Myth busting: NHS not so efficient after all

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.

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.

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.

Universal healthcare and market-based systems aren't mutually exclusive

An op-ed published last week in the New York Times laments Americans' decline in support for government involvement in the redistribution of wealth - or, as the Times author Thomas Edsall calls it, ‘sharing’. Edsall analyses a bunch of polls throughout the article, but what he finds troubling I find to be good common sense. For example, most Americans aren't incredibly trusting of their government:

Even worse for Democrats, the Saez paper found that “information about inequality also makes respondents trust government less,” decreasing “by nearly twenty percent the share of respondents who ‘trust government’ most of the time:”

Smart thinking.

Furthermore, most Americans aren’t convinced that Obamacare is going to be the shining, efficient, cheaper, all-inclusive beacon of hope it was promised to be:

An earlier New York Times poll, conducted in December 2013, found that 52 percent of those surveyed believed that the Affordable Care Act would increase their medical costs; 14 percent said it would reduce costs. Thirty-six percent believed that Obamacare would worsen the quality of health care compared to 17 percent who thought it would improve it.

Also probably wise.

On the whole Edsall appears to understand people’s perceptions of government care (to my relief and his dismay) quite well – except for in one area.

Esdall claims the “most dramatic” change in public opinion has been people’s perception of the ‘right’ to healthcare. He cites the two Gallup polls in an attempt to claim that majority support for guaranteed access to health coverage has dropped radically over the past six years:

The erosion of the belief in health care as a government-protected right is perhaps the most dramatic reflection of these trends. In 2006, by a margin of more than two to one, 69-28, those surveyed by Gallup said that the federal government should guarantee health care coverage for all citizens of the United States. By late 2014, however, Gallup found that this percentage had fallen 24 points to 45 percent, while the percentage of respondents who said health care is not a federal responsibility nearly doubled to 52 percent.

But Esdall isn’t comparing apples with apples. The belief that in a developed society everyone should have access to basic healthcare provisions is not the same as believing that healthcare is a federal responsibility – especially in the United States.

The debate is not – and has not been for a long time – whether or not people should have access to healthcare, but rather how that care should be provided. What kind of delivery of healthcare will create the cheapest prices and best outcomes, and what safety net for those at the bottom will provide the most comprehensive care?

There is huge demand in the States for healthcare reform, and most people want this reform to focus on cheaper access to care. But that can be achieved without fully handing healthcare provision over to the federal government or adopting something that resembles the NHS.

Both the US and the UK should be looking to countries that rank highest for healthcare provisions internationally, which have almost all settled on systems where the central government funds healthcare but does not directly provide healthcare.  The Netherlands, Denmark, Switzerland, and Germany all have healthy relationships with private companies, ranging from insurance companies and charities, that provide better outcomes than those in the UK and in a cheaper, more efficient manner than in the US.

Support for universal access to healthcare and support for market mechanisms in healthcare are not mutually exclusive; there's plenty of evidence to suggest a combination of the two creates the best healthcare systems in the world.

No, John is not responsible for gender gaps

Gender baiting has launched again in the United States, but this time it’s personal. Quite literally – the oppressors’ names are John. From The New York Times:

Fewer large companies are run by women than by men named John, a sure indicator that the glass ceiling remains firmly in place in corporate America.

Among chief executives of S.&P. 1500 firms, for each woman, there are four men named John, Robert, William or James. We’re calling this ratio the Glass Ceiling Index, and an index value above one means that Jims, Bobs, Jacks and Bills — combined — outnumber the total number of women, including every women’s name, from Abby to Zara. Thus we score chief executive officers of large firms as having an index score of 4.0.

The NYT didn’t stop there; the article goes on to use its new Glass Ceiling Index to compare political successes, too:

I have to hand it to the NYT - this is an excellent propaganda piece. Determining the success and advancement of women in their careers to how those numbers compare to men named John, Robert, James, and William gives you some pretty damning results.

Left-leaner’s will find any opportunity they can to blame the sexism and discrimination that is still rooted on our society on employers and business culture; that way they can legislate quotas and pay structures across the board, and at least create the illusion, through force, that equality exists.

