Comparing apples to apples: NHS still ranks below average

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Most healthcare reporting is deeply biased. From blogs to papers to policy, most people have strong preferences for different kinds of healthcare systems that they believe to be ‘the best’, often based on what they view the role of the state to be. Obviously some beliefs are grounded in more facts and stats than others, but given how complicated healthcare systems are, it’s possible to come up with all different kinds of conclusions that appear, at least on the surface, like they’re grounded in fact. Compare, for example, The Commonwealth Fund 2014 report to the 2014 European Health Consumer Index: two studies that compare international healthcare systems. Both published within one year of each other, The Commonwealth Fund ranked the NHS the best healthcare system out of 11 countries, while the EHCI threw it down the list, ranking it 14th after all your obvious competitors, including The Netherlands, Switzerland, Germany, but also after your less obvious contenders, like Portugal.

Both reports appear to be thoroughly researched and have lots of numbers to back them up. So who do you believe? Well, if you favour single-payer health systems, you're probably going favour the Commonwealth Fund's report, which inherently favours centralised systems. (For example: out-of-pocket costs and insurer rejection of full cost reimbursement were considered a black mark against a healthcare system, regardless of access to treatment.) If you rank results higher than the principles around who delivers healthcare or who makes a profit, you're probably going to favour the EHCI's report, that gives more weight to things like waiting lists.

I personally give more credit to the EHCI report because my primary concern when it comes to healthcare systems is patient outcomes. That’s my bias.

Which is why the OECD’s healthcare efficiency reports are so important. The OECD’s stance is that “there is no “one-size-fits-all” approach to reforming health care systems. Policymakers should aim for coherence in policy settings by adopting best practices from the many different health care systems that exist in the OECD and tailor them to suit actual circumstances.” So while the OECD does make some comparisons of countries across the board, it also intentionally group countries together based on different kinds of healthcare systems in order to compare like with like.

Specifically, they break countries down into six groups to compare the efficiencies of similar healthcare institutions to each other, in an attempt to identify where the most improvement can be made within specific systems:

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The UK falls into Group 6, which is characterised as:

Mostly public insurance. Health care is mainly provided by a heavily regulated public system, with strict gate-keeping, little decentralisation and a tight spending limit imposed via the budget process

Seven countries fall into this category: Hungary, Ireland, Italy, New Zealand, Norway, Poland, and the UK. The OECD uses nifty radar charts (click on links) to illustrate how each country compares to both the OECD average as well as Group 6’s average in different areas including efficiency and quality, amenable mortality, prices, resources, consumption, financing and policy. The final chart ranks each country’s to measure its comparative efficiency. The results:

High DEA Score: Norway, Italy Above Average: Poland Average: New Zealand Below Average: UK Low: Hungary, Ireland

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The OECD’s analysis: “The quantity and quality of health care services (in the UK) remain lower than the OECD average while compensation levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems.”

On Tuesday I noted that the UK is one of the OECD countries that could do the most to improve its efficiency in public healthcare spending . But breaking that down even further, the UK doesn’t come close to topping the charts in its own group.

Perhaps the UK should be looking to make improvements to resemble Norway, which tops the ranks for public health services. Or maybe it should be looking towards other categories that focus on social insurance systems. Either way, it's time for the UK to start looking beyond the NHS.

LFTRs: The Future of Green Nuclear?

