Referendums resolve nothing. The campaigns that precede them are mendacious. A thousand factors determine the outcomes, many of them unrelated to the question on the ballot paper. Yet there is an overwhelming case for holding another one.
The next referendum should not be on Europe. We have had more than enough plebiscites on that unavoidably vague and highly charged issue. Instead the question that needs to be placed in front of the electorate is more focused and precise. As people live longer and medical technology develops, everyone agrees that, alongside structural reforms, higher investment in health and elderly care is essential.
Yet no party or leader can find a way to raise the money. The scale of the crisis is vast and the response of government is puny. Look at the current incumbents, still on a buoyant honeymoon with the electorate, but struggling to find a means of providing a tiny bit of extra cash for elderly care at the end of the year.
The referendum would not be about a prime minister, the government or the opposition. It would be about us, our priorities
The situation is perverse. Nearly all voters recognise that modern health provision is worth paying for and agonise separately about the possible future costs of elderly care. Will we have to sell our house? Will we lose our inheritance? Why can’t we get access to drugs available in other countries? Why are survival rates of some diseases higher in other countries? Why do I have to wait a week to see a GP?
Part of the answer to all these questions is obvious. The government needs to raise additional revenue. It will not be cheap but in the end – for selfish reasons and not altruistic ones – we need the only mediating agency available to address the challenge, and that is a government. There is no other institution available that can be held to account in the same way and that can respond to the sheer scale of demand.
Yet the obvious cannot be delivered. The government – any government – cannot deliver because it is too scared to raise taxation or is not trusted to do so. With the UK’s uniquely hysterical pre-election tax-and-spend debates no party can win a mandate to raise taxes in order to provide the necessary levels of investment. Before a general election there is pressure on parties to show how they will cut taxes and reduce public spending.
These debates have no relation to reality and yet constrain governments subsequently. The last election was typical, fought on the fantasy that George Osborne would wipe out the deficit by the end of this parliament. Moving nervily into this fantasy battleground, the Labour leadership wondered fleetingly whether it could argue that elderly care and a modern health service were worth paying for, and concluded that it could not. The priorities would get lost in a frenzy of headlines about tax bombshells.
Even without the headlines we live in a dangerous era of extreme mistrust. Some voters turn against those they elect and, most fundamentally, do not trust them with their money. But what if they had a direct stake in a decision as to how their money was spent? Suddenly the dynamic changes altogether.
The referendum I envisage would be far removed from the mad one on Brexit. A prime minister would offer to facilitate investment in the NHS equivalent to levels in similar countries and to provide a national care service for the elderly of the highest standards, as in Norway, where the wealthiest plead to live in state-run institutions because they are the best available. A government would explain the costs and the tax rise required to pay for them. But the referendum would not be about a prime minister, the government or the opposition. It would be about us, our priorities. The politicians would be ready to act, but equally they would be ready not to act. They would insist that it is up to us.
The referendum campaign would be as much a scrutiny of the providers. Are they efficient, will they spend every additional penny wisely? It would not be a highly charged campaign where political careers are at stake.
If the referendum were lost, the voters would have decided they prefer a lower level of taxation and poorer health provision, while being willing to busk it in terms of elderly care. Governments would have to start charging for more services, and private insurance schemes would flourish. If a majority backed a tax rise to pay for improvements, the entire electorate would have a stake in making sure that what follows delivers good value for money. The scrutiny would not just be on parliamentary committees, the media and the rest. The voters would be keeping a close eye on what happens next.
The drawbacks are many. The Treasury hates any form of earmarked taxation, let alone a tax rise based on the vagaries of a referendum. And why should voters back a tax rise in a referendum? But there is no easy way through the barriers towards civilised provision of health and elderly care services, and this provides a route. The tax-and-spend hysteria of a general election would not be repeated in a referendum because the stakes are less high. The campaign would not be about electing a government.
Indeed, some anti-state newspapers with relatively elderly readers would have to be careful about being too vehement in their opposition. The framing of the argument could be transformative. Instead of the state being regarded as a stifling, profligate monster, voters will be asking of it: what can you do for us? Lost connections between those who feel “left behind” and the ones they elect might be rediscovered. When as chancellor Gordon Brown announced a tax rise to pay for NHS funding, polls suggested the move was popular. Voters make the connections if given the chance to do so.
Referendums on Europe are bound to be preposterous. They are about nothing and everything. Some people have raised the possibility of a “second” referendum on Europe, but we have had two already, one in 1975 and the vote last year. If we have a third, we will have a fourth. The multi-layered complexities of Europe mean a binary referendum is doomed to generate further crises.
Most immediately, there is no obvious solution to Brexit. There is a solution to an underfunded NHS and elderly care service. Yet no government can act without the permission of the voters. So a government sometime soon must seek their permission. I loathe referendums, but in this era of mistrust, government is paralysed. We need one urgently.
Another referendum? Yes, but this time on the NHS | Steve Richards
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