No words are more abused in politics than these. I touched on it already in my previous article here. I will keep highlighting this sort of language and its implications. Because everything in public life is constructed – through stories and language and imagined enemies and belief – and there is always at least one other way. The way that involves not taking the course of action presented as the only way.

Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges (AoMRC), wants ministers and NHS bosses to downgrade some hospitals and push through major rationalisation of key services such as major surgery or intensive care, despite local campaigns to save units. He says this is the only way – yes, apparently there is no other way – to improve healthcare for the most seriously ill. He says too many hospitals provide the same services only miles between one another. There must be rationalisation. There must be cutbacks and hospital closures.

The same services. Yes. Of course they provide the same services. They provide healthcare. They are not department stores competing for market share. They are hospitals, keeping us alive and well in our hour of need. Healthcare provision must surely be one of the core goals of living together in organised society. Yet we are told that having less healthcare available will make everything better for us overall. As if nothing could possibly be changed about the way the NHS is run and funded apart from the volume of service provided.

For me as a citizen, universal healthcare provision is a moral question. Yes, it’s a collective financial burden. But it’s the price we must pay for civilisation. Yes, we live longer and treatments are increasingly complex and expensive. But if it needs funding, we must fund it. Some say that’s naïve. Yet we live in a world in which trillions of dollars are tucked away by the wealthy in offshore tax havens while governments claim that proportional taxation only increases tax avoidance. I am not sure what is more naïve.

The reason I keep writing about language is because it’s fundamentally normative. The pictures that are painted for us have a pre-defined course of action inscribed in them. They are not neutral, nor are they there (solely) to share useful facts. The chairman of a professional medical association speaks with a certain degree of authority. Yet he paints a rather skewed picture.

I will accept that healthcare provision must be reduced if it’s a collective and informed choice. I won’t see it as our only choice, but it will be our choice nonetheless. What I struggle to accept is that we can only afford a downgraded form of civilised society and that there is no alternative.

One of my local hospitals is going to lose its A&E department as part of this rationalisation drive. I guess you can have too much emergency care.