The nuclear industry is abuzz with talk of an avant-garde next-generation nuclear concept, pundits are chattering and governments are starting to show interest; advocacy for thorium is gaining traction and LFTRs are stealing the show. Some, such as fervid thorium exponent Kirk Sorensen, are proclaiming this technology to be the innovation that revolutionises our approach to energy and invigorates our fight against climate change.[i] So, what is thorium? Naturally-occurring and frequently accommodated in amalgams of rare-earth metals, thorium is typically present in the single isotopic form Thorium-232.[ii] It was uncovered in 1828 by Swedish chemist Jons Jakob Berzelius, who, rather imaginatively, named it after the Norse God of Thunder, Thor. Experimentation into the utility of thorium as a nuclear fuel has been relatively unsystematic and underfunded over the past 60 years. Noteworthy examples include investigation into the efficacy of thorium based fuels in Pressurised Heavy Water Reactor 'Candu' units at Canada's AECL Chalk River Laboratories; designs for a thorium fuelled Advanced Heavy Water Reactor in India — construction of which is envisaged for 2022 — and the intermittent operation of a High-Temperature Gas-Cooled 'Dragon' Reactor in the UK, between 1964 and 1973, for a total of 741 full power days. However, it is a series of projects conducted throughout the 1960s at the Oak Ridge National Laboratory in the USA that appeal most strongly to the contemporary imagination.[iii]

The ORNL erected a 7.4 megawatt — a megawatt is equivalent to 1 million watts — prototype Molten Salt Reactor, utilising U-233 as its principal fissile driver; Molten Salt Reactors that utilise fissile thorium are known as Liquid Fluoride Thorium Reactors (pronounced 'lifter' in acronymic form, LFTRs are the most exciting thorium concept and as such shall be the focus of this essay). To elucidate the basic mechanics, LFTRs are bifurcated into two compartments: the reactor core and surrounding thorium 'blanket'. Within the core, isotopic uranium U-233 fissions to expel neutrons, which then exit the core and fuse with fissile Th-233 in the 'blanket'. The fusion with neutrons results in Th-233 transmuting to U-233, which is then transported into the core and fissions to propagate the process — LFTRs 'breed' fuel because of the neutron-dependent transmutation that occurs.

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The technical superiority of LFTRs, relative to conventional nuclear, is conferred by numerous structural refinements. Amongst these, automatic temperature regulation nullifies any requisite for control rods or an active cooling system, as in conventional reactors. To be precise: the molten salt is expanded by heat generated through fission in the core, thus retarding the rate of fission. Conversely, if more power is demanded from the reactor, more heat energy is extricated from the saline and the returning cooler salt augments the rate of fission. Overheating is only conceivable if the flow of molten salt is disrupted and heat energy is agglomerated in the core; yet even this hypothetical is liable to a self-checking mechanism: surfeit heat will melt a solid salt freeze plug, allowing the liquid fuel to safely decant into a drain tank.

The reactor is sustained at atmospheric pressure throughout operation; fluoride salts boil at approximately 1400°C, so needn't be pressurised to retain their liquid state. In a conventional Light Water Reactor, water undergoes intense pressurisation to inhibit extrication into a gaseous state — a consequence of which is the requisite to construct highly pressurised containment facilities. LFTRs obviate this bloated hindrance: reducing size, danger and enhancing aesthetics. The fuel in a Molten Salt Reactor is, obviously, molten, so cannot melt-down in the same way that solid fuel in a LWR can. In the rare eventuality that a LFTR is the object of military/terrorist hostility, the liquid fuel would only contaminate the immediate vicinity, leaving the environment largely unscathed. The products of fission would remain in the saline as stable fluorides, and the construction of a rudimentary protective encampment around the plant would inhibit soil leaching.[iv]

LFTRs can be compact, permitting effective operation in inaccessible locations (country towns, military bases, research camps etc). It's even possible to construct Small Modular Reactors at a central site and then assemble them at the desired location — or, to amalgamate them into a more potent productive unit. Unlike conventional LWRs, LFTRs do not require water to be supplied throughout operation, thus negating the requisite for supplementary infrastructure. As such, it becomes viable to locate them in more densely populated areas. Conventional nuclear produces large quantities of radioactive waste, but LFTRs allow you to siphon-off waste products and reprocess transuranics — all the thorium can be fissioned.[v] Although it's true that LFTRs produce radioactive fission products, only 17% of these have long half-lives — approximately 300 years — and LFTRs are spectacularly more efficient than LWRs: utilising 98% of fuel rather than the traditional 2%. Not even the waste products go to waste, because they accommodate a wealth of valuable industrial compounds. Plutonium is not produced, making it exceptionally challenging to construct nuclear weapons. Even superfluous heat energy needn't go to waste: if redirected, it can feed industrial processes like water desalinisation and hydrogen production.[vi]

