Mrs Jones: While we must all tighten our belts in times of trouble, it seems awfully hypocritical that the Tories promise to safeguard the NHS and then promptly demand cuts of £20bn in the next four years.

Mr Jones: Well yes my dear. With the medical profession lined up against the reforms, the government does not seem to have taken its listening exercise seriously.

UK Healthcare Reform

What:

When the government promised to ringfence the health budget in 2010, you may well have taken comfort in the knowledge that the Tories would be steering clear of our beloved NHS. But just like every government before them and every government yet to come, the coalition can’t resist having a little tinker. The £1.4bn ‘tinker’ of the NHS is being pushed through at a time when savings of up to £20bn have been demanded over the next four years.
The plan aims to take away power from expert ‘bureaucrats’ and give GPs and clinicians more responsibility in allocating the healthcare budget – after all, if you’re smart enough to do medicine, you’re probably pretty good at business administration too.

Who:

The health minister, Andrew Lansley, is taking the lead on these reforms, which he developed during his time in the shadow cabinet. In yet another misjudged political manoeuvre, Nick Clegg has backed the plans.
Despite putting things on hold last spring to ‘listen’ to government critics, ministers seem determined not to let the hostile opinions of doctors, nurses, clinicians and policy experts spoil the party. This week however, the reforms are back in the headlines after even the government’s own MPs have spoken out. A Conservative-led cross-party select committee on health has said the reforms will inevitably lead hospitals and trusts to cut services.

Sound bites to wow with:

‘Introducing free market solutions to healthcare promotes a fundamental conflict of interest between provider and user and leads to over-provision of services.’
‘Decentralising healthcare provision will inevitably lead to a postcode lottery, where standards of care will vary hugely from one area to another.’

Don’t say:

‘Why don’t we just model our healthcare system on the United States?’

I want to make it quite clear that I am not a patriot. I don’t feel that surge of pride when I order chips abroad, loudly and in English. I don’t approach groups of American tourists, defiantly talking about “water bottles” in received diction. And I can only think of two occasions when I’ve sipped tea with a protruding pinkie.

But, despite myself, at the mention of the London 2012 Olympics I feel a desperate urge to wrap myself in a Union Jack and catch the first double-decker bus down to Buckingham Palace. And no, it’s not because that’s where they’re hosting the women’s beach volleyball. It’s because I can’t ruddy wait to have the second greatest four-yearly sporting event in the world (the football world cup would never need CGI footprint-shaped fireworks to make people watch it) in our very own Blighty – and watch us balls the whole thing up with consummate mastery.

Just the build up to the games has revealed the spectacular capacity of Great Britain for lukewarm achievement. Take the Olympic Stadium. It has been charitably described as a “bowl of blancmange” by some. And it’s not even a big bowl. In fact, with a capacity of 80,000, it’s smaller than just about every college (American) football ground.

OK, fine. So our Games won’t be as ostentatious as Beijing ’08. But who wants ostentation anyway, in times like these? No, what we want is efficiency. An understated games that goes off without a hitch. Obviously it was with this in mind that some genius came up with the idea of giving athletes free use of London’s public transport. Usain Bolt is very quick, but not even he will be able to win the 100 metres when he’s stuck at Tower Hill because of signal failure on the District Line. In fact, transportational issues are so high on the list of potential fuck-ups, that the Games’s organising committee has already resigned itself to mitigating the disaster, rather than averting it. Thus, they have made early efforts to recast the inevitable gridlock on London’s roads in a more glamorous light, anticipating a “perfect traffic storm” for the summer of 2012.

Look out world. 

What are the biggest challenges currently facing sub-Saharan Africa?

Africa has is biggest ever opportunity, which is to harness the commodity booms and new resource discoveries for sustained development. Historically, natural resource booms have often been a curse, giving rise to the politics of plunder: the few expropriating what should benefit the many, and the present generation burning up what should also benefit future generations. The challenge is to avoid repeating that sad history. The repeat of history is the default option, but it is not inevitable. For example, Germany is the best-managed economy in Europe because it used to be the worst, but learnt from its mistakes. Africa needs to do what Germany did: legislate the key decision rules; build dedicated institutions that implement the rules; and most important, build a critical mass of citizens who understand the issues and defend the rules and institutions. As the strikes in Nigeria demonstrate, Africa’s citizens are not yet up to speed in their true interests.

What is the evidence that aid to sub-Saharan Africa works?

Aid has got a lot better, but there is still plenty of room for improvement. Its future is in the small, impoverished, fragile states which without aid would simply fall apart. But to date in these societies aid has often merely kept the country on life support. What is needed is to use aid more strategically in developing the economy. In particular, this means supporting decent international firms to come into the country: without them such countries will probably remain impoverished. So aid needs to become both more focused on the plight of the least successful societies, and at the same time, more commercial.

Is recent Chinese investment helping the region’s development?

On balance, yes. The Chinese are not saints: they are primarily interested in helping China. But they are motivated by the notion of ‘win-win’, or projects which generate mutual benefits. This is not charity, but as a result it is less patronising, and it gives the Chinese a genuine motivation to stick with projects until they are successful. That said, at its worst, Chinese investment is indeed helping crooked regimes to remain in power.