But evidence, even from the NYT's own sources, suggests that employers are not the problem.

The NYT's report was “inspired by a recent Ernst & Young report, which computed analogous numbers for board directors…for every one woman, there were 1.03 Jameses, Roberts, Johns and Williams — combined — serving on the boards of S.&P. 1500 companies.”

Lets look at that report a bit closer. It is the case that the number of male directors at S&P 1500 companies is hugely disproportionate to the number of female directors (84%/16%), but there is also evidence that the tide is changing. The graph below details that while far more men hold directorships, they also tend to be significantly older in age; 49% of female directors at these companies are under the age of 60 (compared to only 33%) of men, and 31% of male directors are over the age of 68 (compared to only 11% of women).

Like many other occupations, a lot of perceived gender gaps are going through transitional periods; as women become more educated than men, we start to see changes in occupation breakdowns (but it’s not in the interest of gender-baiters to report it).

My colleague Ben has recently blogged on a paper that found if you control for a person’s background and length of time in the work force, “being female increases the chance of becoming CEO. Hence, the unconditional gender pay gap and job-rank differences are primarily attributable to female executives exiting at higher rates than men in an occupation where survival is rewarded with promotion and higher compensation.”

It’s not employers and it’s not corporate culture that’s holding women back; the reality is that women are making different choices than men. Many of them have to do with family planning, but many of them come down to different goals and ambitions.

Examples include both political and career ambitions. Women and men “win elections at equal rates, raise comparable amounts of money, and receive similar media attention” yet very few women are wanting or willing to run for pubic office. Research conducted in 2012 found that millennial women "just aren't very interested in being the top executives of high-profile companies." Of all the women aged 22-33 polled, only 15% actively wanted to lead a large, prominent business one day.

The NYT can use the Johns and Jameses of the world to paint political and market systems as sexist all they want, but their provocative Index completely misses the point. Women are choosing not to take their careers as far as they can go. And that's okay - if that choice makes them happy and gives them opportunity to peruse other meaningful things. But the real glass ceiling for women is being held up society at large, which often compels women from a young age to make different decisions than men.

Are women being educated about their career options properly? Do they feel supported to have kids (or not have kids) on their own terms? These are the issues that are really holding women back. If we actually want to address gender gaps in the work place, let's let John get on with his job while we tackle our deeply entrenched, and often bias, cultural norms.

Make Britain safer: bring back pistols

We live in peaceful times – at least compared to the past thousand-ish years. Crime, especially personal violence, has been reduced significantly since the 13th century (though not always continuously). The drop looks something like this:

What explains the drastic decline in violent crime, specifically between 1500 and 1900? Why has crime spiked up (moderately) from 1900 – 2010? The widely preferred explanation for the fall in crime – particularly homicide – is referred to as the “civilizing process”, which claims that criminal breaking points can be attributed to the growth of centralised power (i.e. state power), which created more structure and stability in regional areas.

The conventional wisdom…attributes the decline in personal violence to the “civilizing process” first suggested by Elias (1939) who hypothesized that the primary cause was the transformation of Europe from a large number of fiefdoms in the Middle Ages to a small number of large, centralized nation states under a single monarch. The centralised state instituted and enforced a monopoly on violence, known as the king’s peace.

To this day, the ‘civilizing process’ remains the longest-running, widely accepted theory and continues to shape crime and policing policy. But, despite its acceptance, there are some very notable flaws in the theory, including the fact that much of the evidence shapes up to disprove the thesis:

Belgium and the Netherlands were at the forefront of the decline, yet they lacked strong centralized governments. When Sweden joined the trend, it wasn’t on the heels of an expansion in state power either. Conversely, the Italian states were in the rearguard of the decline in violence, yet their governments wielded an enormous bureaucracy and police force...

...the civilizing process theory is not consistent with the rise in violence between 1200 and 1500, it does not explain the sudden and precipitous decline and reversal of trend that occurred in the 16th and 17th centuries, and it is not consistent with the 1793 reversal of trend.