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The structural superiority of the LFTR is compounded by diverse economic advantages. Thorium is three times more abundant in the Earth's crust than uranium, with the largest known deposits in Australia, India, Norway and the USA. Remarkably, the energy in 5000 tons of Thorium would satiate world energy demand for an entire year — and there are 44 million tons of Thorium in the world! A LFTR produces the same quantity of energy from 1 ton of thorium as a LWR does from 250 tons of uranium; and LFTRs, being substantially safer than conventional nuclear, would be capable of jettisoning much of the burdensome regulatory stipulations imposed upon contemporary plants.[vii] According to www.thorium.tv: 'you might be able to go as low as $220 million or below, if 80% of reactor costs truly are attributable to expensive anti-meltdown measures'. By ameliorating the often painful start-up costs, LFTRs could act as a beacon for international capital, allowing for the rapid establishment of a multitude of plants and swift absorption of market share.

Following commercialisation, annual operating costs would nosedive, further incentivising ownership and construction: 'Current operating costs, ignoring fuel costs, for a 1-gigawatt plant are about $50 million/year. With greater automation and simplicity in Generation IV plants, in addition to more reasonable safety and security regulations, this cost will be decreased to $5 million/year' — even fuel will be cheaper: 'Fuelling a 1-gigawatt uranium plant today costs $30 million/year. Fuelling a 1-gigawatt thorium plant will cost only $1 million/year'. Plant ownership would be highly proficuous, and energy consumption more affordable: 'over a 60-year operating lifetime, both plants produce 60 gigawatt-years of power. The total cost for the uranium plant is $4.9 billion, at a rate of $81.6 million per gigawatt-year. The total cost for the thorium plant is $490 million, at a rate of $8.16 million per gigawatt-year. Thorium power makes nuclear power ten times cheaper than it used to be, right off the bat'. Unfettered by the requisite for water transferral and protective encasement, and with fewer transuranic disposal costs, LFTRs are highly economical.[viii]

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Besides the aforementioned benefits, the greatest potential of LFTRs lies in the low-emission sourcing of energy. We need to be pragmatic about the transition to clean energy: renewable is promising but inchoate, and nuclear has the industrial horsepower to effect serious change.

With public support and private ingenuity, the 35% of British energy provided by nuclear and renewable could usurp the 37% share of oil, and eventually the remaining third of market share held by natural gas.[ix] Yet, it's important not to become myopic in focusing exclusively on hypothetical environmental benefits, for this risks overshadowing broader implications. Much global conflict is fought over finite energy resources, so, it's imaginable that a superabundance of affordable and sustainable energy would precipitate an age of heightened stability, energy independence and national security — there would be less war and more prosperity. The inextricable correlation between abundant energy and higher living standards means that a stable energy supply is a requisite of future economic growth; modernisation on this scale would widely extend the reach of capitalism in raising people from perdition in the depths of penury. On a symbolic level, it would transform our relationship with the planet, heralding a shift towards a more symbiotic future.

