Britain's doctors demand GP appointments be paid for - in cash preferably

Quite obviously medical appointments with a general practitioner are already paid for. It's just that it is via the tax system, the appointment itself being free at the point of use. The British Medical Association - the doctors' trade union - is now insisting that this must change. To a system whereby there is an out of pocket expense to the patient for such a visit.

We think that's a good idea, with the appropriate caps on prices for multiple visits, as we already do with prescription charges for example, and we're quite happy with some to much of the cost still being tax financed. The existence of a price up front does usefully change behaviour however minimal it is.

The above isn't quite what the BMA says but it is clearly what they mean. You know, doctors being bright people and all that, they must have thought this through: 

GPs “will go insane” unless strict limits are imposed on the number of patients they say each day, medics claim.

The British Medical Association has called for a cap on the number of patients, with doctors hailing the system in Sweden where GPs see just 13 patients daily.

Medics said they were too often expected to have up to 70 consultations a day – and said this was not safe for them or their patients.

Dr Satash Narang, from Gwent and South Powys division, said GPs would “go insane, quit and become insolvent” if limits were not introduced.

“For the sake of quality and safety of patient care and the sanity of its troops, we urge the BMA to take a fresh approach by defining and agreeing what is a safe workload,” he said.

Previous research has found the average family doctor sees 41 patients each day.

Such limits would mean soaring waiting times to see a GP.

One solution would be that we have four times as many GPs. No one, no one at all, thinks that's going to happen. It's also not what the Swedish solution is. Not at all. 

In fact, Sweden has fewer GPs per head of population than the UK. They've thus, clearly and obviously, not lightened this workload through increased supply. Instead, they must have - and it is must have - changed demand. Which they have one through changing the price.

For yes, those little charts at the beginning of every economics book are indeed correct, supply and demand curves do work, price is the intersection. We can change the price and so affect supply and or demand just as it's possible to fiddle the other way around. 

A GP appointment in Sweden costs £15 to £20 (200 SEK say). The full cost is about what it is in the UK, £200 or so. We have 100% third party financing through tax, they only 90%. But it's that 10% out of pocket that allows fewer, per population, GPs to have those 13 visits and meet demand instead of our 40 rising to 70 and still not meeting it.

Prices affect demand, d'ye see?

As far as we know there are no complaints about the degradation to the health of the Swedish population this causes.

As at the top, doctors are clever people, they have thought all this through, haven't they? 

Vince Cable wants to steal your money

This isn't quite how the distinguished Solon, Vince Cable, would quite put it but this is what he's intending. That he, or the state, or perhaps even more horrifying the local council, should simply be allowed to come along and steal your money.  

That there might be better solutions to the housing problems is possible isn't it? 

What Sir Vince is suggesting is that councils, or perhaps some new body, should be allowed to purchase land and grant it planning permission. OK, fair enough. He's also insisting upon the ability to compulsory purchase. Well, that's a power which needs to be sparingly used but we can at least conceive of that being at times justified.

Then here comes the theft:

The most eye-catching element of Cable’s speech, among sections released in advance to the Guardian, is a so-called British Housing Company, an arm’s length government agency assigned to acquiring land at low cost.

Using compulsory acquisition powers given by law, the organisation would aim to save money by purchasing land at a price that would not include a hike in value factored in to include possible planning permission.

“The aim would be to acquire sites at a price as low as 40% of land acquired in the open market without paying the ‘hope value’ which attaches to those sites currently earmarked as having development potential,” Cable is to say.

That idea of compulsory purchase is and has to be backed by the insistence that market price will be paid. That hope value is part of the market price. Insisting upon not paying that market price is theft.

It is true that it's annoying to have to pay more for that hoped for value if planning is granted. But then the only reason there is that option value is because we don't grant enough planning. If we did grant enough then the hope value would be nothing.

But then if we issued enough planning to bring the hope value to zero then we'd not need the compulsory purchase, nor the state purchase of the land, as land with or liable to permission wouldn't have a higher value, would it?  

Or, as we might put it, if Vince actually tried to solve the underlying problem then he'd not need to insist upon state theft. Which would be a useful thing to do really, being as we are against both the problems in the housing market and also state theft.

Greetings from Australia!

After moving from Sydney to Perth at the beginning of the year, I became involved in an organisation called Mannkal. This organisation offers many different opportunities to university students and aims to provide a different view point than most of the educational institutions. Myself and two other students from Perth have made our way to London to intern for two months with the others interning at the Centre for Policy Studies and the Institute for Economic Affairs.

