has a vast lead over the Tories as the party to be trusted with the health service, anything that sounds as if it undermines the founding principle of universal access free at the point of use is out of the question. The problem is that Labour has signed up to tight spending constraint if it forms a government and under those circumstances NHS funding is certain to become a volatile issue. People are living longer, suffering from chronic conditions that are expensive to treat – especially if they result in prolonged hospital stays – and costs in medicine tend to rise faster than inflation. Even without the ongoing fiscal crunch, this would be an issue of existential urgency for the system as it is currently configured.

MPs in all parties know this but it has become hard to say so aloud for fear of facing the follow-up question – what would you do about it? In theory, health spending this parliament has been “ring-fenced” but it doesn’t feel that way in the context of local authority cuts, which have severe consequences for social care, and “efficiency savings” that amount to real terms cuts when imposed in a climate of rising costs. GPs say privately that a growing part of what they do amounts to managing patient expectations downward and rationing.

This model of service erosion is no-one’s preferred policy but it is the inevitable consequence of persistent failure of political courage on all sides. The Tories had their moment to bring public opinion with them in a conversation about reform and they blew it with a vast restructuring that alienated pretty much everyone apart from private healthcare providers. The Lib Dems are desperate to scrub away as much trace of complicity with the Tories’ mangled reforms as they can before polling day, although Nick Clegg was a prominent co-mangler.

Labour, meanwhile, does have a plan to transform the provision of health services – the “whole person care” idea developed by Andy Burnham. This puts the emphasis on public health and investment in prevention to save costs down the line. It also envisages the merger of health and social care.

There are obstacles. First, even if the numbers can be made to add up over the long-term, it looks like a hefty up-front expense and yet another epic re-organisation to boot. Second, Ed Miliband’s office is deeply suspicious of Burnham, believing him to be building a support base in the party machine and manoeuvring into a position to be ready for a leadership contest in the event that Labour loses the next election. With an eye on those ambitions, neither Miliband nor Ed Balls seems in a massive hurry to give the shadow Health Secretary the kind of boost that would come from the adoption of his health plans as a flagship reform proposal going into the general election.

Finally, there is a feeling among some Labour MPs and activists that owning up to the imminent cost crunch in the health service and offering a complicated reform agenda to address it just confuses the message, when all the voters need to know between now and May 2015 is that “you can’t trust the Tories with the NHS.” This school of opposition would gladly build an entire campaign around the anti-Conservative message played on a loop alongside pictures of David Cameron and George Obsorne looking smug interspersed with reminders of their “tax cut for millionaires.”

The reality is that Labour expected problems with the NHS to be more extreme and more salient in political debate than they have proved to be so far. (That isn't meant as a denial of the severity of the problem, only as an observation that they haven't blasted other matters off the front pages.) It is an issue where the opposition has a huge potential advantage but only if voters think it is a matter of such urgency as to trump other questions when weighing up who to vote for – the economy; immigration; crime; education etc. Labour’s dilemma is that the obvious way to make more political noise around the health service is to talk about the funding crisis but doing so invites scrutiny of the opposition’s proposed solution. And that is a conversation the party is not yet ready to have.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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Leader: The unresolved Eurozone crisis

The continent that once aspired to be a rival superpower to the US is now a byword for decline, and ethnic nationalism and right-wing populism are thriving.

The eurozone crisis was never resolved. It was merely conveniently forgotten. The vote for Brexit, the terrible war in Syria and Donald Trump’s election as US president all distracted from the single currency’s woes. Yet its contradictions endure, a permanent threat to continental European stability and the future cohesion of the European Union.

The resignation of the Italian prime minister Matteo Renzi, following defeat in a constitutional referendum on 4 December, was the moment at which some believed that Europe would be overwhelmed. Among the champions of the No campaign were the anti-euro Five Star Movement (which has led in some recent opinion polls) and the separatist Lega Nord. Opponents of the EU, such as Nigel Farage, hailed the result as a rejection of the single currency.

An Italian exit, if not unthinkable, is far from inevitable, however. The No campaign comprised not only Eurosceptics but pro-Europeans such as the former prime minister Mario Monti and members of Mr Renzi’s liberal-centrist Democratic Party. Few voters treated the referendum as a judgement on the monetary union.

To achieve withdrawal from the euro, the populist Five Star Movement would need first to form a government (no easy task under Italy’s complex multiparty system), then amend the constitution to allow a public vote on Italy’s membership of the currency. Opinion polls continue to show a majority opposed to the return of the lira.

But Europe faces far more immediate dangers. Italy’s fragile banking system has been imperilled by the referendum result and the accompanying fall in investor confidence. In the absence of state aid, the Banca Monte dei Paschi di Siena, the world’s oldest bank, could soon face ruin. Italy’s national debt stands at 132 per cent of GDP, severely limiting its firepower, and its financial sector has amassed $360bn of bad loans. The risk is of a new financial crisis that spreads across the eurozone.

EU leaders’ record to date does not encourage optimism. Seven years after the Greek crisis began, the German government is continuing to advocate the failed path of austerity. On 4 December, Germany’s finance minister, Wolfgang Schäuble, declared that Greece must choose between unpopular “structural reforms” (a euphemism for austerity) or withdrawal from the euro. He insisted that debt relief “would not help” the immiserated country.

Yet the argument that austerity is unsustainable is now heard far beyond the Syriza government. The International Monetary Fund is among those that have demanded “unconditional” debt relief. Under the current bailout terms, Greece’s interest payments on its debt (roughly €330bn) will continually rise, consuming 60 per cent of its budget by 2060. The IMF has rightly proposed an extended repayment period and a fixed interest rate of 1.5 per cent. Faced with German intransigence, it is refusing to provide further funding.

Ever since the European Central Bank president, Mario Draghi, declared in 2012 that he was prepared to do “whatever it takes” to preserve the single currency, EU member states have relied on monetary policy to contain the crisis. This complacent approach could unravel. From the euro’s inception, economists have warned of the dangers of a monetary union that is unmatched by fiscal and political union. The UK, partly for these reasons, wisely rejected membership, but other states have been condemned to stagnation. As Felix Martin writes on page 15, “Italy today is worse off than it was not just in 2007, but in 1997. National output per head has stagnated for 20 years – an astonishing . . . statistic.”

Germany’s refusal to support demand (having benefited from a fixed exchange rate) undermined the principles of European solidarity and shared prosperity. German unemployment has fallen to 4.1 per cent, the lowest level since 1981, but joblessness is at 23.4 per cent in Greece, 19 per cent in Spain and 11.6 per cent in Italy. The youngest have suffered most. Youth unemployment is 46.5 per cent in Greece, 42.6 per cent in Spain and 36.4 per cent in Italy. No social model should tolerate such waste.

“If the euro fails, then Europe fails,” the German chancellor, Angela Merkel, has often asserted. Yet it does not follow that Europe will succeed if the euro survives. The continent that once aspired to be a rival superpower to the US is now a byword for decline, and ethnic nationalism and right-wing populism are thriving. In these circumstances, the surprise has been not voters’ intemperance, but their patience.

This article first appeared in the 08 December 2016 issue of the New Statesman, Brexit to Trump