It might strike you as being rather bizarre that governments are only just apperceiving the benefits of green nuclear, but a miserable, stultifying confection of radiophobic media bias, wincingly high research costs and Big Nuclear's vested discouragement — LFTRs would render all exorbitantly pricey uranium plants — in which corporations have large sunk costs — superannuated and obsolete — have made investment impolitic until now. Despite all this, we probably would have had functioning MSRs operating around the world by now if the Nixon Administration hadn't jettisoned the thorium project at ORNL in the 1960s; ironically, it was one of the benefits of thorium, the conspicuous absence of plutonium production, that the administration perceived to be a weakness — the DoD was seeking to use nuclear power to foster its domestic nuclear armaments programme.[x] Political expediency has since resigned any aspiration of resuscitating the research programme to destitution in the graveyard that is the government archives. Only in the USA — and more recently China — have government research budgets had the available funds to finance a serious thorium research programme; so, to put it simply, no one has been willing to foot the bill — it's a classic case of short-terminism triumphing over prudence. What about private firms? Only established energy companies would be able to raise the capital, and every energy company interested in nuclear is already a stakeholder in conventional uranium reactors[xi]: what's the point of sinking money into research for a decade, only to have the eventual conclusion of that research invalidate your principal market assets? Energy companies need to sell the nuclear energy produced — technically converted from chemical to electrical energy, 'produced' may invoke the erroneous notion of energy being generated ex nihilo — by current reactors to justify the massive capital costs associated with establishing those reactors: for firms with a vested interest in conventional nuclear the development of thorium is unneeded and may actually pose an existential threat to their market share (smaller firms have tried, but the fiscal horsepower is lacking). Disparate incidents — Castle Bravo, Chernobyl and Fukushima being the most memorable — have caused the public and media to perceive nuclear with gratuitous cynicism. Less than 40% of people in the UK and US are supportive of nuclear power — in countries like Germany that dips as low as 7% — and this is as much the product of sensationalist journalism as it is general ignorance.[xii] Contrary to popular belief, nuclear power actually obviated an average of over 1.8 million net deaths worldwide between 1971-2009, due to the preclusion of burning fossil fuels to supply this energy and the decreased air pollution and green house gas emissions that ensued[xiii] (that's just conventional nuclear, imagine what thorium would do). A sad series of unfortunate coincidences have culminated to relegate this visionary technology to the slideshows of conference power-points — until now.

Despite an ambitious grassroots campaign in the USA to promulgate awareness, much of the intrigue surrounding thorium has been engendered by the Chinese government. The ravenous Chinese industrial economy demands fuel, lots of it, so their government is frenetically sinking billions into exploring a diversity of conceptual energy sources. Their home-grown thorium research initiative has been expedited, with the aspiration to construct a 2MWt pilot plant (Thorium-Breeding Molten Salt Reactor - Liquid Fuel) by 2018, a 10MWt experimental reactor by 2025 and a 100MWt demonstration plant by 2035. 750 staff will be employed by the project by 2015 — which is a lot as research projects go — so it's fair to say there's no deficiency of enthusiasm for it. In nuclear-averse Norway the opportunity has proved too good to pass up, and private research is underway at the Halden Reactor Project. Having withheld its signature on the Treaty on the Non-proliferation of Nuclear Weapons, India has faced difficulty in importing uranium to fuel their current fleet of nuclear reactors, so aims to construct a Heavy Water Reactor capable of utilising their extensive domestic thorium reserves. It's reasonable to posit that the USA will eventually join in: forecasts reveal that domestic coal production will decline over the next decade, and LFTRs would be an intelligent substitute. So, the future of energy is at a crossroads: we either turn a blind eye to pioneering green nuclear technology and go it alone with renewable, or, we adopt a mixed, pragmatic approach, and permanently refashion mankind's relationship with the planet.

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[i] http://www.forbes.com/sites/kirksorensen/ [ii] http://www.ncpa.org/pub/ib149 [iii] http://www.world-nuclear.org/info/current-and-future-generation/thorium/ [iv] http://www.the-weinberg-foundation.org/wp-content/uploads/2013/06/Thorium-Fuelled-Molten-Salt-Reactors-Weinberg-Foundation.pdf [v] http://www2.hmc.edu/~evans/LamThorium.pdf [vi] http://thoriummsr.com/intro/pros-and-cons-list/ [vii] http://en.wikipedia.org/wiki/Thorium [viii] http://www2.hmc.edu/~evans/LamThorium.pdf [ix] http://www.eia.gov/countries/country-data.cfm [x] http://thedigitalfirehose.blogspot.co.uk/2013/09/why-are-we-using-uranium-instead-of.html [xi] http://en.wikipedia.org/wiki/List_of_companies_in_the_nuclear_sector [xii] http://www.bbc.co.uk/news/science-environment-15864806 [xiii] http://climate.nasa.gov/news/903/

