The Daily Mail’s actually right about NHS Wales here

It’s ever so slightly uncomfortable top be agreeing with the Daily Mail here as they’re being so nakedly politically partisan about the NHS, the Labour Party and Wales. However, it should be said that they’re actually correct in what they’re saying:

Today this paper publishes the first part of an explosive investigation which blows away Ed Miliband’s claim that his party can be trusted with the NHS.

Indeed, there is no need to imagine how the service might perform under Labour. For the evidence is before us in Wales, where the party has had full control of the funding and management of health care since devolution 15 years ago.

As Guy Adams exposes on Pages 8 and 9, a picture emerges of a Welsh NHS on the point of meltdown, in which the wellbeing and often the lives of patients are routinely sacrificed on an altar of Socialist ideology.

The Welsh NHS has of course complained and the Mail’s response to those complaints is here.

We here at the ASI might not have put all of this into quite such politically loaded terms but the basic critique is correct, in that NHS Wales performs less well than NHS England. And we also know why this is so: NHS Wales has not adopted the last few rounds of a more market based structure as NHS England has. We’ve also known this for some years:

Some would argue that the drops in waiting times were driven by increased spending, rather than targets, patient choice and hospital competition. Hence the fears sparked by the McKinsey report of the possibility of massive cuts in services. However, money alone cannot explain why waiting times have dropped and equity has improved in England. During the same period that we examined waiting times in England in our study, Scotland and Wales, which both explicitly rejected market-driven reforms, have spent more per patient but have seen much smaller decreases in waiting times.

The more market orientated NHS England is both more equitable and more efficient than the less market orientated NHS Wales and NHS Scotland. Indicating that market based reforms are a pretty good idea: whatever that socialist ideology (although to be fair about it, it’s really just an innate conservatism allied with the traditional British dislike of anything that smacks of trade rather than a principled socialism) might have to say about it.

Silicon Ovaries

It’s only apt that Silicon Valley’s new plan to tackle gender imbalance involves cutting-edge technology, a dose of futurism and flash-freezing things in sub-zero temperatures:

Apple and Facebook are offering to freeze eggs for female employees in an effort to attract more women on to their staff, according to US media reports.

Apple, the world’s most valuable brand, said it would offer the perk to US-based staff from January. “We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families,” the company said in a statement to ABC News. “We continue to expand our benefits for women, with a new extended maternity leave policy, along with cryopreservation and egg storage as part of our extensive support for infertility treatments.”

Facebook offers up to $20,000 (£13,000) for egg freezing for female employees. The company also offers adoption and surrogacy assistance and “a host of other fertility services for male and female employees”, the company said. (The Guardian)

Even though the schemes are unlikely to have huge take up, it’s an idea with a commendable sentiment behind it. The tech world is notorious for its lack of female representation and lingering sexism, and women make up only 30% of Apple and Facebook’s workforce. Their support of ‘cryopreservation’ will benefit both the firms and their employees.

It’s damn inconvenient that the years in which women are able to best forge a career are often also those of peak fertility. This not only creates huge opportunity costs when selecting a career/family/income combination, but restricts the pool of talent available to employees. Being able to keep young eggs on ice (and being aided financially to do so) expands the range of work/child  options women have, and makes some of the tradeoffs a little less binary and severe.

 There are a number of ways we try to reduce the ‘costs’ of raising a child, from statutory maternity pay and free childcare to paternity leave and work crèche schemes. All of these actions shift part of the cost of child-rearing from one figure (usually the mother) to another actor, such as the state, an employer or a partner. It’s usually a good thing that these costs are shared out amongst others, but it would be even better if the costs were simply reduced. Something like fertility preservation does that— it uses technology to augment the options available to women and reduces the opportunity cost of pursuing a career— without the need for state intervention, relying on a partner, or for social behaviours and cultural shifts to occur. If a woman voluntarily choses to use her 29-year old self’s eggs at the age of 39, everybody wins.

Of course, Apple and Facebook have chosen to foot the bill here, and no firm should be forced to provide such procedures for their employees. But these leading companies clearly think that $20k is a small price to pay to attract and retain top female talent. Certainly, a firm which signals that it is prepared to help employees overcome obstacles to their life choices (amongst many other generous perks) will be a draw for many, and can help women to achieve the success they’ve always been capable of.

Naturally, there will be those who recoil in horror at the idea of Facebook laying a frosty, calculating hand on their employees’ ovaries. Some consider it a neanderthalic and clumsy way of improving women’s standing in the workplace, whilst others worry that supporting such technology gives a strong and unpleasant message to women that forging a career whilst raising a family is a faux pas.

Cryopreservation’s hardly going to become a mainstream phenomenon any time soon, and for now is only really an option for a small number of women. Were employers to start actively encouraging the treatment or making employment decisions based upon it, then we would need to have a serious conversation about the way in which it was used. Egg freezing’s also in no way a panacea. If Silicon Valley really wants to boost the women in its ranks, there’s plenty of other things which they can do, like offer more schemes for current parents, and foster a more female-friendly everyday culture.