Being new to neoliberal ideas, I was drawn to the Adam Smith Institute and their range of publications and opinions. I was also drawn to London due to the excitement and uncertainty of Brexit negotiations and how this will end up shaping the future of the UK. As an Australian, I am particularly interested in the renegotiation of immigration policy. Separation from the European Union allows for a closer relationship with Australia and the UK may be more inclined to strengthen this relationship.

Last week saw the completion of my Commerce degree and now, thanks to Mannkal and the ASI, I’m interning here for the next two months. I believe this will be a great opportunity for me to use the knowledge that I learnt in my degree and draw on my interest of a freer society for all. I am very excited to start my next educational journey and career in a place that has such a significant influence within the UK and worldwide.

Those poor children working in the tobacco fields

The Guardian wants to tell us of the horrors of child labour. Fair enough, we're against it too. They are looking specifically at that which takes place in the tobacco fields. Which seems an odd thing to be doing as much to most of what then same newspaper recommends increases the poverty of those who grow tobacco.

The children working the tobacco fields: 'I wanted to be a nurse'

Children in poor families work the fields in Malawi, impacting schooling, reports Sarah Boseley, amid signs of a growing international crisis. 

Poor rural children do work in the fields. That's what poverty means, having to work rather than something better, like going to school. This was true of our forbears when England was as poor as Malawi is now. It's true of all other places as poor today as well.

Quite why tobacco is singled out we're not sure. Because they most certainly don't go on to point out how public policy more generally makes this all worse. Malawi itself gains tax revenue from tobacco exports. The sales price is of course set by the international market - that tax comes from what the producers, the farmers, would have got. Yes, export taxes - unless you've a global monopoly - are incident upon the producers, not the buyers.

We in the consuming nations also tax tobacco highly. We may have good reason to as well but there's no doubt that our doing so reduces those rural incomes. UK alone tobacco duties are more than Malawi's entire economy. Further, even while w tax the EU offers growers within the EU subsidies. One calculation insists that such are, per pound grown - just the subsidies that is - higher than the market price Malawians receive.

Our actions are increasing this poverty which is being complained about.

All of which is interesting but not really the point. So, what o we do about it? Well, obviously enough, try to make Malawi richer, so that there are no children poor enough that they must work in the tobacco fields rather than going to school. Fortunately we know how to do this, neoliberal globalisation.

Other parts of this reporting insist that there are similar problems in Bangladesh. Which there may well be. But Bangladesh also has those clothing sweatshops where people stitch our £1 t-shirts for £50 a month. As Paul Krugman says, this isn't great but it's better. And it isn't the children of those sweatshop workers out in the tobacco fields, they in school instead.

We've thus got a solution. We should be buying things made by poor people in poor countries, that neoliberalism and globalisation. This makes them richer.

Ah, but The Guardian is against fast fashion, cheap labour and sweatshops, isn't it? Which is a bit of a problem, as they're against the solution to their complaints. We at least are recommending something that obviously works... 

To apply a little bit of Bernard Levin to the passing scene

Bernard Levin had a concept he called the sieve of history. We continue to perform, view, adulate, the great works of art of the past not because they reflect the time and place of their creation. Nor because of current fashion. Rather, because they have indeed passed through that sieve and shown that they are indeed great works of art.

Not that the movie was quite right but Mozart is indeed a better composer than Salieri, despite what the fashions and money flows of the time might have indicated. The historical Salieri knowing this very well of course.

The drive to rid schools of “dead white men” like Shakespeare will leave children at the mercy of fads and fashions, Jenny Agutter has said.

The veteran actress urged teachers not to remove literary greats from school curricula on spurious grounds.

“Definitely don’t remove someone who is dead and white just because they are dead and white,” she told The Telegraph.  

“That is pigeon holing and shouldn't be allowed. There are French writers who are dead, there are Greek writers, there are all sorts of people who are dead but one doesn’t want to put them in that category.

“My feeling is that the best writing crosses time and social backgrounds. No one should be classified as black, white, dead or alive if the writing is good.”

While it is important for children to learn about writers from different backgrounds and countries, “we must not lose our literary heritage”, Agutter said.

Othello and Desdemona can, if we wish, be viewed as a musing on the difficulties of inter-racial marriage - something that certainly accords with current preoccupations. But to do so is to miss that it's a great exposition of the difficulties of jealousy, one of the human perennials. 

