First, do we agree that health care is underfunded? If we agree that we need to invest more, the second question is what is the best way of raising the resources: do we pay for it through general taxation, do we pay for it through specific taxation, in other words Social Insurance, which is a tax on employees and employers, or do we make people pay direct in a private health service?”He moves on to the third question, the one that is central to the whole debate “Is the additional money enough? No. It’s got to be investment matched by reform.” Mr Blair answers his own question unequivocably He goes at least as far as Mr Brown has done. “We believe that the best way to do it is through general taxation.” Note also that Mr Blair has a pejorative phrase to describe the alternative of Social Insurance He calls it “specific taxation”. As far as he is concerned, there is no getting away from it: the euphemistically titled Social Insurance is still a form of taxation.Mr Blair is speaking on his way back from Dublin Castle where he has been holding talks with leading members of the Irish government. The brief flight becomes something of a political journey as he speaks expansively for the first time about his position in the previously unexplored area marked “tax and spend”.Like Mr Brown he displays no great enthusiasm for an earmarked health tax, known as hypothecated taxation.

Such a tax has the support of the Health Secretary, Alan Milburn, and Charles Clarke, the Labour party chairman. Mr Blair does not rule it out, but his comments are hardly a clarion call. “A hypothecated tax is still a tax that comes out of general taxation. Whatever discussions people want to have about it I don’t think it’s a central question.

This is the central question: do you take the money out of general taxation, specific taxation or a compulsory payment scheme?”Sipping tea on a small plane, easily filled by his senior staff, Mr Blair answers his own question in detail “People should start analysing different health systems. A lot of vague nonsense is talked about the French and German systems. There is a real anxiety from employers in France, especially, about the massive rise in non-wage costs under their social insurance scheme. We also have to understand that, in addition to the investment they raise through social insurance schemes France and Germany invest more public spending in their health care systems than we do”.Mr Blair believes that voters will be willing to pay more tax if they can be convinced that their money will be productively spent So he makes the case, first, for the NHS as an institution. “Pound for pound the NHS is one of the more efficient health care systems in the world.

However if you say to me can we make it more efficient, I say ‘Yes’. But the Tories are saying that money is poured into the NHS and nothing has happened The reality is different. We’ve had decades of underinvestment and only two years of significant investment.”He seeks more significant investment, dismissing the latest round of stories suggesting he was wary of his Chancellor’s tax initiative. “I’ve been saying for years that we’ve got to have a properly funded health system, matched with reforms. Similarly, Gordon highlighted the reforms in the TenYear Plan when he made his statement last week.