The trouble with Tony, ' a dismayed exCabinet minister told me just before Mr Blair's visit to the TUC lions' den in Brighton, 'is that he's managed to persuade a moderate bloke like John Monks [TUC general secretary] that he believes in a mixed economy on health and education.'
Myself, I think It is all been exaggerated. But in the wake of the education white paper and the ongoing excitement over the private sector's role in the NHS, confusion is understandable. It has been inflamed by fat-cat incompetence at Marconi and by similar summer displays of pragmatism on the UK-EU health front.
My holiday policy is never to buy a British newspaper or attempt to tune into the BBC. So I was unaware of the health secretary's dramatic policy switch until I read a triumphalist account in the Sunday Times. It caught ministers on the hop in July by highlighting the European Court ruling in favour of foreign patients seeking treatment within the EU.
Two points are worth clearing up.Mr Milburn's office wasn't simply negligent.
He had been told that the European advocate-general expected the court to rule the other way. When that proved wrong he was told that the ruling didn't undermine the traditional (limited) access provided by the E112 form to people in need of treatment abroad. Second, the minister wasn't 'leaned on' by Number 10 to make his policy U-turn on his return from that family holiday to Florida's DisneyWorld. He acted after a departmental conference call on getting home.He did not talk to Tony Blair.
Primary legislation will not be needed.
Powers within the 1972 European Communities Act (the law which took us into Europe) will be used to pass an order - by 1 January - amending the ' 1977 NHS Act, which restricts the sending of NHS patients for treatment abroad.
The change will only apply to the EU.
Privately, ministers hope that fresh competition from France and Germany, whose healthcare problems are the opposite of ours - ie excess medical capacity and mounting financial deficits - will force down the (excess) prices charged by the UK's minuscule private sector.
In Kent there is even talk of setting up (cheaper) care homes in France or Belgium.
The traffic is not all one way, incidentally. The French are examining English boarding schools and, of course, We are teaching the Germans football.
But Milburnian pragmatism is the bit that infuriates some old comrades on the left. 'As with our attitude towards the private sector [last year's concordat], we were starting to look unreasonable. It had become a political issue rather than a legal or technical one, ' explains one adviser.
There are pitfalls, as HSJ's editorials suggest.
Who pays for travel? What about aftercare, especially if the foreigners botch it?
On the other hand, while Minister Milburn was agonising, I was checking out French healthcare at the poolside. Try this story for size. Rose, a retired British professor's wife, long resident near Toulouse, needed an operation for what the local hospital told her - within a week - was a leaky heart valve.
Within another week she had had the op in the public teaching hospital in Toulouse (the private hospital was an option), was sent home for a month then admitted to a rehabilitation clinic for five weeks' intensive treatment, learning how to cope again. 'It was like a five-star hotel.
But all we paid was 70 francs (£7) a day.'
Rose's treatment came under EU reciprocal health arrangements (the E111 form we all take on holiday). As a pensioner she did not need the insurance top-up which most French people take out to cover the 30 per cent of costs which they are expected to pay for GP or hospital care - '£400 every three months for me and my baby', a French friend explains.
It makes you think. . . The Blairites are not going to embrace the French mixedeconomy model - not yet. But it does point to a further modest reduction in the NHS's role as a near-monopoly provider of UK healthcare.
I should add that Mrs White visited a nice French GP with a throat infection.
Having forgotten her E111 she paid cash -£26 for the visit and the penicillin. It brought her out in spots and made her even iller.