Watching the drama of health reform debate week after week, I sometimes think of a clever young Tory think tanker called Danny Kruger. Remember him?

In 2005 Danny was forced to stand down as his party’s candidate to fight Tony Blair in Sedgefield because he had been heard promising “a period of creative destruction in the public services” if Michael Howard won.

Then I thought the sacking unfair, but Howard was taking no chances: Danny was dropped. Howard failed, but his protégé and Danny’s former boss, David Cameron, is now in Number 10. The PM used a Telegraph article last week to promise private companies, and voluntary and charitable groups, that he will end “the grip of state control” on services like the NHS.

Since when the non-state school sector has had a similar message and Labour’s health spokesman, John Healey, has written to Andrew Lansley (no reply as I type) seeking “clarification” over the question of NHS competition by price - which Monitor’s new chair, David Bennett, has cautiously endorsed.

Is this “backdoor privatisation”, as Healey and angry letter writers suggest? I don’t think so and note that Ed Miliband avoided using the word in his attack on Tory NHS policy at Labour’s recent Welsh conference. The policy is more half-cock and romantic than that, more a case of “creative destruction” intended to generate hybrid but fruitful forms of innovation to save the NHS some of the £20bn targeted by the “Nicholson challenge”.

Danny Kruger’s world view is that socialism stands for abstract values and state power while Toryism is about community, individualism and tradition. So targets for his disdain include “philistines and profiteers, deluded do-gooders and residual socialists” - i.e., vulgar Thatcherism as well as lefties.

What has this to do with Mr Lansley’s lonely struggle to sell his vision of healthcare? Not a man for flowery language, yet he too is caught in the gulf between his cloudy vision and all too visible NHS reality. Whereas he lacks a clear message on primary care, let alone hospitals, voters can read every day about NHS cuts: in frontline staff as well as managers, in cancelled operations and ward closures. It drives the Tories wild with frustration - “so unfair” - but it’s their own fault.

Ditto public health. The health secretary has been touring the studios explaining why he voted to ban smoking in public and to curb low cost alcohol, grossly inadequate though medics say his strategy is. But he deems similar interventions against unhealthy food inappropriate. Why? Because consumers take more responsibility when they are more in control, he explains.

It’s American “nudge” theory in practice, steering people to change their ways rather than dictating or snatching the crisp packet from fat people on the bus. Why nudge doctrine doesn’t also apply to booze and fags is not made clear. Lansley’s critics duly accuse him of being in the pocket of the commercial interests whom he chooses to consult. And his wife, Sally Low, is a lobbyist, add harsher critics. That strikes me as mean. Many married couples manage conflicts of interest and Low has, reportedly, got out of health issues.

Much more wounding is the jibe that to the food and drink industry “nudge, nudge” is really ” wink, wink”. Hence Professor Sir Ian Gilmore’s remark on Radio 4’s Today programme that “as health professionals we often find we don’t have the same influence on government” as industry does.

Hang on there. Isn’t empowering the professions part of the Cameroon shtick, part of what Andrew Lansley wants to do for doctors and other fields of NHS expertise? No wonder David (brother of Ed) Miliband argued this week that the coalition is ignoring the basic human need for security.