If you want my money, I want to see some changes

'It has become incredibly easy again to argue that higher spending is the answer to all woes'

The NHS debate

Rise in national insurance of £4bn may be unveiled to boost NHS

Blair drops pretence over health tax plans

Money alone will not cure the health service ills

Now Tories concede taxes may have to rise

Higher taxes needed to deliver on policies

What the professionals want

Donald Macintyre: Why Labour chose to risk its neck on the NHS

David Aaronovitch: If you want my money, I want to see some changes

Leading Article: Cast off the Bevanite mantle; it is time to hand power to the patients

Pinch me. There must be some extraordinary results coming up in the political polling being carried out for our three main parties. For the Liberal Democrats to argue that direct taxes should rise to pay for even higher spending on the National Health Service is what we now expect. That Tony Blair on Wednesday night, and Alan Milburn on Thursday, should make such a commitment virtually explicit in advance of April's budget is something of a surprise. I know that they've hinted at it before and all that, but I really didn't think that they meant it. Somehow or other Gordon Brown would, I had imagined, find a way of raising a bit extra even on top of existing commitments, without actually doing the tax deed. Wrong, apparently.

But you could have knocked me over with a Jo Moore apology when Liam Fox, the Tory health spokesthing, spoke out yesterday. Because what he said was that he too thought that the taxpayer might have to shell out a bit more to pay for health. Not the consumer, mind, but the taxpayer. "Taxes may have to rise," he told the BBC. "We said recently that we wouldn't rule out money going into the health service if necessary... What we need to make sure is that money is being spent sensibly." Rather than stupidly – well yes, of course. So there we are; eight years into New Labour and eight months into IDS's new radical era, and what it amounts to is that everybody agrees that direct taxes should go up to pay for health.

You'd have to be pretty reactionary to disagree with this lot. Kind of off-the-wall Adam Smith meets Tamburlane type. And there is nothing magical about current income-tax rates that says that a couple of pence, more or less, would do great damage.

All the same, the political gamble that the Government has already taken with the NHS is enormous. It has decided hugely to increase its direct funding, while changing very little about the essentials of its operation. There will be small, incremental reforms, and even these, it seems, will be fought every inch of the way by some of the employees and their various unions and associations.

Also on Wednesday night in the course of the BBC's NHS extravaganza, Mr Blair was asked why he would not contemplate any forms of charging patients for services. The example given to him was the cost to each patient in Sweden of visiting their GP. Ah, he said, but it costs very nearly as much to administer the charge as was collected from it. So, no thank you, we'll do it all from taxes.

But there were always important secondary arguments for charging, which were that it might create a sense of responsibility in the payer, and that it would diminish the dreadful paternalism – of noblesse oblige – that so often characterises doctor-patient relations. Patients would take more care to keep their appointments, and doctors might be nicer to them when they did. The same principles, incidentally, hold true of prescription-charging and charging for eye and dental check-ups. It is interesting that these charges have not somehow turned out to cost more than they raise.

The gamble lost would mean that taxpayers – forking out the increased amount for public services whose delivery they cannot affect – may turn round at the end of it and conclude that they would be better off making their own provision. And happier with a government that encouraged them to do so. Watch Liam Fox then.

Of course, one super wheeze that might put off that evil day is the hypothecated health tax, as supported by 69 per cent of those voting in the BBC's NHS Day poll. This, essentially, is a way of trying to get people to pay more tax than they might otherwise be happy to stump up, by telling them that £X of what they pay goes on health. But it's a con. Do we also tell voters that £Y goes on overseas aid, or asylum-seekers, or probation services, or social security? And would they be permitted to withhold one and pay the other? No wonder the Government isn't biting.

Incidentally, though the BBC NHS Day was valuable, the Corporation ought to treat itself with the same scepticism with which it deals with others. The poll result that claimed to be showing that free support care for the elderly was the "number one priority" of the British people was so obviously wrong it made me want to beat my TV to death with a copy of the BBC Producer's Guidelines. The 54 per cent that made this issue "number one" over cancer services and waiting times dwindled to 26 per cent when the same question was asked on the BBC's website. The old watch more telly, that's why.

Finally, I wonder whether a fully centrally funded NHS can ever be properly devolved. The pressure on a government that raises all the money for health will always be to intervene and to tell the myriad limbs and digits of this vast organisation what they ought to be doing. We need the opposite to happen.

Let's suppose, however, that in this one case we agree to give our politicians' instincts the nod. What else does it imply? The omens are not good. It has become incredibly easy again to argue or imply that higher spending (than whatever it is we are spending) is the answer to all woes. Since the beginning of this month the Lib Dems – according to their website – have argued for more money to put more police officers on the streets, to fully-fund performance-related pay for teachers, to scrap tuition fees and reintroduce student grants, to fully-fund travel for students in rural areas, to make Educational Maintenance Allowances universal, to abolish prescription, dental and sight charges, to pay no-fault compensation to Gulf War veterans, to spend more on debt relief and aid, to give greater subsidies to small and medium farmers, to pay the Gurkhas more and to fully-fund personal care for the elderly no matter what their means. And today is only the 22nd.

And what does their Treasury spokesman, Matthew Taylor, say? "Small tax rises, for those who can afford them, are vital to fund the rescue of the NHS. You can't get something for nothing, and it's time Gordon Brown was honest enough to say so." Small? How small is small? Perhaps it's time Matthew Taylor was honest enough to tell us.

Fortunately some in the party can see where all this is headed. The article on these pages this week by Paddy Ashdown's successor in Yeovil, David Laws, was fascinating. It amplified his earlier warning that the Lib Dems had "become the most conservative of all the political parties on health policy – the most producer-orientated, the least willing to contemplate private involvement or imaginative ways of raising extra money, the most opposed apparently to choice and giving information to patients about service standards. Our thinking has become almost socialistic, as opposed to being liberal".

Laws is right. And raising tax must not become the great mental excuse for dodging reform and innovation. Or, to put it another way, I am not stumping up extra money just to fund the radical syndicalism of Bob Crow and his railway comrades. Hypothecate that.

David.Aaronovitch@btinternet.com