A masterly piece of political game theory

This is a subject of some controversy so please, put aside your thoughts, passions and logic on the subject itself, abortion, and instead just think about the political tactic being employed here.

In general in the US it is the left that is strongly in favour of the right to abort. In general again, it’s generally the conservative right that is against. Also, again in general, it is the left that is in favour of detailed and sometimes expensive regulation of activity and it’s the right which is against. So, what would be a useful political tactic if you were against the general availability of abortion? Quite, regulate it:

The last restriction under the law goes into effect Sept. 1. All abortion clinics at that point must have upgraded their facilities to ambulatory surgery centers. Busby says many can’t afford it and more will close.

“This would basically force all the clinics to become mini-hospitals,” Busby said. “They have to have hallway widths a certain length, and a janitor’s closet, male and female locker rooms, which is completely unnecessary – and a bunch of other regulations that are really not appropriate or do anything to increase the safety of one of the safest procedures in the country.”

Pro-life groups supported the law, saying it would protect women by making abortion safer. At the time of the passage of the law, The Texas Tribune quoted Republican state Sen. Donna Campbell saying: “There’s nothing in this legislation that will close a clinic. … That’s up to the clinic. If they want to put profit over a person, that’s up to them.”

The right has been saying for years that regulations can be expensive and those who would regulate have been shouting that that’s nonsense for the same amount of time. Rather a case of the biter bit.

Sadly, of course, no one is going to learn anything from this. Certainly not those who generally propose regulation: for do note that while they argue that clinics should not be subject to this level of regulation they’re not, not at all, arguing that mini-hospitals can be trusted to work out whether they need a janitor’s closet for themselves. Still regulation for thee even if not for me.

Len McCluskey is not entirely correct about the NHS and TTIP

According to Len McCluskey the upcoming Transatlantic Trade and Investment Partnership is going to mean the end of the NHS. As one might expect from such a source he’s slightly, umm, shading, the reality of what is going on here.

Now Cameron is set on giving these US investors new powers to sue any future UK government if it makes changes to health policy that might stop the dollars rolling in.

The deal will mean that American investors will be able to haul any UK government that tries to reverse privatisation to a tribunal – the “investor state dispute settlement” that would operate outside the law of this land. These tribunals will have the power to award billions in damages and compensation for lost profits and the loss of projected future profits, with no right of appeal. Yes, that is right – no right of appeal.

In short, the British public would face massive costs to bring NHS services back into public hands, making it nigh on impossible.

What is actually happening here is two things. The first being that the investor dispute system under the TTIP is arbitration rather than court action in the state in question. This is for the fairly obvious reason that the disputes will be between the government of the country and the investors and the government of a country controls (well, D’oh!) the legislature of that country and therefore what the law is. And as we’ve seen that’s a very dangerous place for investors to be in. Those who lent money to Greece in Greek law bonds found themselves having a 70% haircut imposed after the Greek Government (and legislature) changed the collective action clauses (what portion of a bond issue must agree to changes in those bonds) after the bonds had been issued and paid for. Those who lent money to the same government but in English law bonds got paid out in full. Because the Greek Government didn’t have the power to change English law in that manner.

We might not think that that could happen in our own dear courts in England and Wales. But this is a deal that includes the entire EU and as we’ve seen this has happened in the past couple of years here in the EU. So what is being offered is legal certainty to investors, that certainty being ensured by insisting that governments cannot change the rules of the game after the whistle has blown. All of which seems fair enough.

As to the second part, what this actually means, it just means that governments must adhere to whatever contracts they sign with foreign investors. If the contract says that it can be cancelled with no compensation to be paid then it can be cancelled with no compensation to be paid. If the contract says that compensation must be paid upon cancellation then compensation (whatever a government might do to change the law later) must be paid.