UK poverty is rising we're told: they're wrong

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We're told today that poverty is rising in the UK. Apparently the baby eaters have decided to push into destitution yet ever more of the inhabitants of this sceptered isle. On the grounds, presumably, that they just hate poor people. This is not in fact true and this report doesn't show anything like that happening either:

Poverty in the UK is increasing after two years of heavy welfare cuts have helped to push hundreds of thousands of people below the breadline, according to an independent study of the coalition government’s record.

Although middle-earners saw incomes rise marginally after 2013, policies including the bedroom tax and below-inflation benefits rises have reduced incomes for the poorest, pitching an estimated 760,000 into poverty since the last official figures were produced, according to the New Policy Institute (NPI) thinktank.

The report itself can be found here. The reason the statement is incorrect is because they haven't looked at poverty at all. There is, by any historical or global standard of measurement, no poverty in the UK today. There is, of course, inequality, and this is what they are measuring. That number of people are, by their calculations, now getting under 60% of median income. That is, they are looking at relative poverty, not poverty.

Which is, of course, why inequality was renamed relative poverty (and the relative almost always immediately dropped) so that the terminally aggrieved would have something to complain about still. After all, how can you go on shouting about the horrors that capitalism afflicts on the poor when capitalism has abolished poverty?

Change the definition and carry on shouting, obviously.

Why we vote

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It’s difficult to understand why people vote, let alone why they vote the way they vote. No individual can reasonably expect her vote to determine or even influence the outcome of an election. In America, the chance of a one-vote victory margin that would determine the 2008 presidential election was about 1 in 10 million in some swing states, and 1 in a billion in places like California or Texas.

As Sam Dumitriu notes, this might still make voting worthwhile if you’re an altruist and you expect one candidate to make the world better than the other by more than a few billion dollars. But most people don’t think like this, and that has led some people to assume that voting is “expressive” – people do it to signal their allegiance to a particular tribe or team, not because they think the party they are voting for is best for themselves or the country.

Truthfully telling people you have voted certainly does seem to be a reason for voting, although the study the Freakonomics guys cite is from Switzerland, where I’ve heard they’re much more concerned with neighbourliness and civic duty than, thankfully, we are in England.

But does expressive voting determine how we vote? If it tells us anything it must mean that people are supporting parties or policies that, on some level, they believe to be counterproductive. Certainly if many (or any) people who are planning to vote Labour secretly believe that the Tories are actually best for the country, this would be a mark in favour of the expressive view of things.

In The Myth of the Rational Voter, Bryan Caplan argues that this is unlikely – people rarely feel good about voting for policies or parties that they think are bad. Group loyalty may well be a factor in determining how people decide what’s good to vote for, but surely it rarely trumps what people think is good.

In fact, barely half of each party's voters during the current UK election say they're proud to vote for their party. That obviously includes 'expressive' voters and people who like their party because they think it's the best one on its non-identidy merits.

Another problem with this view is that it also assumes that people realise that their votes don’t matter, but when polled people vastly overestimate the power of a single vote – the median American estimates that “there is a 1 in 1000 chance that their vote could change the outcome of a Presidential election” – the reality is between one in 10 million and one in a billion, remember. Yougov finds that “the less likely you are to think your vote will actually matter, the more likely you are to vote.” (I’m guessing this is because you’re more highly educated.)

That supports the idea that people vote for reasons of civic duty primarily, and for some people because they think their vote will affect the outcome of the election. For many people, no doubt, it’s both.

