Clegg's speech on why he had got involved in politics – focusing on unequal health outcomes in Sheffield – was the first point at which the debate reached beyond our internal obsessions to touch the concerns of the wider electorate.

And when Huhne was forced to offer the evidence for linking Clegg to this claim

I don't go along with those Lib Dem MPs who propose American-style school vouchers or replacing the NHS with privatised health insurance.
(from Huhne's first campaign email)

all he had to say was "Well David Laws is one of your close supporters".

It was a weak point. Laws is one supporter among many (Phil Willis, Steve Webb, etc), has not been an advocate of "American style vouchers" in the past, and isn't proposing them as Education spokesman at present (his Orange Book chapter spent a great deal of time dismissing the Tory "patient´s passport" proposal). In any case, Huhne's historic views (from his time on the public services policy commission) were not far from the Laws position in the Orange Book.

In those days, Huhne wanted to see public services that were accountable to elected local bodies, but was happy to see provision of services coming from public, private, or "mutual" bodies. (Personally I always saw the "mutuals" element as a figleaf, but perhaps I am just cynical). The core of the proposals was the creation of a clear purchaser/provider split. The purchaser was to be a regional, elected body. The provider might be anyone.

David Laws took this one stage further in the proposals he floated in the Orange Book. He kept the purchaser/provider split that Huhne had backed, but also offered a choice in purchaser. Essentially every citizen could choose once a year which organisation would use their taxes to purchase their healthcare.
Just how close Huhne was to this can be seen from his 2004 article in Liberator. While restating his preference for the policy commission conclusions, Huhne wrote that

"David Laws suggests that people could opt in to a range of different providers rather like US style Health Maintenance Organisation (HMOs). Quality would be ensured by competition: if someone was dissatisfied with their HMO at the end of the year, they could switch to another.

"This is certainly a health model that a region could try out if it wanted to (and the commission stressed the importance of experimentation as a key reason for decentralising the giantist NHS)."

However Huhne was fairly dismissive of the HMOs, suggesting that their impact is limited and that insurance results in litigation costs. This is perhaps the big question about the Laws' proposals. HMOs are often seen as doing well in terms of encouraging preventive medicine (they have an incentive to keep down future health costs) and in encouraging innovation among health providers. But it is clear that the cost of disputes is an issue (at least in the US, it would be interesting to have more information on the Swiss experience).

Sadly Huhne's earlier commitment to public sector reform seems to have evaporated (see James Graham for an interesting take on this). His recipe for the public services now seems – according to his manifesto - to amount to little more than a wish for elected control. And this is nothing more than a Liberal Democrat piety. It is hard to resist the thought that Huhne has trimmed on this out of fear of upsetting that section of activists which still believe that there is nothing wrong with our public services that spending more money wouldn't put right.

Will this do?

No – and for reasons that Huhne knows full well.

If we are going to attract extra support – to become credible – voters are going to need to believe that we have proposals to improve public services. As Huhne himself has accepted, you can't push the tax take much above 40% of GDP, so there are only two ways to provide better public services: grow the economy faster than other parties, or improve the efficiency of the public sector (both is best, of course). (Improving efficiency upsets some people - but it is not about simply cutting costs. It is about providing the scope to keep services up to date).

There are only two available models for seriously improving the efficency of health services. One is to make use of a system of targets to compare performance and spread best practice. The second is to introduce some decentralised control of performance through some kind of market mechanism.

Liberal Democrats dislike the way both solutions have operated in practice – this one included.

Local control would be a good thing. But on its own it is not going to lead to more efficient services. Indeed, it might well lead to more conservative decision-making (where is the local politician who will close even those hospitals that really should be replaced?) it may very well lead to decreased efficiency. If it ever happens, expect to see it accompanied with a similar set of performance measurement to that we see in the NHS at present, or in local government, allowing Whitehall to pressure local politicians into making the unpopular decisions.

So we will need more to say on public service reform – and this is the point on which Clegg's commitment to look further at how public services are delivered is the harsh truth if we are serious about pushing for extra votes. The Clegg proposals for a pupil premium, mini-schools, and increased parental choice is a move in that direction in education (in this case accompanied by substantial extra expenditure).

Whether we have the courage to propose effective measures on health is another matter.

But the NHS would benefit from effective reform. One of the reasons so many small health units have been closing is that the NHS is addicted to large hospital schemes (the way we set up PFI schemes is part of the reason). Other European countries are much more focused on small, flexible and innovative health providers. We are probably already falling behind in ways that we won't identify until far too late – despite all the extra money Labour have pumped into the NHS. Liberal Democrats have everything to gain from an examination of all the options - and nothing to lose from having the debate.