In this it is very similar to current law on such things as nationalisations for example. Any government is allowed, under international law, to nationalise anything that it might wish to. The UK Government could, if Red Ed were elected to power, simply decide to nationalise all private sector providers of health care and or health care services. Nothing at all to prevent them doing so: but under current law they would have to pay a fair market price for those assets. Under the new TTIP system they would also have to pay a fair market price for them.

The only people who could possibly complain about this would be those who would like to nationalise things without fair market price compensation: you know, thieves.

The whole TTIP system is simply a method by which governments can be forced to stand by the contracts they have signed with people not employed by those governments deciding whether they have or not. Which, given the power that governments do have to confiscate things from people, all seems entirely fair and just.

You can’t save the NHS money by giving lardbuckets gastric bands

Apologies that we have to return to one of our treasured themes here at the ASI. But once again we are seeing the fallacy that reducing the number of fat lardbuckets will save the NHS money. It won’t we’re afraid, it just won’t:

The National Institute for Health and Care Excellence (Nice) has just announced that it is considering lowering the BMI threshold for people with newly diagnosed type 2 diabetes for assessment and referral for bariatric (stomach-reducing) surgery. If this goes ahead, it could mean more than 800,000 additional people qualifying for possible gastric bands or similar treatments.

Perhaps some people out there right now are gearing up to the standard reaction, along the lines of: “Lazy, unmotivated lardarses getting mollycoddled by the state after they’ve stuffed their faces and not exercised. Why should the state pay for that?”

No mention of how losing weight (and avoiding maladies) through such surgery could save the NHS millions and therefore be classed as relatively cost-effective.

The problem with this saving the NHS money argument is that it is simply untrue. For obesity (and we do mean obesity here, not simply being overweight or a bit tubby) kills people younger than they would otherwise have been likely to die. And in a health care system where all medical expenses are picked up by the same organisation a longer life leads to greater total expenditure. This is well known and has been proven:

The actual numbers for lifetime from 20 years old medical costs were:

The lifetime costs were in Euros:

Healthy: 281,000

Obese: 250,000

Smokers: 220,000

This does not, of course, mean that the NHS should not fund gastric bands. We generally think that then purpose of said NHS is to aid us all in living longer and healthier lives so if that’s the appropriate treatment to lead to that desirable outcome then that’s just fine. But we can’t bolster our argument in favour of the procedure by insisting that it will save money. It won’t: if it works it will cost more, not less, over time.

It is this specific argument, the cost saving one, that is fallacious, not all and every argument about gastric bands or, indeed, the NHS itself.

I’m afraid that the latest ONS statistics on health inequality are simply wrong

This is a point that I’ve made before here and it’s no doubt one that I’ll have to make again. The ONS statistics on health care inequality, deprivation and lifespans are simply wrong. Yes, I’m certain that they’ve been accurately collected, that the usual skill and excellence has been used in their presentation. And yet they are indeed wrong for they are not a representation of what it is that they are purporting to be measuring.

Children growing up in the richest areas of Britain can expect to live a full, active life for as much as 20 years longer than their counterparts in the poorest neighbourhoods, an official analysis shows. A generation of young people living in the most deprived areas are likely to see their health effectively broken 15 years before they even reach pension age, it warns. Those from more well-off backgrounds are forecast not only to live longer overall but to enjoy good health for a much larger proportion of their lives. Although it has long been recognised that there is gap between rich and poor in terms of life expectancy, the divide is more than twice as wide when viewed through health expectations. According to the Office for National Statistics, men from the most deprived 10 per cent of the population have an average life expectancy of just 73.4 years, compared with 82.7 years on average for those in the least deprived 10 per cent – a gap of more than nine years.

The full report is available here.

There are two major and two minor problems with the approach being used here. The first major one is that no one at all is measuring the lifespans of those born into or growing up in any area. What is being measured is the age at death of people in a particular area. And, as you might have noted from your own lives there’s not all that many of us who actually die in the area of our birth or childhood. Certainly not at the level of detail that these figures use: the information is collected from 30,000 or so areas, or some 2,000 people in each. I would lay pretty good odds that the vast majority of this country moves more than a couple of streets over their lifetimes. Which means that we might well be measuring something interesting: perhaps the way in which the rich, those with likely longer lifespans as we know, move into less deprived areas over their lifetime as they, well, as they become rich.

