Nick Boles today unveils a “fantastically powerful move” to rid the Conservatives forever of the charge “which has bedevilled us in every election campaign” of being intent on the destruction of the National Health Service.
In this interview, and in the latest chapter of his book Square Deal, also published today on ConHome, he proposes to transform National Insurance into National Health Insurance, and to devote the proceeds of the tax entirely to the NHS.
The Treasury has a long tradition of strangling proposals for hypothecated taxes at birth, but Boles points out that Nick Macpherson, until recently the Permanent Secretary of that department, has recently come out in favour of a hypothecated tax to pay for health.
Boles himself has survived two life-threatening attacks of cancer, is still recovering from the second of these, and says he now understands the expression “a new lease of life” in a different way.
Square Deal opened with a plea to revitalise modern conservatism by drawing inspiration from the dynamic programme with which Teddy Roosevelt reinvigorated American conservatism, taking on the robber barons, breaking open their monopolies and ensuring a “Square Deal” for ordinary Americans.
In the second half of this interview, Boles nominates Ruth Davidson rather than Boris Johnson as “the Teddy Roosevelt heir in the UK context”.
ConHome: “The readers are going to want to know about your own health. How are you?”
Boles: “Amazingly well. If you have chemotherapy and all your hair falls out, it can grow back very different from it was before. So I was privately hoping for a mop of blond curls. I fear I have to report that that is not what’s happened. I don’t even have much more hair than I had before, and I was hoping for a lot more, certainly on the top.”
ConHome: “It looks fine, actually.”
Boles: “But what has happened is it’s come back a lot less grey. I was nearly as grey as you. Otherwise, my health, it’s gone, but then it had gone ten years ago. The phrase ‘a new lease of life’ is one that I now understand in a way different than I did before, which is that you do feel like you’ve had your lease renewed, but it is still a lease.
“And once you’ve had a serious illness, you cease to think you have a freehold. And I remember saying after the last time, ten years ago, I’d never be surprised again to be told I had cancer. And I wasn’t. I was shocked, but you’re not surprised.
“You have a more contingent view of life. It’s great for now. And it won’t last, because inevitably things normalise quite quickly, but at the moment I’m still in that very lovely period which is where the simple things give you enormous pleasure. I mean literally a good night’s sleep.
“I’ve started drinking again. Almost all people who have chemotherapy, you lose your taste for alcohol and it becomes very metallic, and coffee also. And you don’t quite know when it comes back, but for me it came back, I was trying, I was having the odd sip from about July onwards, but it was only in November, at dinner in the Barry Room with Michael Gove and Simone Finn, where one of her particularly good bottles of Italian red was the thing that suddenly turned it back on.
“So that pleasure, the pleasure of walking a dog, the pleasure of a London view” – he turned and looked at the wonderful view from the Portrait Restaurant at the top of the National Portrait Gallery, where this interview was conducted, over the roof of the National Gallery and towards the Palace of Westminster – “one becomes a little bit as if one’s slightly high, and then gradually normal ambitions, frustrations, anxieties reassert themselves. For the moment I’m in the honeymoon period. The only thing is that every now and then you run into the fact that you’re not yet fully fit.”
ConHome: “When you run for a bus.”
Boles: “Yes, and realise you’re puffed out. And I’m slightly dying to be able to cycle to the House of Commons. I’m sort of aiming for the spring, but I don’t think yet. And, you know, you hope that it’s forever, but it might not be.”
ConHome: “And is your new thinking about health particularly informed by your recent experiences? As you say, you’ve been through something similar ten years before.”
Boles: “Yes. In a sense it’s so simple, and it’s a bit obvious, which is that the National Health Service, for all of its flaws, is almost the only bit of the British state that is genuinely and truly loved. For all that people complain about it constantly, they have an emotional attachment to it. The same is probably true of the military, though there it’s a bit different, because I don’t want to think of them as part of the British state, the regiments and so on.
“The second point which very directly relates to my experience is that you just have no idea how important it is, when you are ill, that nobody ever says anything about the cost.
