Health becomes political Looking back, it is astonishing that in the early years of the NHS health was hardly a political issue at all. For more than a decade its minister was excluded from the Cabinet. Nor can a single reference to health issues be found in the definitive study of the 1959 election -despite expenditure having been kept down; indeed, there had been much less change than we are now inclined to think. The shake up came after the Conservative victory in 1959 with the arrival of Enoch Powell, determined to breath life into the Guillebaud report on the cost of the NHS and do much else. In getting the NHS moving, perhaps he even deserves a niche in the pantheon with Nye? Since then, there has hardly been a moment of rest: medical advances on a scale without precedence, the rise and rise of the aged population and the triumph of the consumer society over the producer society. We have scarcely begun to come to terms with any of these individually, let alone in combination. Only think of the score of questions that now buzz so insistently about each of them. But, in combination, their force has obliterated much of an ancient land-scape. Sum it up for your own condition: “The patient is different, the doctor is different, medicine is different.” But the consumer society? We certainly know who is in it and who is not, since Douglas Black's concern has essentially been with the outcasts from it. The first blast on the trumpet was Macmillan's “You never had it so good” on his way to winning in 1959. In no time at all, almost all politicians were singing to no other tune. They had found a new cause to take the place of the two that had held the stage for so long: coping with the working class and dealing with the Germans. The consumer—or if you prefer, the voter—was endowed with rights. Instead of the Rights of Man we had the Rights of the Consumer: the Social Contract gave way to the Sales Contract. Above all, the electorate was fed with promises, sometimes elevated to pledges, about what could be enjoyed as a standard of living or delivered as a level of public services. Lemons at half time Not that there was any escape from much previously acquired baggage. The ghosts could not so readily be put fully to rest. Not so in the Far East, where the consumer society arrived as a kind of Big Bang. If you are inclined to think that much of the future can be glimpsed there, consider that a good deal of primary care is now organised supermarket-style in big urban areas. And who is to say that it might not be right for large, rootless populations? That was one interpollation, a kind of lemon at half time. May I take a suck at one more? For the past few decades politicians have been able to act as they have because of the perfecting of the two devices of taxation on which their policies rested. These were that there should be no receipt of wage or salary before deduction of tax and no purchase of goods or services before payment of tax; in effect, no living at all without previous deduction.