A new paper from Carlisle E. Moody published last month provides an alternative theory last century’s decline in violence. The paper, “Firearms and the Decline of Violence in Europe: 1200-2010”, finds that the sudden historical drops in crime are consistent with the “invention and proliferation of compact, concealable, ready-to-use firearms” which “caused potential assailants to recalculate the probability of a successful assault and seek alternatives to violence.”

And unlike the civilizing process theory, Moody's firearms theory remains consistent with the evidence and breaks in violence. As concealed weapons became more available historically, crime rate dropped radically. (Bolded mine.)

Homicide was increasing before the invention of concealable firearms and decreasing after. While there may be many other theories, the sudden and spectacular decline in violence around 1505 and again around 1610-1621 is consistent with the theory that the invention and proliferation of concealable firearms was responsible, at least in part, for the decline in homicide. The landscape of personal violence was suddenly and permanently altered by the introduction of a new technology. The handgun was the ultimate equalizer. The physically strong could no longer feel confident of domination over the weak.

Some of these arguments may sound familiar; they're the ones those crazies over the States tend to go on about - guns 'equalize' the playing field regardless of physical strength and 'psyche out' violent perpetrators who might be more willing to attack their victims if they knew they were unarmed.

But according to the report, those crazies have some strong points. The report cites several studies which found that the possibility that a victim might be armed deters criminals from acting:

Even in the United States today, criminals are reluctant to encounter armed victims. In 1981 Wright and Rossi interviewed 1874 incarcerated felons in ten states. Eighty-one percent agreed with the statement, “A smart criminal always tries to find out if his potential victim is armed.” Thirty-four percent report being, “scared off, shot at, wounded or captured by an armed victim. (Wright and Rossi 1986, pp. 132-155) Using the same data, Kleck found that, among criminals who had committed violent crimes or burglaries, 42 percent had been deterred during an attack by an armed victim and 56 percent agreed that, “most criminals are more worried about meeting an armed victim than they are about running into the police.”(Kleck 1997, p. 180)

Perhaps, then, we might admit (based on evidence, consistency and lack of other credible theories) that firearms reduced violence historically; but in the modern era, guns cause more violence than they deter. But that's not the case either:

The government in England has been placing increasingly stringent controls on guns especially handguns, since 1920, reducing both the actual and the effective supply of firearms. (Malcolm 2002) The homicide rate in England in 1920 was 0.84 and the assault rate was 2.39. In 1999, the corresponding rates were 1.44 and 419.29. Thus both the homicide and assault rates increased as the effective supply of handguns declined.

That's a 17,544% increase in England's assault crime over the past 100 years. In truth, there is no explicit correlation between gun control laws and murder rates between countries (Switzerland and Israel “have rates of homicide that are low despite rates of home firearm ownership that are at least as high as those in the United States.”) It is the case that handguns used in crimes in the UK have doubled since they were banned in 1997. Guns can't account fully for the drop in crime throughout the 20th century, nor can they account fully for the rise in violent crime over the past 100 years, but there is no doubt that accessibility to firearms has worked as a successful deterrence against criminals in progressive societies and that bans have ensured that any handguns in England are only falling into criminal hands.

Should we proliferate handguns around England tomorrow? Probably not. (Obviously we should begin with firearm training sessions - safety first!)  But liberalizing gun laws should not be off the table. Historically, they've earned it.

President Obama: the ultimate poverty hypocrite

Americans are experiencing buyer's remorse. Last summer CNN found that 53% of those polled would choose Mitt Romney to be president today, over the 44% who chose Barack Obama. And with Obama’s approval ratings fixed these days below 50%, I suppose it’s only human to get a bit testy with those you're compared to:

President Obama poked fun at former rival Mitt Romney and leading Republicans on Thursday, saying the GOP’s rhetoric on the economy was “starting to sound pretty Democratic.”

At the House Democratic Caucus retreat in Philadelphia, Obama noted that a "former Republican presidential candidate" was “suddenly, deeply concerned about poverty.”