“Of course the problem with social care is that the cost is a very big part of the assessment.
“We are going to need to spend more money on the Health Service, one way or another, whether it’s like the Americans do, which I would not support, they spend a lot more than we do, a lot more, as a percentage of GDP nearly double what we do, and their GDP is higher than ours. But whichever way we do it we’re going to have to spend more because we’re ageing and because medical technologies are getting more expensive.
“At the moment the conversations about funding public services and about running a Budget are always skewed by the fact that the NHS is sitting there, always needing more, and genuinely needing it. And that overwhelms a proper debate about schools and about these other things. They’re always ambushed by the NHS, not improperly, but just as a fact of life.
“And my main suggestion is that we need to give it its own clear funding stream that is then permanently separate.”
ConHome: “The Treasury hates hypothecation.”
Boles: “Well, you say that. Of course that is the tradition, and I think it’s probably the bias. But Nick Macpherson, Permanent Secretary of the Treasury until very recently, is in favour of exactly what I’m proposing.”
ConHome: “Has he said it?”
Boles: “He has said it recently. My argument is that you basically take National Insurance, which used to have a particular purpose which it no longer has, so it’s now a payroll tax. And you basically call it National Health Insurance. All of its revenues go into a separate fund, the National Health Fund, with separate funds for Scotland and Wales, and all of the funding of the NHS would come out of those funds.”
ConHome: “And is that roughly the right amount of money at the moment?”
Boles: “It isn’t, it falls a bit short, but that’s where my little twiddle comes, which works quite well. For those people who are economically inactive, the Treasury would pay an equivalent contribution. Then the numbers add up.
“If you need to increase funding, which over the next few years we will definitely need to do, there are a few obvious things you can do. They’re not without controversy but they’re obvious. You can firstly start charging people who are self-employed something closer to what employed people are charged.”
ConHome: “Hammond tried to do that last time.”
Boles: “Yes, he tried to do it, but the problem he ran into was we’d made a manifesto commitment not to change National Insurance. If you make this National Health Insurance there’s no justification, given that self-employed people use the Health Service just as much as employed people.
“The other thing you do is that you charge it on people’s employment income who are working after the state pension age. You could then consider charging it on unearned income. You wouldn’t charge it on people’s pensions.”
ConHome: “So then at the general election you’d say how much you were going to put National Health Insurance up by.”
Boles: “And it becomes a separate issue. You could have a party which said, ‘We want to cut public expenditure, or at least restrain the growth of public expenditure, and to cut taxes. But we also want to put more money into the National Health Service.’
“It has been Lib Dem party policy. It has been Labour Party policy.
“Any big thing like this will require cross-party consensus of some kind. Nick Macpherson is key, if you’ve actually got the voice of sound money at the Treasury. And he reiterated it last week when the whole debate started up again about the NHS’s winter problems.
“From a Conservative point of view, this would be a fantastically powerful move, which would put us in a secure position on health that could take us through the whole of this Parliament and the next election.”
ConHome: “Except that Labour would say, ‘We’re going to put this up’, and then what would the Tories say? I mean it would be a difficult judgment. People are not keen on paying more tax of any description. Personally I don’t like the idea that the self-employed, of whom I happen to be one, would have to pay more.”
Boles: “What you’ve done by doing this is you’ve changed the nature of National Insurance in a fundamental way.”
ConHome: “It actually becomes insurance, as Beveridge intended.”
Boles: “Exactly. And the reason the self-employed pay less National Insurance is they don’t receive the same benefits in terms of sickness pay and holiday pay. And one’s not saying they need to pay the exact same rate. It’s just that they probably need to pay more if this is paying for their National Health Service. But on the political point, I think you’re right, there would then be a debate about how much.
“But we would have put beyond question something which has bedeviled us in every election campaign, which is do we believe in the NHS, are we going to cut the NHS, are we going to privatise the NHS. You know that every Labour opposition has made that argument and every Lib Dem.”
The other half of the interview ranged more widely over the future of conservatism.
