The foundations of populist politics are easy to explain.
First you say that the people are oppressed by an elite.
Then you say that the experts in that elite are not telling the truth.
In place of their expert view you offer an alternative explanation that undermines that expert view.
You wait for anger to rise as people turn against the elite.
You then capture that anger for political gain.
Having done so you offer a solution that concentrates the power - which usually means the economic power - of a few amongst the elite that you have previously been attacking, with suitable kickbacks built in to provide political economic return.
You then declare that the people now have the solution they desire although in practice not only has nothing really changed, but matters might actually be very much worse, and there has most certainly been no gain for ‘the people’.
Sajid Javid’s NHS reforms now announced for this model exactly.
Out of the billions of new funding to be raised from a wholly unnecessary increase in national insurance on the low paid a small part will be going to GPS, who provide more than 90% of all NHS appointments.
People are then being told that they have a right, in exchange for their additional national insurance, to see a GP face-to-face.
As a matter of fact GP practices have been unable to meet all demand for GP appointments - which is rising steadily per head of population - on a face-to-face basis for years. So triage systems, usually involving telephone appointments, have been put in place to ensure that the worried well get the reassurance which is all that they really need, albeit over the phone, and the really sick hopefully get to see the doctor whose attention they really need.
Experts have worked out how to match demand and supply, and overall it pretty much works, although it is is incredibly stressful for GPs because it increases the risk that they take because they cannot always eyeball a patient, which is a pretty powerful diagnostic tool in a great many cases.
Javid is now saying GPs have this wrong. He says they are lazy experts rationing care.
He says their claim that they do not need to see all patients face-to-face is false.
His claim is that they do not have the ability to decide who needs to be seen.
His suggestion is that it is not the doctor who should determine who needs a face-to-face appointment, but the patient. His suggestion is that it is the patient who is the expert, so they must reject the arrogant elite who say otherwise.
He is deliberately fuelling anger amongst the patients who cannot get to see a doctor face-to-face by telling them that they have a right that is not actually theirs to enjoy: the GP contract does not say that a patient must be seen at their demand. It provides the GP with discretion, and rightly so. Their ability to direct healthcare to those who really need it is critical to effective healthcare supply when there are limited resources.
Javid’s aim is simple. It is to turn people against GPs, and so the NHS. A false service expectation - that anyone must be seen on demand by a GP - is being created to fuel resentment and then anger.
It will then be said that the NHS is failing.
It will then be argued that a private sector alternative would be better.
The NHS GP service will be privatised.
GPs will be stripped of their existing contracts and be offered employment contracts on worse terms.
Some will retire. Others will work to contract. There will be a poorer service. But the elite - excepting those running the new service who will provide the political kickback to the politicians - will have been tamed.
People will be told they have a better service. It will actually be worse. But they will be told otherwise. And because people will be relieved that the cause of their anger - NHS GPs - have been defeated, they will accept the lower service.
Meanwhile the kickbacks will continue. And new resentment will be fuelled against hospital doctors, who will become the new enemy.
This is what Sajid Javid is doing in plain sight. And the media are interviewing this Ayn Rand enthusiast as if he us really seeking to find a solution to NHS issues instead of seeking to destroy it - which is so obviously the case.
And so the destruction of all that is valuable goes on.