When Liberal Democrat MPs decide this week how to vote on the Health and Social Care Bill most will have to decide how much they are willing to compromise on fundamental values. For a few in the party, there has never been much wrong with the bill. As I have written elsewhere, these people have been trying to inject competition and profit-making into public services for years, under the misnomer of 'choice'. The coalition with like-minded Tories has allowed them to drag Liberal Democrat members in such a direction, using the excuse of necessity. That explains why some Liberal Democrats were such enthusiastic advocates of the bill in its original format - before Liberal Democrat conference told the leadership to go back to the Conservatives and renegotiate.
Any coalition involves compromise. We all accept that. Indeed, all political parties are to some extent an institutionalised compromise. But how far must one go? On the evidence since May 2010, most Liberal Democrats seem to believe that 'Quite far' is the right answer. The attitude of most Liberal Democrats I speak to, when asked if being in government is worth all the flak they take, is expressed thus: 'Something is better than nothing' and 'Don't let the best be the enemy of the good'. For all those activists who have spent decades frustrated by their lack of power at a national level, these are attractive perspectives. Such activists point to real policy gains which they feel have been worth making concessions (and even outright surrenders) to achieve. This is the reasonable approach of the 'nice party', even when dealing with a party which is still very clearly (as we saw during the AV referendum) rather 'nasty'.
Such an approach is now being applied to debates on the Health and Social Care Bill. Liberal Democrats are able to point to lots of changes to the bill. People are crediting Nick Clegg and Paul Burstow with securing these. No doubt they have worked hard to do so, though one wonders why they were such enthusiasts for the initial bill, and why it took a party conference resolution for them to challenge their Tory colleagues on reforms which were far outside (and arguably contradicted by) not only both parties' manifestos but also the coalition agreement.
But just because changes have been made, Liberal Democrat MPs should not feel they have to vote for the bill. In its fundamentals, it remains much the same threat to the basis of the NHS as it did when it was first published. At its core is the potential for competition and profit to enter the system, undermining the world-renowned efficiency which the public sector NHS already delivers. Yes, that's right, 'efficiency', a virtue which is always said to come from the private sector but is in fact delivered by our NHS better than private systems around the world. Meanwhile, these market forces will operate in a system where there will be greatly reduced democratic accountability at national level, and nothing like the increase in local power which is necessary if there is to be such a reduction in ministerial influence.
Nobody believes the NHS is perfect. I have seen personally and at first hand what it means when staff fail to deliver basic care. But on the whole, for the majority of people, most of the time, it is far better than the American system which it will end up emulating if these reforms go through.
Last week, I heard a Liberal Democrat MP on the radio say that MPs should not get bogged down in the minutiae of the bill when deciding how to vote, adding that big changes have been made and that they should now vote for it. I think he was right about not getting bogged down in the minutiae. In any grand reform it's the picture that counts. But for that very reason, while that MP has said he will be voting for the bill, other MPs must oppose it in the Commons, and not leave crucial amendments to the Lords. None of the issues over which people such as Shirley Williams have expressed concern, such as the repeal of the government's duty to provide a comprehensive system of healthcare, are minutiae. Allowing private companies to challenge GP consortia is not a piece of minutiae. Nor is allowing the National Commissioning Board to distribute funds with no regard to equality. And as Polly Toynbee has pointed out, Monitor's future role in promoting competition has barely been touched.
The big picture is this, do we want to save what Shirley Williams described as ' a public service free at the point of need for all', or do we want to allow it 'to die'? This is the big picture which the public perceives and understands. They will cast it in terms as simple as that, and nobody should imagine that reforms to the minutiae which Liberal Democrat MPs have secured, will ever persuade voters that the party in government did all it could to defend the NHS. In 2015, the party will no doubt argue that it had no choice in 2010 but to enter into a coalition with the Tories, and that it has significantly restrained them. But that will be not be an adequate case if on an issue so resonant with voters the party has allowed feral Tories to run riot and destroy the NHS. Such Vichy-style collaboration would be punished.
Reasonable Lib Dems, unused to influence, have become easily satisfied with short-term success. But short-term gains to demonstrate so-called 'credibility' in government are not worth the price of accepting the broad framework of a Conservative agenda which will do long-term harm. That is exactly what the Health and Social Care Bill threatens to do. A vote for it in its current from will mean the death of the NHS. If Lib Dem MPs have left it to the Lords to fight against it, the passage of the bill will also see the death of Lib Dem credibility as defenders of the nation's favourite institution.