“That's great! Let's go do something about it!” Obama added in a not-so-veiled jab at Romney.

What’s not particularly smart, however, is to frivolously attack someone’s track record on poverty when your own record looks abysmal:

A few ugly facts about the Obama Presidency:

• Median household income has slumped from $53,285 in 2009 to $51,017 in 2012 just up to $51,939 in 2013.

• In comparison to his three previous successors, this fall in median income looks even worse:

• Real median household income was 8.0% lower in 2013 than in 2007.
• Nearly 5.5 million more Americans have fallen into poverty since Obama took office.
• Obama oversaw the first time the poverty rate remained at or above 15% three years running since 1965.
• Home ownership fell from 67.3% in Q1 2009 to 64.8% in Q1 2014; black home ownership dropped from 46.1% to 43.3%.
• Labour force participation rate fell from 65.7% in January 2009 to 62.7% in December 2014.
• The federal debt owed to the public has more than doubled under Obama, rising by 103 percent.
• 13 million Americans have been added to the food stamp roll since Obama took office.

Obama has been very successful in painting a picture of himself and the Democrats as the 'Party of the Poor', and did an even more sensational job convincing 2012 voters that Romney's riches and successes put him out of touch with the middle-class America. But in reality, the president's policies have pushed millions more people into financial stress and poverty.

And he's still causing damage; even his latest State of the Union address called to raise taxes on university savings accounts and still cited fake unemployment numbers, as if this somehow helps the double-digit workers who have given up looking for jobs.

Perhaps the president really thinks his increased federal spending will pay off for the poor. Maybe he really believes that multi-millions more on food stamps is a saving grace instead of a tragedy. But regardless of intention, the facts speak for themselves.

Obama's talk on poverty is cheap. And his mockery of Romney cheaper.

Let them eat cake...and buy discounted TVs

Already (and keep in mind they’re five hours behind), Americans are storming Wal-Mart, Best Buy, Macy's (and a whole lot of small, independent shops too) to snag the best Christmas deals of the season. It’s Black Friday- the biggest shopping day of the year in the States, when stores open ‘early’ and offer huge discounts on otherwise pricy, luxury goods. Unlike the Brits, who started looking forward to Christmas post-Halloween, Americans had to at least pretend they weren’t listening to Bing Crosby on their iPods until the day after Thanksgiving; and now, with less than a month till Christmas day, shoppers will spend well over $1billion today alone to make up for their tireless waiting.

Over the past few years, this all-you-can-shop American trend has spilled over to the UK, with Amazon, Apple and Wal-Mart’s Asda taking the charge to bring discounts, up to 70%, to British consumers. Still in its early phases of becoming any kind of British tradition, the demand from customers for these kinds of deals continues to sky-rocket; last year, according to Visa’s estimate, £1million was spent on its cards every three minutes, and it’s expected this year’s charges will be up 22%.

And this year’s looking even bigger:

However, this year, the day is expected to be even busier. Black Friday 2014, scheduled for November 28, should be the biggest online shopping day ever in the UK.

Christopher North, managing director of Amazon.co.uk, said: “Black Friday took an incredible leap forward in 2013 with so many more customers taking advantage of the great deals on that day, resulting in sales of over 4m items for the very first time in our history.

“This year, we are offering more deals and savings than ever before and we are expecting record numbers to benefit from Black Friday Deals Week.”

Some take a moral stance against Black Friday, arguing that it promotes consumerism and unnecessary purchases; and some in the UK have gone so far as to say it defies British identity, as Black Friday has, until recently, been a post-Thanksgiving, US tradition.

It seems almost too obvious to point out that the the millions of pounds that will be spent in the UK today are a huge boost to business; benefiting not only businesses and their employees, but the customers themselves who are able to buy electronics and goods they could not otherwise afford at hugely discounted prices. It's all very well to claim the moral high-ground on consumerism if you and your family want for nothing; but for many customers, necessities in the digital age (like computers and phones for their kids) aren't accessible at their normal prices.