Ultimately, egg storage is another medical innovation which — like the pill— affords women a greater range of life choices. And far from establishing expectations of what a female employee should do with her womb, Facebook and Apple’s support of the proceedure indicates a commitment to heterogeneity and flexibility. It is smart of them to support such a range of lifestyle and career choices, and with luck initiatives like these will help to enrich the lives and bolster the careers of the women who’ve chosen to work there.

The NHS: bread and circuses

Juvenal, as every schoolboy used to know, coined the term “panem et circenses” almost exactly two millennia ago to describe the way politicians bought votes with little regard for important issues of state.

What goes around comes around: this party conference season has seen Labour, Lib Dem and Conservative Parties trying to outbid one another in their promises for the NHS.  I am not suggesting that the NHS is mere entertainment even if party conferences are.  The point is that NHS spending is becoming a bribe in the same way bread and circuses were.

Any amount of money can be thrown at the NHS, just as it could at the Roman games.  And consuming more increases the appetite for more again.  Somehow questions of value for money, compared with other ways in which our money can be spent, need to be honestly and realistically addressed.  Does a Health service need to pay for people’s life choices or how they wish to look?  Does it need to accommodate elderly, but healthy, people who have nowhere else to go?

Does it need to fund legions of lawyers, managers and compensation claims for real and exaggerated errors?  Harold Wilson started this problem in the 1960s when patients became customers and could suddenly claim.  Until then the only customer was the state and we all had to take our chances.

Emotional wool seems to cloud all NHS discussion.  As it is all free to us individuals, we, naturally enough, only want the best even when the merely good would be good enough.  For, roughly, the same treatment, big hospitals cost double cottage hospitals which double GPs.  Scale does have benefits for specialism but also diseconomies. Only the hassle of big hospital visits, and car parking charges. keep us local.

The cutting edges of medicine, technology and techniques always cost more but some means of rationing will have to be found.  Alternatively, alcohol, tobacco and fatty foods should be prescribed as bread and circuses were.  Dying younger would keep NHS costs down and morale up.

The latest attempt from the booze wowsers

We do love this latest attempt at justifying minimum alcohol prices:

Minimum alcohol pricing of 45 pence per unit would be 50 times more effective in targetting harmful drinking than current policies which only ban the selling of alcohol as a loss leader, research suggests.

Really?

Researchers at the University of Sheffield compared the effects of the two policies on public health using a mathematical model alongside General Lifestyle Survey data to estimate changes in alcohol consumption, spending, and related health harms among adults.

What did that model look at?

In their findings, published by bmj.com, they estimated that below cost selling would increase the price of just 0.7 per cent of alcohol units sold in England, whereas a minimum unit pricing of 45p would increase the price of 23.2 per cent of units sold.

They estimated that below cost selling would reduce harmful drinkers’ mean annual consumption by just 0.08 per cent – or around three units per year. By contrast, a 45 pence minimum unit price would reduce consumption by 3.7 per cent or 137 units a year – a 45 times greater effect.

So they plugged the price change into their estimate of the elasticity of demand and found that….wait for it, wait for it….higher prices reduce demand and or consumption?

Gosh, do we really need a team of highly trained and expensive alcohol researchers to tell us that?

Unfortunately this latest paper fails to tell us the three things we’d actually like to know about minimum alcohol pricing.

This first being should we be attempting to reduce consumption in the first place? Current levels of booze taxation more than cover the public costs of boozing. There are, indeed, substantial private costs remaining: but those are being carried by the people doing the boozing which is just where they should be. Is there actually a reason or justification left for public policy action in this case?

The second is whether that rise in prices actually reduces harmful drinking, or just deters the occasional tippler from a small pleasure. There is, after all, fairly convincing evidence that the addict will always feed their addiction while the diletante is more amenable to price signals.

And thirdly, even if the above can be answered in a manner that leads to our wanting to increase the price, why on earth would anyone want to have minimum pricing? Not only is it illegal under EU law but it puts the extra cash into the hands of the retailers and manufacturers. Rather than into the Treasury as would be the case if prices were raised through higher taxation.  Minimum alcohol pricing just doesn’t make sense.

On Ed Miliband’s new tax on tobacco profits

Ed Miliband has decided that there should be higher taxes on the profits of cigarette companies. The argument being that smoking costs the NHS money and that thus some cash should come from the one activity to cover the other. However, that activity of smoking already more than covers the public costs associated with it. As is helpfully pointed out here:

Estimates for the amount spent on tobacco in the UK in 2011 range from £15.3bn to £18.3bn. The cost of smoking to the NHS is put at between £2.7bn and £5.2bn.

The Treasury earned £9.5bn in revenue from tobacco duties in the financial year 2011-12.

When even The Guardian is pointing out the mathematical difficulties with a Labour Party leader’s promises then it would be fair to say that it’s not really going to fly, wouldn’t it?

And that is rather the point about smoking. The activity is already sufficiently taxed that it pays for all of the public costs associated with it and more (and that’s to ignore the fact that shorter lifespans as a result save the NHS money). There are substantial private costs of course: but public taxation isn’t the correct way to deal with such private costs either.