We fear the BMA has the wrong end of the stick here

The BMA, the British Medical Association, tells us that the NHS, that National Health Service, needs another £9.5 billion stat. That is, the trade union for Britain's doctors says that the employer of near all Britain's doctors should have lots more money.

Well, yes, OK, that's what unions are for but we do fear that they've rather got the wrong end of the stick:

Dr Mark Porter, the BMA’s chief, said: “These figures are especially concerning given that everyone can see a huge crisis unfolding within our NHS, with record numbers of trusts and GP practices raising the alarm to say they already can’t cope.

“The NHS is at breaking point and the STP process could have offered a chance to deal with some of the problems that the NHS is facing, like unnecessary competition, expensive fragmentation and buildings and equipment often unfit for purpose. But there is clearly nowhere near the funding required to carry out these plans.”

It's the unnecessary competition and expensive fragmentation that betrays the error here. For as Adam Smith pointed out those 241 years ago, long enough for people to grasp the point, we become richer through the division and specialisation of labour. Yes, that damn pin factory.

This does indeed apply in medicine - the literature is chock full of research showing that hospitals which do a lot of one type of operation have very much better results than those which occasionally dabble. That doctors themselves study certain specialties is again proof that the specialisation of labour applies here.

One of us here at the ASI spent a decade as the only person in the world doing a specific job. One part of the lighting industry uses rare earths to alter the colour emitted. That unique job was making sure of a supply of just one of those rare earths to that industry. No, not mining it, not processing it, not turning it into light bulbs, just ensuring that there was a supply of the right purity, in the right size, in the right place at the right time. That's the sort of granularity which private industry gets to these days. Just the one person in the world doing a specific task - OK, that level of granularity is still pretty odd but still, that's the possible end point of the process.

Fragmentation is not thus expensive, it's the process by which we become more productive and thus richer. And competition is just the method we use to decide who we are going to divide and specialise with.

Thus we really do conclude that the BMA have the wrong end of the stick here. The very things they are complaining of are the very things which, in every other walk of life at least, make us more efficient. And if it works everywhere else there is no reason at all why it won't work in medicine.

On the subject of Merrie England

The Observer draws our attention to a little book called Merrie England:

When Merrie England (quoted above) was published in 1893, it became a literary sensation almost overnight. Written in vivid, plain English by the Manchester-based socialist campaigner and journalist Robert Blatchford, the book was presented as “a series of letters on the Labour problem, addressed to John Smith, of Oldham, a hard-headed workman, fond of facts”.

To this fictional resident of one of Lancashire’s grimmest mill towns, Merrie England advocated a socialist transformation of the most advanced capitalist economy in the world. Using his Latin pen-name, Nunquam, Blatchford deployed satire and polemic to call for communal collaboration to replace competition and chasing profit as the driving force in human lives.

“Take the case of a tram guard working, say, 16 hours a day for £1 a week,” begins one of Nunquam’s rhetorical salvos. “That man is being robbed of all the pleasure of his life. Now there ought to be two guards working eight hours at £2 a week. If the tram company makes big dividends the cost should come out of those dividends.”

The implication there is that the dividends are enough to cover the wage bill going from £1 a week to £4 a week. And if we're honest about it we too would probably say that if dividends are four times the entire wage bill then there's a bit of room for a pay rise. We're not, however, entirely sure that the example is factual.

The paper uses this as a lead in to a discussion over the Labour Party's woes:

It has been estimated that 149 of Labour’s 232 constituencies voted Leave, in defiance of the party’s wishes and at odds with the overwhelming majority of Labour’s mainly professional membership. 

Well, yes, seems about right. However, the part that really interests us is this small detail:

Blatchford’s coruscating critique of free market economics and the culture of individualism became part of the warp and weft of the nascent Labour party.

Those were heady times for a British working class growing in confidence and taking its first political steps. Over a century later, the modern Labour party could use a Merrie England.

Possibly so. It's just that looking at the frontispiece of the original we note something that amuses. The publication was (in part) funded by advertising quack medicines to those stout working classes.

How's that for sticking it to the capitalists and critiquing the free markets?

This looks eminently sensible - not very new though

Apparently there's some great new breakthrough in being able to make cancer drugs cheaper for patients and the NHS. This sounds like an excellent idea to us, wouldn't we all like more people to be cured more cheaply?

The high price of new cancer drugs is indefensible and unsustainable, say two of the world’s leading cancer research institutions, who propose a different way to develop them that could sideline big pharma.

“There is a clear and urgent necessity to lower cancer drug prices to keep lifesaving drugs available and affordable to patients,” say leading scientists from the Institute of Cancer Research in the UK and the University of Texas MD Anderson Cancer Center, where many important new cancer drugs have been invented, in a paper in the journal Cell.