Boles: “So are you persuaded of the idea of Teddy Roosevelt as a source of inspiration?”
ConHome: “Well I think the idea of saving capitalism from itself is a very good idea. People do tend to think of capitalists as mean-minded tax evaders who have no real loyalty to this country.
“And as my old boss Andreas Whittam Smith used to point out, businessmen hate competition. In fact most people hate competition.”
Boles: “And you could say that they rightly – because it’s in their shareholders’ interest – will do everything in their power to prevent competition. Certainly in housing, which is one area I’ve written a lot about, the major housebuilders actually benefit massively from the complexity of the planning system, because they and only they can afford to make it work.
“One of the things I like most about Teddy Roosevelt is that he associated the interests of the consumer with also the small businessman and the small farmer. He saw that they effectively were on the same side, and that the big corporations and big businesses were on a different side.”
ConHome: “So could you name the big corporations your anti-trust policy or whatever is going to deal with?”
Boles: “Housing is now the most concentrated housing industry we’ve ever had, whether it’s Persimmon or Taylor Wimpey or Berkeley Homes or whoever. They’re the beneficiaries of a market that’s rigged by government.
“The energy market is another one we could talk about… Apple, Amazon, Google and Facebook. I’m sure that in the next 20 years, their power will end up being forcibly reduced by governments. They are as it were the robber barons of our age.
“I think that understanding that the interest of the small producer is aligned with the interest of the consumer and is not aligned with the interest of the big monopolistic producer is Teddy Roosevelt’s big interest, and I think it applies in a different way today.”
ConHome: “He was a man of quite stupendous energy. Do you have a person in mind? Because obviously if you want to have the Roosevelt approach you need a Roosevelt. When he was cleaning up New York he walked around all night with a great New York journalist, Jacob Riis, seeing whether or not the police were doing their job. Amazing stuff.”
Boles: “It is amazing stuff, and it’s quite hard to see an equivalent. I mean somebody who you and I both know reasonably well and have different views about…”
ConHome: “You’re referring to Boris?”
Boles: “Yes. There are some similarities. That sort of infectious ‘Oh come on it’s all going to be great’ energy and restlessness, and all of that. I think the difference is whereas I think Roosevelt has a world view, he’s quite organised intellectually, he’s got a world view from which he derives various policy positions, and he then acts to implement his policy positions. He’s pretty consistent.
“The power of big businesses needs to be controlled. Consumers need to be protected. The natural world needs to be protected. And America must stand up for its values and its interests around the world, and be assertive.
“And those are pretty much the four planks of Roosevelt. You can trace them back to the governorship of New York. I don’t think any of us would claim Boris has a similar world view.
“I see something in common between Ruth Davidson and Teddy Roosevelt. She manages to be patriotic without being crusty. You know there’s nothing she’d love more than jumping out of an aeroplane or getting on a tank or abseiling down some cliff in Wales while it’s sleeting.”
ConHome: “So do you regard her as a future leader?”
Boles: “Oh I bloody well hope so. When is another question, and which cycle. She’s very young. Is it this time, or after one’s had a period in opposition and some kind of a Labour government? Who knows? But no, I think she’d be terrific. And it’d be so much fun to watch.
“And that’s what you felt with Roosevelt, that it was clearly fun to watch. And there were dust-ups. And another thing about her I like is that, it’s not that she crosses the road to bop someone on the nose, but she’s certainly not afraid of bopping them on the nose if they look like they’re asking for it.
“And I quite like that approach to leadership, you know, not the conciliate everyone approach, but be clear about when you disagree with people. I nominate Ruth as the Teddy Roosevelt heir in the UK context.
“But ideas come first, and it’s not enough to have individual policy ideas, however admirable. There’s got to be an overarching story.”
ConHome: “So Square Deal is part of this, and Onward is part of it too?”
ConHome: “You’re part of it?”
Boles: “Not part of it, but very friendly, and I’m a huge fan of Neil O’Brien’s, and I think my only hesitation is I don’t yet know his/their overarching story.”