All of this may help us to understand why people vote the way they vote: is it mostly self-interestedly, as many public choice economist believe, or altruistically, as most political scientists believe? I will try to answer that in my next post.

Here's one reason for slow growth: regulation

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Perhaps we do want to drill for oil in the heartland of the Home Counties, perhaps we don't. That's rather a political question and probably one best solved by politics. Instead, we want to draw attention to one of the reasons why the richer countries tend to have lower growth rates:

It is understood that although UKOG, which is chaired by Mr Lenigas, and its partners have local planning permission and a licence for the site in Surrey they would still require formal approval from the newly established OGA before any flow testing operations- vital to the project’s commercial future - could begin.

UKOG, whose shares are traded on the London Stock Exchange’s junior Aim market, said in a statement to the stock exchange that planning permission to proceed at Horse Hill was in place and that it had “already submitted the applications to the authorities for their consent” to conduct a flow test of the well.

However, The Telegraph understands that no such application had been received by the Oil and Gas Authority as at the close of business today, Aoril 28.

A spokesman for Mr Lenigas – who is playing an active role in driving the scheme forward – said that the company stands by its original statement “which is entirely accurate”.

According to guidelines, a well test would require planning permission from the Mineral Planning Authority, environmental permits from the Environment Agency (EA), a review of well plans by the Health and Safety Executive and finally regulatory consent from the OGA.

This process could take months, which if so would potentially put the company’s plans to flow test Horse Hill this year under pressure.

Leave aside, entirely, the interesting financial background to this. Consider instead this regulatory thicket.

It's entirely possible that this is environmentally sound. That it really should take many months for the authorities to decide whether someone should be allowed to carry out a flow test. We find that hard to believe, given that well tests are a normal, routine, and well understood part of the process. But let that stand: there's still, obviously, a restriction of the growth rate of the economy when people trying to do new things meet such regulatory thickets.

If there must be regulation then it needs to be simple, obvious and above all fast. The current regime doesn't meet those tests: and this is a part of the explanation as to why growth rates are slow. We've allowed the necessity of a certain amount of bureaucratic licence gaining to become the equivalent of a barnacle encrusted hull on a ship. This reduces the speed through the water: time to haul the system out for a good careening.

Nepal’s quake exposes hidden problems and solutions

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Caught in Nepal’s 7.9 Richter Scale quake that left 5,000 dead acknowledged so far, New York Times correspondent Donatella Lorch observed: “People here help one another because they know the government often cannot. They reach out to one another, and they persevere. They open their shops, because what else can one do when the world is upside down?” She’s right.

Avalanches, mud slides and antiquated buildings boosted rural casualties compared to downtown Kathmandu, which suffered less than expected apart from relatively few old monuments and newer substandard dwellings. But walls fell down everywhere, chiefly surrounding government buildings and army barracks. “That’s because politicians and bureaucrats demand huge kickbacks, leaving the contractors no choice but to cut corners on safety,” explained a builder. “The private sector usually gets it right.” Elsewhere I met groups of young entrepreneurs bemoaning officialdom under-equipped and paralysed for days. We can never rely on government again, they concluded.

In a campaign limited to fearful whispers, Nepal’s late 2013 elections surprisingly trounced the Maoists, who fell from first to a weak third place. Just one of the Maoist leaders reportedly stole one billion dollars; yet the ruling centre-right Congress Party is less corrupt but irredeemably feckless. Post-earthquake frustration won’t drain the political and bureaucratic swamp, but mounting public irritation may offer a remedy.

The Red Cross Federation took only a few days to fly Scandinavian field hospitals into India’s Gujarat State after a deadly quake in 2001, but when they arrived the private sector was already there. “National trade associations for jewellers, the dairy industry and others were working in unison, providing food and medicine to tens of thousands of their countrymen, much faster than even the NGOs. We were amazed,” a Red Cross expert recalled. “When government officials arrived a week later, and started ordering everyone about, the businessmen told them to get lost. Everything was already so well-run that the bureaucrats had no choice but to fall in and cooperate.” Watching, and soon to become Gujarat’s Chief Minister, was the free-market Narendra Modi, now India’s Prime Minister. 