How absolutely super, eh? So, what's the magic ingredient in this?

Pharmaceutical companies used to justify their prices by pointing to the high cost of clinical trials involving many thousands of patients. But that is no longer always necessary, the scientists say in their paper. The new targeted drugs require a test for a genetic biomarker to see whether patients will respond or not. That means the drug can be trialled on far fewer people. The drug crizotinib, used for advanced lung cancer, was approved following a trial involving only 347 patients, they point out.

We're not convinced that is actually new though. The standard analysis of drug costs has been that it can cost $800 million to $ 2 billion (dependent upon who you want to believe and how you assign opportunity costs and the expenses of failures) to get a new drug through clinical trials and to FDA or equivalent approval. Further, the standard solution to these costs has been to reduce the costs by reducing the level of proof required - with the FDA specifically to argue only on proof of safety and leave effectiveness to the market (generally you must prove that the new drug is better than those already available in order to gain a licence).

Thus this proposal is not exactly new. Lower the costs of a drug gaining approval and drugs will be cheaper, yes, seems obvious enough and what some have been shouting about for some decades now.

The only remaining oddity therefore is this wibbling about "Big Pharma." Why shouldn't the big firms take part in exactly the same process? If said new process makes drugs cheaper than why not allow all to do so?

Why isn't this just blindingly obvious to everyone?

Apparently it's the naughty young people, with their mobile phones and their social media accounts, who waste all the food. We do have to wonder why anyone bothered to try to find this out - surely it must be obvious to everyone?

A generation gap in attitudes towards cooking and eating is helping to fuel the UK’s food waste mountain, research reveals, driven by time-poor millennials who do not understand the value of the food on their plate. 

In contrast to savvy older consumers familiar with post-war rationing, the study suggests, those aged 18 to 34 are preoccupied by the visual presentation of food to photograph and share on social media while failing to plan meals, buying too much and then throwing it away.

The UK churns out 15m tonnes of food waste a year – of which 7m tonnes come from households. The estimated retail value of this is a staggering £7.5bn, and the government’s waste advisory body, Wrap, calculates that a typical family wastes £700 of food a year.

A national supermarket study of the food waste patterns of 5,050 UK consumers, published on Friday, reveals nearly two-fifths of those aged over 65 say they never waste food, compared with just 17% of those under 35.

Using American figures, just because we have them at our fingertips, a poor family in 1963 spent 33% of income on a basic but nutritious diet. Today that is more like 11%. And here in the UK food spending is, on average, some 10% of household income today.

None of us should really be surprised that something which has become markedly cheaper in real terms is subject to a little less conservation now, should we?

More than that, these millennials are not "wasting" food because they don't know the value of it. Rather, they are wasting it because they know the value of it. That value being very much less than it was and thus less effort need be expended in avoiding waste.

It has always struck us as extremely odd this concentration upon food waste. It's easy enough to get someone to understand the value of time. Who these days would stoop down to pick a penny up out of the gutter and who wouldn't have done so 100 years ago? The relative value of a penny and the time taken to collect it having changed markedly over this time to the extent that your correspondent has seen beggars throwing away coppers collected as just not worth the effort.

But when it comes to food this obvious point seems to escape people. Food is now cheap, it is logical and righteous that people expend less effort to conserve it. And yet when it is cheap, needing less attention paid to it is when we are all taxed to have bureaucracies like WRAP shouting at us for doing what is logical and righteous - not caring about it very much.

The best we can come up with as an explanation is that those who rule us were brought up by rather strict nannies of that earlier generation and thus are infested with the idea that food is rare and expensive. Time to wake up and smell the broccoli ladies and gentlemen. Recent decades have solved one of humanity's perennial problems, the availability of cheap food. We just don't need to conserve it as we used to.

What a delightfully delicious dilemma

The usual hipsters and food faddists are soon going to face the most delightfully delicious dilemma. Quinoa has the merits of being a forgotten grain from a little regarded civilisation. The "rediscovery" of it thus brought tears to the eyes of all who would mark their social prowess through their bowels. And so it became tres trendy, certifiably chic.

The same group of cheerleaders are of course largely the people who insist that no GM will ever sully those bowels. No, we're not sure either but they at least insist they have some reason why.

At which point:

It has become a byword for metropolitan, health-conscious dining, but new research suggests quinoa could be destined for a far more important future.

Scientists believe the “supercrop” could solve the problem of feeding the world’s growing population.

The resilient seed, which was once the "mother grain" of the ancient Andean civilisation, thrives in harsh environments and provides a more balanced source of nutrients than cereal.

Well, isn't that lovely? And now for the dilemma:

Experts have now discovered a way of manipulating the quinoa plant changing the way it matures and produces food to make the bitter seeds sweeter.

