The Sketch: It's hard to think clearly when you're drowning in alphabet soup

I've always been very clear on that," Andrew Lansley told the House. It was so untrue. He's never very clear, not about anything. He knows too much. He wants us to know he knows too much. He gives us the background, the foreground, the underground to every question.

"And another thing," he says, when you're already lost in the thickets of the SHAs, PCTs, ISTCs, the CAUCs. He is the reason why his reforms – most of which seem perfectly sensible – are deemed to be odious heresies.

He looked all right during Health questions, almost heroic. The Tory right gave him covering fire, lobbing pro-competition questions at him and insulting "our flip-flopping Coalition partners". He answered in a polite, sturdy way; if not victorious, at least undefeated.

But he's what politicians look like even when their head is actually on the chopping block. That expression of absent grandeur may very well be the shape his features fall into after the axe has done its work.

He was giving guarantees. This was mocked by that angry sixth-former on the opposition frontbench. She harangued Lansley for the massive increase in waiting times; he quoted figures showing waiting times had fallen. Health statistics being what they are, no one believed either of them.

But it's all his own fault. There are any number of persuasive themes with which he could concentrate support, but here are three. One: "I know you are, but what am I?" – when accused of being a privatiser. This is childish but unanswerable. The Tory proposals originated with Labour. Lansley will acknowledge this only when desperate. It should be a big, open, generous assertion.

The second argument appeals to Third Way enthusiasts. If a private company can match NHS standards and prices a patient should be allowed to choose it for the treatment. Lansley repeated this in terms so careful, so cautious, he seemed to be hiding something. But a third of the country instinctively likes it and another third would come round to it.

The last approach appeals to theologians – and considering the NHS is now the national religion, that means all of us.

It's not so much reform as the Reformation. Instead of taking papal instructions from the Vatican offices of Whitehall, individual GPs will now have a direct relationship with the modern God (money). If they err they'll be punished by having to live with their consciences.

Okay, yes, it's the weakest argument now I look at it. But at least it means something to someone.