What should outsiders who want to help sub-Saharan Africa do?

Both social enterprise and private enterprise now offer outsiders ways of being really useful to Africa. At its best, social enterprise brings the practices of effective organizations to environments which lack them; enabling poor people to gain access to services and products that would otherwise be the preserve of the privileged. After years of neglect, private enterprise is at last interested in African opportunities. Of course, some private enterprise is part of the plunder machine that has looted Africa. Reputable companies have until recently shied away from being tainted by what they perceive as corrupt environments.  Because young people are not willing to tolerate corrupt practices, they are the ideal workforce to enable decent companies to do business in Africa without damage to their reputations. As with social enterprises, Africa sorely needs what effective modern organizations can bring.   

Newt Gingrich has won the South Carolina primary. Faced with waves of what would be considered obstacles to any normal candidate, including his serial adultery, his wildly oscillating political positions and an endorsement from Chuck Norris, he has outlasted the other non-Romnies to not just squeak past Mitt but trounce him by a margin of 14%. This is a man who was forced out of the highest position he ever held by his own party (whom he would later describe as ‘cannibals’), who divorced one of his wives while she was suffering from cancer, and who, most gravely of all for a Republican, once tried to raise awareness about climate change.

Pundits keep on describing the search for a ‘real’ conservative to replace Mitt Romney, who is probably quite accurately suspected of being more interested in low corporate tax rates than home-schooling and gay-bashing, but Gingrich’s win suggests different forces at work. For one thing, he would be one of the most radical candidates to stand for President in decades. He routinely predicts World War Three. He seriously advocates colonising the moon. He would ignore the judiciary if it disagreed with him. He writes alternative histories and children’s books about American exceptionalism. Slightly demented policies have long been a byproduct of the Republican obsession with ideological purity, but this is something different.

Gingrich’s appeal is, I think, not the actual content of his policies or even the values they represent, but their sheer wide-eyed radicalism itself and the maniacal confidence with which he expounds them. His ascent is perhaps the climax of the Republicans’ protracted, messy divorce from reality, and their retreat into a fantastical world in which shadowy ‘elites’ wage proxy wars against middle America in hospitals, schools and gay bars.

You have to place yourself within this imagined dystopia to really understand Gingrich’s appeal. His apocalyptic warnings that American civilisation itself is nearing collapse start to make sense if you believe that everything you hold dear is under constant siege. His snappy, aggressive debating is suited to a political war zone, while Romney, with his constant smile and tiresome practicality just doesn’t seem angry enough. Romney promises to get Obama out of office. Gingrich promises to ‘knock him out’.

That aggression, and that macho contempt for anyone who does not believe in him is what gave Gingrich the edge in South Carolina. Sure, Ron Paul has radical plans to dismantle the modern financial system, but he views supporters of the status quo only as idiots; Gingrich one-ups him, claiming that they are actually evil, or agents of the ‘secular-socialist machine’, to be precise. Rick Santorum has plenty of hatred in him if his policies are anything to go by, but it never quite shows through; it is, after all, hard to look outraged wearing a sweater-vest.

Gingrich’s skill is to take the kind of gutsy anger that once powered Sarah Palin’s brief flight in the polls  and marry it with enough intelligence to carry his points beyond mere rants into something with at least the feel of a political vision. His style is radicalism for its own sake; that is, there are no real plans, only a constant sense of righteous anger about to be unleashed upon the establishment. He has replaced political principles with abstract nouns, like ‘greatness’ and ‘civilisation’. Even the Tea Partiers, crazed though they may be, at least have a concrete goal of cutting spending.

Yet with a meticulously compromising President in power, who brought Republicans into his cabinet, adopted Republican plans for his modest healthcare reforms and even maintained Republican tax cuts, why do so many Americans buy in to claims that he is the socialist anti-Christ? I suspect, in part, that among the patriotic middle-aged, a kind of nostalgia has been growing for the days of the Cold War and the single, simple enemy that the ‘Evil Empire’ provided as a foil to America’s heroism.

By the patriotic middle-aged, I mean in particular the generation old enough to remember the fall of the Berlin Wall, but too young to fully remember the Vietnam War, the generation raised on the purest narratives of American greatness. No satisfactory replacement has ever been found; even the once-trumpeted War on Terror has produced only a spluttering, ceaseless trickle of deaths, and whatever victories have been won remain half a globe away, intangible for most Americans. It’s that deep longing for simple divisions between good and evil that has pushed Gingrich to the front.

Of course, he will never likely be President; his mental state and approach to decision-making have been tactfully described as ‘erratic’ by members of his own party. Yet he is not just another ‘traditional values’ candidate buoyed by rural voters, but the first to directly represent the Republicans who grew up with the mythology of the Reagan era, and live now within the terrifying news-world created by Fox.

That’s what makes Gingrich worth paying attention to – he represents not a set of policies or values, but a mindset, a schizophrenic worldview in which every problem is a conspiracy and every solution a chance to ‘rebuild civilisation’. Newt is not the first politician to be crazy, but he may be the first man in history to make craziness into a passable political brand. And he is worth following for it.