As for British identity - Black Friday is far too new to the UK for us to know how it–as a sales pitch or as a tradition–will play out in the future. Under no circumstances should Britain adopt the crazy shop-till-you-drop celebrations if it doesn't want to; but no one can deny the huge, and ever-growing, demand from British consumers for the Black Friday tradition. And as long as there's demand, let the rush commence.

A blagger's guide to the US midterm elections

Tomorrow's midterm federal elections in the United States will determine the political landscape of President Obama's final two years in office, and even though he's not up for re-election, his policies 'are on the ballot'. Here’s a quick breakdown of the game-changing races, the political mood across the swing states, and what to look for on Tuesday night.

Currently

As President Barack Obama resides over the White House, the legislative branch is operated by a divided Congress, with the Republicans in control of the House of Representatives (233/199 with John Boehner as Majority Leader) and the Democrats in control of the Senate (55/45 with Harry Reid as Majority Leader).

On Tuesday

The House of Representatives will remain firmly controlled by the Republican Party, whose historic sweep to victory in 2010 took 63 seats away from the Democratic Party. Even if the Democrats managed to win all 26 swing-elections this year, enough seats securely lean GOP to give the Republicans a comfortable majority (218+ seats).

It also appears the GOP will retain the majority of Governorships, though a few key races–like Governor Scott Walker’s (R) highly contested race in Wisconsin–threaten to throw GOP darlings out of office, who otherwise would be strong presidential candidates in 2016.

The real toss-up tomorrow will be which party controls the Senate for the next two years. And looking at the polls, it’s the Republican’s election to lose.

The Breakdown

Republicans have to gain 6 seats in the Senate to have a clear majority - if they take 5 and leave the Senate 50 / 50, Vice President Joe Biden gets the tie-breaking vote, meaning Democrats would retain control of the Senate regardless of any other race won.

Currently, the GOP is set to pick up three ‘easy’ seats in West Virginia, South Dakota and Montana: traditionally red states on the state and national level; not to mention areas where President Barack Obama lost badly in 2012.

That leaves the GOP in need of three more wins in the swing states, of which there are roughly 7 or 8, depending on your source: Alaska, Colorado (leans GOP), Georgia, Iowa, Kansas, Louisiana, New Hampshire, North Carolina.

The Republican advantage

The GOP has small, built-in advantages to any mid-term election, though this year is looking even better for the party than usual. Unlike the House, where each elected representative is up for re-election every two years, Senate seats are elected every six years on a rotating basis. This year, it just so happens that more Democrat-held seats are up for re-election, and they’re up for election in areas that aren’t considered ‘safe seats’ or ‘strongholds’.

It’s also the case that significantly less people show up at the voting polls for mid-term elections than for presidential elections (roughly 37.8% in 2010, compared 56.8% and 53.6% in 2008 and 2012); and those who do show up tend to lean Republican.

Interesting race to note: Kansas and 'The Establishment'

“Why Kansas Senate race could decide everything” –No pressure, but the traditionally red state that should be a safe seat for GOP candidates has been upset by Democrat-mascarading-as-Independent Greg Orman, who is running against establishment GOP candidate Pat Roberts.

Orman is, for all intensive purposes, a left-wing candidate (left-wing enough for Kansas Democrats, at least, who pulled their candidate off the ballot to give Orman a better shot at the seat). He’s shown commitment to Obamacare and campaign finance reform, and hasn’t ruled out caucusing with Reid and the Democrats, even as an Independent, to give them the 51-majority-mark to retain control of the Senate.

But as opposed as Kansas voters are to Orman's policies, they're potentially more offended by Robert's status as a 'Washington insider'. This rebellion is not just a trend in Kansas, but rising up across the entire country, as the majority of Americans now claim they don't trust the Federal Government. The Tea Party movement capitalised on this sentiment in 2010, and even 2012, but has done little to convince Kansas voters that Roberts isn't part of the structural problem.

Interesting race to note: Colorado and the 'War on Women(?)'

