Similarities between the Tory and Labour plans for the NHS mask the Tories' big idea—a subsidyfor patients who choose to go private. Nicholas Timmins reports

The conventional wisdom in much of the media is that there is not much difference between Labour and the Conservatives when it comes to the NHS. Both are fighting over whether the extra NHS spending since 1997, a doubling in cash terms by this year and a near doubling in real terms by 2007-8, after discounting for inflation, has been wasted. They battle jointly over access, choice, waiting lists, and bureaucracy in remarkably similar language and, in some areas, remarkably similar policies.

But that is to miss two absolute firsts. For the first time since the foundation of the NHS in1948, the Conservatives are going into a general election with spending promises that, at least at the time of writing, stretch further into the future than Labour's. The second, against this apparent total commitment to the NHS, is an opposite—a promise to break with more than 50 years of history and to offer patients and the private sector a direct subsidy if patients choose to leavethe NHS and go private.

The first is a measure of how far Labour has won the battle over the need to increase NHS expenditure. There may be doubts over whether the extra spending has produced enough improvement. Butthe Conservative plans to match Labour's spending …