The political right and a vision of Britain.
If Cameron loses IDS and Johnson together with their Tory chums on the hard right of politics will take over the parliamentary party.
This is something that they seek to come to pass. Many also seek to remove the social welfare model altogether.
Brexit will have many unseen consequences. That is because the support for Brexit principally comes from the right of UK politics. Not the centre ground where most people inhabit. They are being led astray and will regret it.
The Tory leader says it is 'futile' to continue to pour billions of pounds into a system that is crying out for reform.
In a landmark document setting out an alternative vision for the health service, Mr Duncan Smith says Labour's tax rises have made little difference.
'The problems of the NHS are not just a matter of money, it is the system that is failing,' he says. 'Despite increasing taxes by £100billion since they came to office, they have failed to deliver any significant improvement.'
The Tory report says that overall UK spending on health still lags behind Europe.
Although spending in Northern Ireland and Wales is 9.2 per cent and 9.1 per cent of gross domestic product, putting them almost on a par with France, the UK as a whole reaches only 6.8 per cent.
But waiting lists are even worse in Northern Ireland and Wales than they are in England, says the report, which shows that performance depends not on money but on how systems work.
'We could spend as much as France or the Netherlands and still not enjoy the quality of care they provide, because this Government refuses to change the way the NHS is run,' Mr Duncan Smith says.
'Britain is stuck with a 1940s solution to 21st century problems.'
Labour's targets of matching European spending were doomed to failure if they were not accompanied by reform of the system, argues Mr Duncan Smith.
He adds: 'We must have a system based on need, not on the ability to pay. But that need should be defined by patients working with doctors, not by politicians.
'Above all, we owe it to the most vulnerable - the elderly, the sick and the poor - to renew the promise of the NHS and to make it fit for the century we live in.'
Labour claims that the Tories are planning a two-tier health service, based on ability to pay.
But this is dismissed in the report, called Alternative Prescriptions, which hints at a possible switch to a social insurance system similar to those used in France, Belgium and Germany.
It says these are fairer than Britain's fully tax-funded system, which forces people stuck on waiting lists to pay extra to go private.
Social insurance involves contributions from employers and workers funding health insurance. It is usually compulsory, and paid at a flat rate regardless of an individual's health.
The report says a move towards this would not necessarily create a two-tier system.
Mr Duncan Smith insists that he believes in a system that is 'available to all on the basis of need'. He says: 'Our goal is to make the NHS the best health service in the world.'
But the Conservative vision marks a move away from the post-war consensus on health. It clears the way for a radical Tory system involving a mixture of state funding, social and private insurance and voluntary provision.
The report says the nearest equivalents to Britain's NHS were the systems in the former communist countries of Eastern Europe.
Like us, their health services were funded 100 per cent by tax. But now even Hungary, the Czech Republic and Slovakia have moved successfully to mixed health care economies.
In preparing the report, shadow health secretary Dr Liam Fox travelled the world talking to doctors, nurses and hospital managers.
It says that survival rates in Britain for certain illnesses are among the worst in the civilised world. For ovarian cancer, for example, survival rates across Europe are 20 per cent better than in Britain and 50 per cent better in America.
For prostate cancer, the rate is 33 per cent better in Europe and over 100 per cent better in America.
People in the UK are also among the least happy with their health system. More than 40 per cent are 'very or fairly dissatisfied'.
In Austria, Belgium, Denmark and Finland, by contrast, less than ten per cent of people are dissatisfied.
Mr Duncan Smith says: 'In Germany, for example, the idea of national waiting lists is unheard of.
'In Denmark, people have a legal right to treatment within four weeks from their first GP appointment.
'Compare this with a 15-month "target" in Britain, counted from the time patients finally manage to see a consultant.'
Shadow chancellor Michael Howard says the Tories were learning from other countries but had not yet decided on whether to back a social insurance-based system.
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