Part of the former Hermit Kingdom’s problem has been mistaking First World wealth for governmental competence. But thriving banking, telephone and IT sectors bring savvy young Nepalis home from abroad, and with them comes a can-do attitude. Private sector self-reliance may be what the country needs.

Well, yes, this is what happens in recessions

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Interesting new figures out from the TUC:

The coalition government has presided over the worst five-year period for living standards since modern records began more than half a century ago, according to the Trades Union Congress.

In an analysis based on data from the Office for National Statistics, the TUC said the 2010-2014 period was unique in seeing a drop in real household disposable incomes.

RHDI – a yardstick of living standards that takes account of incomes, benefits, taxes and inflation – was 0.6% lower in the half-decade ending in 2014 than in the five years ending in 2009, when it rose by 6.9%.

We have two responses to this. The first being that it was probably Done It Duncan who pieced this together:

Living standards are a key battleground in the general election campaign and in last month’s budget, George Osborne said on this same measure they would be on course to be higher in 2015 than when the coalition came to power five years earlier. The two measures differ because the chancellor was comparing a forecast with RHDI for the end of this year with RHDI in 2010, while the TUC is comparing an average of RHDI per head between 2010 and 2014 with an average of the previous five years.

We do rather wonder how many tweaks and variations Duncan had to make to his spreadsheet to get a version which showed a fall. However, there's another point to this, which is that yes, this is what happens in recessions. The economy becomes smaller. As a result the incomes of the people of the country fall. That's what all of these words actually mean.

"Living standards fall in recession" is about as startling as the claim "water is wet". So, err, quite what everyone is chuntering on about we're not quite sure. Unless it's an insistence that there shouldn't have been a recession in the first place and we're OK with that idea. Only that we can't bring ourselves to blame the people clearing up after a recession had already happened for the existence of a recession. That blame rather belongs to those who didn't prevent the recession itself we feel.

Myth busting: NHS not so efficient after all

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The NHS has long coasted on the widely held belief that it is one of the best healthcare systems in the world because it is so efficient. While European systems boast better patient outcomes, and the United States points to its excellent pre-emptive care measures, NHS loyalists cast that all aside, because unlike any of those other countries, the UK is able to keep its healthcare spending below 10% of GDP, free at the point of use, with relatively good outcomes. No other country can beat that efficiency. Well, it turns out most of them do.

In 2010, the OECD published multiple papers that specifically looked at the efficiencies of different health care systems. In its report “Health care systems: getting more value for money”, the OECD found that there was “room in all countries surveyed to improve the effectiveness of their health care spending.” Some countries, however, could see significant efficiencies gained. And the top three countries that could benefit the most: Greece, Ireland, and the United Kingdom.

By improving the efficiency of the health system, public spending savings would be large as compared to a no-policy-change scenario, amounting to almost 2% of 2017 GDP on average in the OECD. It would be over 3% for Greece, Ireland and the United Kingdom.

Potential savings

Breaking with myth, the UK is one of the countries that could do the most to improve its efficiency in public healthcare spending. Even more than the United States.

What the loyalists don’t seem to realise is that efficiency can’t simply be determined by how much money a country puts towards healthcare. The real question is how efficiently those monetary resources are being used to obtain better health outcomes.

And according to the OECD, both the UK and the US still have a long way to go:

Australia, Iceland, Japan, Korea and Switzerland perform best in transforming spending into health outcomes

In more than one third of OECD countries, exploiting efficiency gains in the health care sector would allow improving health outcomes as much as over the previous decade while keeping spending constant (Figure 2, Panel B). Germany, the United Kingdom and the United States fall into this group.