We can also - and we do - run this the other way around. It's not just that what were considered great works are, some mote of flour might, over the years, become recognised as a great as it wasn't in its own time. It's still too early for A Confederacy of Dunces but it's a strong contender.

What is a great work of art is, therefore, something emergent from the system - something you'll note is a preoccupation of ours, systems and emergence. To complain about what has emerged is an exercise in missing the point therefore.

One point of the current complaints we do agree with though. That classic canon survives as such, has become such, because it does speak to those great human problems and emotions that are common to us all across time and geography - race and culture too. Where we agree is that each modern work should indeed be accorded the same consideration as to whether it's to be included in that canon of the future. Exactly what the sieve will achieve whatever we do otherwise of course. 

Or as another of our preoccupations might put it, equality of opportunity is the aim, not equality of outcome.

Gosport Memorial Hospital shows that Friedrich Hayek was right

There's nothing that will produce more gales of laughter at a meeting of the bien pensants than Hayek's idea that the NHS would lead to serfdom. What? Government provided health care will lead to anything other than a properly planned and efficient health care system? Nonsense, eh, and then the entire argument Hayek actually made is suppressed in gales of giggles.

The argument he actually made simply being that to give the state power over us gives the state more power. If we have government running health care then our health care will be under the control of the state, the politics and politicians who drive said state power.

At which point we get:

Exactly the same cause of death was routinely given by those doctors involved in the “life-shortening” of the mentally incapacitated in Germany in 1939-41. This programme of extinguishing what the Nazis termed Lebensunwertes Leben (life unworthy of life) came to an end when another bishop — Galen of Münster — heroically thundered from his pulpit that fellow citizens were being eliminated merely for being a burden to society, as if their lives had no intrinsic value.

And yet more than 50 years later the same chilling disregard for the intrinsic value of life, however “difficult”, was manifested in an NHS hospital. Is Gosport an isolated case? I wouldn’t count on it.

(That's paywalled, an open discussion here.)

Gosport Memorial Hospital, a part of that NHS, was routinely killing people by overdosing them on opiates. Because, you know. No, really, that was the reason given.

As Hayek might have put it, the difference between socialist and national socialist state power over our lives isn't all that great. Their controlling health care does indeed lead to this serfdom where our very lives are in their gift.

But is is to laugh that this could possibly be true, isn't it? The difficulty being that Hayek was in fact right.

Having given the state control of health care we find that the national religion is topping us left, right and centre for the reason of being a little inconvenient to the state and or its avatars.

Having ignored the warning what do we do now?

Doesn't this just illuminate those social mobility statistics

There is much shock horror as it is said that white working class communities, families, might not have quite the ambition and drive for their children as is evident among migrants. There's a little caveat to apply here, given which it doesn't seem that remarkable. An then there's that effect upon those social mobility statistics:

White working-class children have fallen behind because their families can “lack the aspiration and drive seen in many migrant communities,” according to Amanda Spielman, the chief inspector of schools in England.

The caveat there is "many." Certain immigrant groupings - we dislike this talk of "communities" of such - do indeed appear to have a certain driving ambition for their children. That all will become doctors, pharmacists, engineers- secure and well regarded professionals. This has always been so of course, the jokes about the Jewish mother desiring that a son be a doctor or a daughter marry one are at least a century old. That migrants might have this, well, why do people migrate? In order to make life better for their children is a pretty obvious incentive, isn't it? 

Certain other such groupings perhaps don't have that same cultural drive. Shrug. People are as people do.

However, that implication for the social mobility statistics. If there are certain portions of the country that don't have that drive and ambition for their children then in those sections there's unlikely to be all that much social mobility, is there? Rather Shakespearean, the fault is not in the stars - the external environment - but in ourselves. 

As ever, the identification of the cause is important to solutions. For if this really is about the internal family dynamics of some sections of the British white working class then all the usual suspects - income inequality, capitalism itself, the iniquities of neoliberalism - aren't the cause, are they?  

We'll not try to insist upon this diagnosis of the base problem being correct. But we do insist that if it is then near all the plans currently being pursued - even the basic whining about the problem itself - to increase social mobility are wrong.

Maybe the Asda Sainsbury's merger is a good idea, maybe it isn't, but...