Researchers from the King Abdullah University of Science and Technology sequenced the Chenopodium quinoa genome, creating the world's highest quality quinoa sequence which has already yielded insights into the plant's traits.

The reason you sequence the genetic code is so that you can manipulate it. Thus, coming soon enough, GM quinoa.

Which of the two fads will win? More of a cheap and nutritious grain with which to feed us all, in that most healthy manner as is currently claimed? Or the method of making it cheaper and more nutritious blacklisting it from all GoodThink diets?

Our suspicion is that GM making it cheaper will be the thing which makes it unfashionable. For how can you go around making a moral statement by consuming something that's cheap enough for everyone?

There's a reason we use prices to ration things you know

The intricacies of how supply, demand and prices interact seem to be a mystery to all too many people. Unfortunately, those who are so flummoxed appear to include large numbers of those who have the statutory right to reach into our wallets:

Introduction of 30 hours free childcare could mean shortage of places

Well, yes, thanks to The Guardian for that headline. We'd go so far as to insist that when something formerly paid for becomes "free", free at the point of use at least, then demand is really very likely to outstrip supply.

Because, you know, that balancing act performed by prices.

From September, three- and four-year-olds in England will be entitled to 30 free hours of care per week in term time - up from the current 15 hours.

But a poll of local authorities by the Family and Childcare Trust found uncertainty about impact of the policy.

The government says quality, affordable childcare is central to its agenda.

The survey was sent to all 152 local authorities in England, and 112 of them responded.

Of the 112, over half (54%) said they did not know if they would have enough childcare available for pre-schoolers using the 30 hours.

A third (33%) said that there would be sufficient places, while a further 13% said there would not be enough.

This is of course not free nor any reasonable simulacrum of it. Someone, somewhere, is going to have to pay for those places and that care. And doing so through the taxation system rather than the price one is the wrong way to go about it.

What we would actually like to happen is that those who can earn more by going to work rather than caring for their own children - and wish to, of course - do so. And those who earn less than the cost of child care don't. Hiding that decision from the price system is therefore the wrong thing to be doing.

It's actually making us poorer which isn't the point of government nor policy at all.

Sadly, Hans Rosling has died

It is not a surprise that Hans Rosling has died, it's been known for some time that he was terminally ill. However, there is of course a sadness for his family and friends and also for us out here in that wider world. For in his final career he became an evangelist for the truth about our world. Things are getting better, fewer children die, the population explosion is near over as a result, the world is getting richer and better day by day.

This is of course in direct contrast to the usual jeremiads about how capitalism and globalisation are leading us down the path to damnation. And as such, of course, all most useful.

If you've not seen any of his talks then we recommend this, the first and breakout one at TED. This one about the decline in child mortality is also close to our hearts. And we have a very soft spot for this about the washing machine. How the mechanisation of drudgery makes us all so much richer.

If you prefer static imagery and data sets to video talks then Max Roser presents much the same information here.

The essential lesson on offer being, and one without which we simply have no hope at all of deciding what to do next, that the good old days are right now. Further, that as long as we don't mess up there is no reason why they shouldn't keep getting better off into the future.

That is, roughly and imprecisely to be sure, with backsliding here and there, we're on the right track with this economic development thing, with that just passed greatest reduction in absolute poverty in the history of our species.

Rosling wasn't feted and awarded in the same manner that Paul Ehrlich, who has been wrong on every point concerning the same matter, has been but then that's just how society seems to work. Gloom sells better than optimism.

All (all!) that Rosling did was stand up and tell us the truth about our world. A worthwhile thing to do with a life, don't you think?

Sheesh, the latest Brexit disaster

It strikes us that there does seem to  be a certain amount of umm, reaching, over the disasters that will befall us once Brexit actually takes place:

British tourists will face crippling mobile phone roaming charges in Europe after Brexit, leaked EU plans revealed today. 

EU lawmakers banned phone operators from charging holidaymakers roaming charges - the extra fees for making and receiving calls when abroad.

And from June this year consumers will be able to send texts and surf on their mobile at the same price they pay at home.

But European Parliament documents on the new rules say they should not apply to British travellers after the UK officially leaves the EU - expected to be in spring 2019.

So the situation post-Brexit will be exactly the same as it is today and has been for the past decade or two. This does not strike us as an agonising problem.

As to why this will be true:

However, a leaked analysis on UK withdrawal from the EU confirmed this would not apply to Britons post-Brexit.