Colorado’s Senate race between Cory Gardner (R) and Mark Udall (D) was thought to be a swing race until very recently, when polls started indicating that the race was leaning red.

Traditionally a semi-swing state, with strong recent ties to the Democratic Party (Colorado voted for President Obama in 2008 and 2012), all signs indicate that it is not necessary the Democratic Party’s platform, but rather their political tactics, that have put left-leaning voters into the opposition’s camp.

Mark Udall (nicknamed Mark Uterus by journalists) used and abused the ‘war on women’ rhetoric to the point where it has become a joke, not just in Colorado, but throughout the entire country.

And unlike 2010/2012 elections, when it was politically popular and beneficial to use the phrase, Colorado Democrats are watching it backfire, as the gender-voting gap (for women, not for men) shrinks between Gardner and Udall.

It’s important to note the tide isn’t simply turning because of Democrat error. The GOP has finally gotten some sense on the issue, and Gardener has been campaigning to make birth control over-the-counter, non-prescription drug. A politically smart tactic on multiple levels: not only does it relieve fear that he is an anti-reproductive rights candidate, but making birth control over-the-counter is a step past what Democrats can offer women; Obamacare relies on birth control being provided via insurance policies.

If Udall loses tomorrow night, the Democrats would be unwise to see it as any kind of fluke. The ‘war on women’ has always been based on inaccuracies and lacked substance or evidence, and may not continue to sway voters as it once did.

Why is the Senate a game-changer?

Who controls the Senate for the next two years will not only have a deep impact on the end of Obama's presidency, also on the 2016 elections, when several prominent Senators will be looking to claim both the Democrat and GOP nomination.

Over the past four years, Harry Reid's policy of obstruction has stopped major legislation from being voted on in the Senate, protecting Democrats and the President from having to state their opinions publicly (by casting their vote or being put in the situation to veto legislation). If Republicans take control of the Senate, new Majority Leader Mitch McConnell (R) will most certainly hold the Senate to votes on legislation from the House; come 2016, ambitious Senators will be running on their voting records, not just their political promises.

Early signs on Tuesday night

If North Carolina and New Hampshire, which are thought to be leaning ever-so-slightly blue, come out early for the GOP candidates, we are probably looking at a sweep across the board, with a strong majority of GOP reps taking the Senate.

Likewise, if Montana, South Dakota, and West Virginia–all leaning red–turn out to be tight races with close vote counts, the GOP could be looking at a long night of close races and very possibly a crushing defeat.

If neither scenario plays out, anything goes. There's no doubt that the GOP will be taking seats away from Democrats on Tuesday night–but if they fall short of 6, even by 1, it's at least two more years Harry Reid and political gridlock, Not to mention an even tougher hill to climb come next fall. As if Capitol Hill weren't elevated enough.

Does the GOP need a new stool?

Does the GOP need a new stool?

This is the question that upcoming TNG guest Tim Stanley's been asking in a recent blogpost for the Daily Telegraph. To give a bit of context:

the Republican stool is at risk of losing its balance. As William F Buckley once argued, support for the GOP historically rests on three conservative legs: free market libertarians, social conservatives and foreign policy hawks.

However, in the absence of a strong anti-communist message American politics has drifted leftwards, whilst the GOP's 'Middle American' unity has been replaced with a "discordant alliance between wealthy grey technocrats and populist crazies". The legs of the Republican stool now look wobbly and unbalanced, leading to some uneasy and often contradictory politics. As a consequence, the Republicans fail to provide a convincing or consistent alternative to the liberals and Obamanomics.

So, what's the solution? Tim suggests that it lies in a 'rugged constitutionalism', where politics is conducted at a state level, individual freedom carries real significance, and Republican governments promise to largely get out of the way. Certainly, this has real appeal to libertarian-leaning conservatives both in America & the UK, but what's the likelihood of it actually becoming an election strategy?

Fortunately, under 30s are invited to ponder this question further at the TNG with Dr Stanley on this very subject tomorrow.

The event starts at 6pm in the ASI offices, and RSVP either on Facebook or to events@old.adamsmith.org.