This leads onto our second major problem: the way that these figures are interpreted is that it is the inequality and deprivation which leads to the health and lifespan inequality. But we know absolutely that while this could be, probably is, true in part, we also know absolutely that it is not true in whole. For health inequality will also lead to wealth and income inequality. That poor sod permanently laid off sick at the age of 40 just isn’t going to become one of the financial grandees of the country living in a pile in some undeprived area. So some part (an unknown part) of the inequality that we note will have a reverse causation to the one being assumed. Even assuming that inequality (to say nothing of deprivation) causes lifespan inequality, we also know that health inequality will cause income inequality.

One minor problem is the level at which this information is collected. When we’re looking at groups of 2,000 people we really are looking in much too much detail. You’d only need a decently sized old agers home in such a district to rather sway the figures. I can point you to a couple of streets in the centre of Bath with an age profile wildly higher than that of the town or the SW in total. Because they happen to be the couple of streets where a long running (and very good indeed) charity run sheltered accomodation for old folks of the town. And this then brings us on to our second minor problem. The poverty rate (a useful synonym for the deprivation rate) is lower for the old these days than it is for the general population. Thus we would expect an area with lots of old folks to have a lower deprivation rate than one without.

These figures will, as with the earlier ones from the Marmot Report, end up being used to argue that deprivation and inequality kill therefore we must have more redistribution. You can hear the pencils being sharpened for the compsing of the tirades already. But this simply isn’t what the figures are telling us because they simply are not measuring what it is assumed that they are.

No one at all is measuring the life spans of people born and or brought up in different locations. They are measuring the age at death of people in those areas, an entirely and completely different thing.

The NHS is meant to be for patients, not staff

Jeremy Hunt has annoyed people today by refusing to give NHS workers a blanket 1% pay rise on top of the incremental pay rise they were already supposed getting. That’s hardly a surprise: the NHS is a religion, and Hunt’s decision is the equivalent of giving the finger to the Pope. But he’s got a point.

According to the BBC’s Nick Triggle, “all NHS staff will be getting at least a 1% pay rise. Just over half receive incremental pay rises each year – determined by their length of service and performance. Those whose incremental increase is less will have their pay rise made up to 1%, but many will get more. Last year, the average incremental pay rise was 3.5%.”

In other words, today’s announcement means that NHS staff won’t be getting an additional 1% pay rise over their existing agreed pay increases. That’s a real terms drop, but lots of the coverage I’ve seen has suggested that this means that nurses won’t be getting any rise at all.

Remember that real private sector wages have fallen every year since 2010. Public sector workers already have greater job security than private sector workers, so it’s difficult to see why they should be regarded as being automatically entitled to pay rises that most private sector workers aren’t getting.

Obviously, there’s no ex-ante reason NHS staff should get a pay rise. The point of the NHS is to provide care for patients, not to provide welfare to NHS staff. Since the NHS’s budget is limited, a pay rise to staff means foregone spending elsewhere.

It’s worth noting that, at least according to the government, this pay rise would be equivalent to 6,000 nurses. Now, I don’t know how the NHS should spend its money – it may well be the case that NHS patients are better served by additional staff or more investment in medical equipment than they would be by this wage increase. Maybe a pay rise is the best way to improve patients’ outcomes, maybe not.

I’m left wondering why NHS pay should be a political issue at all. In the end, this story just underlines the need for devolution of pay bargaining to NHS trusts. National pay bargaining makes little sense given differing labour markets and patient needs across the country. In other words, a pay rise that makes sense for patients in Suffolk may not make sense for patients in Sunderland. We don’t want Whitehall to determine supplies of medical equipment or the allocation of labour hours between staff. Why should pay negotiations be any different?