The document was drawn up earlier this month by the European parliament’s committee on industry, research and energy, and endorsed by MEPs. It states that “regulation (EU) No 531/2012 on roaming will no longer apply with respect to the UK, impacting business and other travellers to and from the UK”

Why would this be so? Because the various levels of the EU will no longer have the power to impose regulations upon doing business in Britain. It does not mean that roaming charges musty be imposed, it just means that a certain set of government will not be able to insist that they're not., Something really rather different. For:

Other companies have voluntarily dropped them as they sought a competitive edge before the expected 2017 ban.

Really? Izz'at so? There are enough British consumers who are worried enough about this that not charging roaming gains a provider a competitive advantage? And why would we expect this not to be so even in the absence of governmental insistence? 

And if there aren't enough people who think it important enough that offering the option would not provide a competitive advantage then roaming charges or not does not actually matter, does it?

Freedom Week 2017

Applications for Freedom Week have just opened. And if you are aged between 18-25, you should be interested.

A joint project of the ASI and IEA, Freedom Week 2017 will be held from 3 – 8 July.

What is Freedom Week? It is a week-long series of lectures and seminars where around 30 of the best and brightest young thinkers are gathered for the time of their lives. I say this not because I work for the ASI (though I do), but because last year I went on Freedom Week, and it proved to be one of the best weeks I’ve ever had.

Though daunting at first, meeting all on the week was a pleasure, everyone was so interesting and kind, and willing to lock horns on subjects from Veganism to the Gold Standard. Many I met on Freedom Week have proved to be friends that I still talk to and meet today. Through attending, I met the team at the ASI, including President Madsen Pirie who pointed me in the direction of applying for one of their Gap-Year internship positions, as well as giving invaluable university advice. And that is why I am sat here writing this now, in the ASI office in Westminster!

Regardless of your background, Freedom Week will give you the opportunity to explore the economic, philosophical and political implications of free market ideas, immersed in talks from some of Britain’s leading thinkers.

As if that wasn't enough, there'll be as many evening activities as you can handle, including a BBQ, a drinks reception, several dinners in the College, trips to local pubs and a seriously fun pub quiz. Attendees will also be able to try their hand at punting on the River Cam, and will have free time to explore Cambridge.

Memories have been etched into my mind that will stay with me forever – all of them good. We worked as hard as we played on Freedom Week. It proved an unparalleled opportunity to network, but doing so was never a chore.

And the best bit? It is all completely free, all expenses paid (apart from beer money of course!) Though, I should mention, gaining a place is highly competitive.

Our brand new website is now live and ready for you to apply. Places are given as and when they come, so don’t delay, pop your name into the hat for the spiciest soirée out there.

Sadly, all too many don't understand business rates

Business rates are not perfect as they rely upon the rentable value of the building, not the land it is upon. But they are the closest we've got to a good tax, a land value tax. Meaning that if we're going to have a debate about rates and the current revaluation then it would be a good idea if we all understood them:

April’s new business rates will be the final nail in the coffin for many small shops. A re-evaluation means that overall high-street retailers will need to find an estimated extra £125m to pay increased rates (according to business rent and rates specialist CVS). This lumbers the average small shop with an extra £3,663 added to its rates bill and, as I can attest, there aren’t many that are going to be able to pick up their pricing guns with a devil-may-care shrug and get back to work.

No, in anything other than the shortest of terms it will be landlords who pick up £125 million less in rent a year. For rates are incident upon said landlords and their rent, not the occupiers of the premises. We know this very well- those 80s special development areas were free of rates for a time, rents rose as a result.

 If you happen to be trading in a property hot spot (and, indeed, your brilliant business may have contributed to the success of that place, as in Southwold and Port Isaac, areas with notably good independent shops that will be hit by rate hikes), or big brands have arrived and now surround your enterprise, then your valuation goes up and you find yourself catapulted out of the small business relief zone.

Yes, that's the point. There's a limited supply of land in those hot spots, taxing that land is the least distortionary tax that we have. It's a good tax. And note what is being taxed - that the other people around that property are adding value to it.

But the revaluation works for the online retail giants. According to CVS analysis, the nine Amazon distribution centres in England and Wales will be able to knock £148,000 off their property tax liabilities this year (despite annual sales in excess of £6bn). Similarly, fashion retailer Boohoo gets 13% knocked off the bill for its distribution centre in Burnley; so it goes on.

Quite so, this is what we want to happen. There's a limited demand for chi chi shopfronts in Burnley and there's lots of land. Thus we tax the use of low value land more lightly than the use of high value land.

 So the true value of the high street remains undervalued, fiscally and culturally. 

Which is to miss the point so badly it's like watching England try to pass the ball on the weekend. The exact thing which is being taxed is that value of the High Street. Because that's how the tax is calculated, the value that being on the High Street adds to a particular property for use as a retail or any other business use.

And if we're not going to understand these basics about business rates then we're never going to be able to have a reasoned discussion about them, are we?