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I’m not predicting the end of this health care tale. Perhaps, if the right reforms were made to the NHS to drastically improve efficiencies, the UK would have a system that not only demands less public spending, but also creates better health outcomes too. To compare apples with apples, Norwegian healthcare is " is mainly provided by a heavily regulated public system, with strict gate-keeping" and grouped together with the UK in the OECD's categorisations for healthcare systems; yet Norway's system is ranked much better for efficiency (more details to come in next blog...).

I just thought I'd flag up that, as things stand, the NHS under-performs on just about everything that matters.

The Ayn Rand Institute Europe

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Today in Copenhagen is launched the Ayn Rand Institute Europe. Its mission is to promote awareness and understanding of Ayn Rand's philosophy of objectivism, and to spread awareness of her life and work, including her highly influential novels The Fountainhead and Atlas Shrugged. Heading up the programmes is Annie Vinther Sanz, originally Danish but now living in France, who has spent two decades in international business and now heads up her own consulting firm. And she is fluent in six languages (don't you hate people like that?).

Lars Seier Christensen, CEO of Saxo Bank, is chairing the new Institute's advisory board, and the event takes place at Saxo Bank's impressive headquarters. Some 300 people are expected at the launch, which includes short talks by Christensen, the head of the Ayn Rand Institute in the US Yaron Brook, and our own Eamonn Butler.

Eamonn admits that he is not an earnest devotee of Ayn Rand, though he shares some of her conclusions – like the importance of free-market capitalism, the rule of law, property rights and a robust system of justice. But that, says Yaron Brook, is exactly why he has been invited to give the main talk. Eamonn is strongly aware of Rand's importance to the intellectual right and her ability, through her novels in particular, to win people over too it.

Many young people, in fact, have been won over to the ideas of capitalism, and a belief in individuals as ends in themselves rather than mere cogs in some collective, by reading Rand. In the words of Jerome Tuccille, 'It usually begins with Ayn Rand.

Rand, Eamonn will say, has many supporters in the United States, where she lived for most of her life. The former Federal Reserve Chairman, Alan Greenspan, was a member of Rand’s inner circle. And her work influenced many other notable people, such as the former head of BB&T bank and of Cato, John Allison; Supreme Court Justice Clarence Thomas; Star Trek creator Gene Roddenberry, and PayPal creator Peter Thiel. Entrepreneurs, indeed, still name their children after her or her fictional characters.

She has, perhaps, less traction in Europe. That may be because the American right is more concerned with the protection of individual liberty, while the European right is more about conserving existing institutions. But as a result of today's launch, there is no doubt that Rand is about to become even better known, and much more influential, in Europe too.

Woe and thrice woe as the decline of Britain is upon us

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So we're told by an academic, must be true 'coz it's science, right? Britain is doomed to decline and fall because, well, actually, because us moderns just aren't up to much:

Britain is experiencing the same decline as Rome in 100BC, with the collapse of civilisation inevitable, a scientist has warned.

Dr Jim Penman, of the RMIT University in Melbourne, believes Britons no longer have the genetic temperament to advance because of decades of peace and a high standard of living.

He claims that the huge success of the Victorian era will not be repeated because people in the UK have lost the biological drive for innovation.

Instead, Britain is existing in a period similar to the decades before the fall of the Roman Republic where social tensions were rife, the gap between the rich and poor was increasing and extremism was growing.

Hmm, well.

We do think that in order to be able to do history well you need to actually know history. At which point a little putting of that huge success of the Victorian order in context is possibly needed. Per capita GDP, from 1700 to 1870, is usually estimated as having at 0.5% or so a year. Our experience of the 20th century was very much better than that. And here we are now, with GDP per capita over the past four years growing by 1.1%, 0.9%, 0.0% and 1.1%. This in the middle of what we all agree is the worst recession of modern times. We generally think that trend growth is 1.5 to 2% for this number.

Or about 3x that 19th century number, just if we keep generally rolling along without too much strain or effort. If this is failure compared to the Victorian success then bring it on we say.