We have no particular view on the Asda and Sainsbury's merger. Consolidation in an increasingly competitive market doesn't surprise us and it's something which sometimes works, sometimes doesn't. We are though surprised at some of the reasons offered as to why it might be a bad idea. Take this from Neil Parish MP:

 In a bruising session on Wednesday morning, Neil Parish, chair of the parliamentary environment food and rural affairs committee, told Asda’s chief executive Roger Burnley there was “no logic to this deal other than a financial fix for both of you”.

Finance is fairly important to capitalist organisations. Even to retail chains as House of Fraser, Poundworld, BHS and others have recently demonstrated. But it's this:

He said the companies were also likely to reduce staff at head office further down the line.

“You are going to run two separate things?… it’s unbelievable,” he said. “This is baloney … Six months or even a year further down the road it is going to be one system.”

Saving on bureaucratic and management overheads is a bad idea? We should be insisting upon companies having more people at head office? 

Yes, obviously, there's the amusement at watching a farmer who has played politics for a few decades arguing business strategy with experienced CEOs. But getting the basic worldview so hopelessly wrong isn't amusing. The aim of all production being to destroy the jobs associated with making or delivering whatever it is. This reduces the costs of doing so and also frees up said labour to go and produce some other good or service. Increased labour productivity is, after all, the major determinant of future living standards.

We had to look this up but Mr. Parish is apparently a Conservative MP. Aren't we entitled to have at least those au fait with the reality that jobs are a cost, not a benefit, of production?

It's Cost of Government Day

Each year the Adam Smith Institute calculates Tax Freedom Day. It’s the day of the year when the average Brit has stopped working for the taxman and started working for themselves. This year it fell on May 29th (the latest it’s been since reliable records begin).

But so long as the Government runs a deficit (and according to the independent OBR they won’t stop until 2031), we’re merely storing up tax liabilities for future generations.

That’s why we also calculate Cost of Government Day, which just so happens to fall on today (21st June). For Cost of Government Day, we include deficit-financed government spending. That’s because when the government borrows money it must ultimately be paid for.

While Tax Freedom Day has gradually got later as the UK recovered from the financial crisis, the opposite has been the case for Cost of Government Day. It now falls 29 days earlier than it did in 2010, as the Government’s austerity plans have reduced the overall size of the state.

The gap between Tax Freedom Day and Cost of Government Day is narrowing too. Cost of Government Day came 65 days after Tax Freedom Day in 2010, but is only 23 days later this year.

As we always try to make clear, Cost of Government Day is a projection. If borrowing is lower than expected, as it seems to be, then Cost of Government Day may have come earlier this year.

But the prospects of Cost of Government Day continuing its downward trend seems unlikely with the Government announcing plans to increase NHS funding by £20bn. Whether it’s funded by higher borrowing or higher taxes it’ll mean the true Tax Freedom Day will come even later.

So the new economics is just like the old, just worse

The Guardian treats us to a story about how just regular everyday people are learning economics. Excellent, we approve. Knowing more means that they - whoever you like to think of as they - are less able to pull the wool over your eyes.

We thought we'd investigate what is in this new economics though. Following links through the site near at random until we came to something of interest.

Time banking. Why not trade time with each other rather than money? Sure, OK, why not? Obviously this is something that the old, boring and standard economics has looked at. A reasonable summation might be that time banking, by the nature of it being near always with people you know, or share a small community with, is a Polanyi style market. As opposed to a money based on, something we might call more Smithian. 

There are indeed advantages and costs to each. Polanyi was quite insistent, as are many who currently recommend such, that this web of local obligations produces that community feeling which is of such value. The Smithian alternative emphasises the manner in which cash is anonymous and works over long distances, allowing that division and specialisation of labour among the billions of us. That latter makes us richer even if not on that community sense.

Our preference is that people get to do whichever they want whenever - you know, we're liberals.

So, the new economics on time banking:

Time banks are growing and remain an interesting alternative to the market.

Ahh, the people doing this educating are ignorant of economics, aren't they? Time banking isn't an alternative to the market, it is a market. We're just using a different method of registering who has a claim on the time or assets of another. We're using that central register, rather than the distributed one of who has the pieces of cash.

Whether people are trading favours, services, time or labour, it's a market, isn't it? The intervention, or not, of cash and money can make that market work better - worse if you're seriously communitarian perhaps - but it's still a market.

So, the New Economics, just like the old but with added ignorance. This might not be a major advance in our civilisation.