The NHS debate

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I made a couple of media appearances yesterday to discuss the National Health Service. One of the points I stressed in both was how dismayed I have been by the level of political debate that this row – kicked off by American criticism of the NHS – has engendered.

The fact is that while there have been some improvements in the last decade, the NHS is by no means "the envy of the world". Indeed, on a whole range of indicators – whether it's patient satisfaction, waiting times, preventable deaths, stroke and cancer survival rates, hospital acquired infections, or the uptake of new drugs and technologies – the UK lags behind other European and developed countries.

The health service is hardly cheap either. We already spend £100bn a year on the NHS in England alone, and that figure looks set to continue rising regardless of who wins the next election. To put it another way, someone earning £30,000 a year will pay £2,300 in taxes to support the NHS. We may spend less than the US, but we also spend similar amounts to our European neighbours and get much less for it.

Britain deserves a proper, grown-up debate about its healthcare. But what do we get? Politicians 'tweeting' about how they love the NHS, and accusing anyone who dares disagree of being traitorous and unpatriotic. This is not just cowardly and infantile; it is also dishonest, shallow, and quite frankly pathetic.

Rather than burying our heads in the sand, we need to realize that there is a lot to learn from other countries – like Switzerland, the Netherlands and Singapore, among others – that provide better healthcare than we do. The key is to take the best elements of various systems come up with a reform model that will work in Britain.

A successful reform would likely embrace two key principles. The first is that healthcare is far too big and complex to be run from the top down. The second is that whether you are relying on tax or insurance to fund your healthcare, you can't completely isolate people from the cost of care, otherwise prices spiral out of control. I'll return to both these principles in future blog posts.
 

Fascism and communism: Two sides of the same coin

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In an article in last week’s Guardian, Jonathan Steele objects to the joint condemnation of communism and fascism. The moral he draws is that “History is too complex and sensitive to be left to politicians". Quite right, but it is also too complex to be used to defend a failed political ideology by crudely trying to show that another is worse.

Mr Steele was upset that the “23 August be proclaimed European Day of Remembrance for Victims of Stalinism and Nazism, in order to preserve the memory of the victims of mass deportations and exterminations". He felt this Declaration to be an attempt by former Soviet countries to discredit modern communists. Perhaps, but this observation does not mean the politicians are wrong to draw a parallel. It would be impossible to deny that Hitler discredits fascism and similarly the case stands for Stalin and communism. The other countless million murders that have taken place under fascist and communist regimes in other times and places also add to the case for the joint condemnation.

The European Declaration acknowledges the Molotov-Ribbentrop pact in which Hitler and Stalin agreed not to attack each other and divide central Europe in anticipation of the ending of hostilities. In 1989, the Baltic Way defied the Soviet Union on the fiftieth anniversary of that pact. Thus, twenty years ago the atrocities of fifty years previous were part of the fabric of the present, as they are still very much in the minds of the people of the region today. Anyone who has visited countries of what made up the Soviet Union is immediately struck by the way in which government and people make every effort to draw attention to, educate and mark the atrocities of communism.

Mr Steele concludes with his fear that, “First they manipulate anniversaries, then they move to textbooks, and the slide gathers speed". Certainly, this is how governments the world over function if they are given control over setting public holidays, education etc. This slide is even more apparent when those in power have little or no limit to their actions; which of course is most evidenced in communist and fascist states, and is also why both these political systems should be comprehensively and unequivocally condemned, either together or separately, but certainly condemned.

Compassion for the victims

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Compassion towards our fellow man comes naturally. Yet there are those who seek to harm via atrocious acts; they dismiss compassion in the process.

Should we find those persons guilty of such transgressions, done under whatever banner, then we are excused from being unconditionally compassionate towards them. Releasing a man on 'compassionate grounds' after he has served only 8 years of a life sentence shows what government officials thought of his victims: very little. His reception in Libya highlights what the Libyans thought of this decision and Scotland.

There has long been a history of political interference in the judicial process and once again we have seen politics impact upon the realm of justice. Newspapers reported over the weekend that both the prime minister, Gordon Brown, and his first secretary of state, Lord Mandelson, have had recent dealings with Gaddafi and his son. We have to surmise what topics were discussed – the politicians involved are unlikely to come clean – but they shouldn't be surprised if two and two are put together and something in the region of four-and-a-half is the result.

There has already been much conspiracy theorising surrounding the Lockerbie Bombing (much relating to international relations and trade), but al-Megrahi was found guilty in an internationally recognised court of law, and justice was done.

8 years for killing 270 people? Justice should be allowed to take its natural course. And yes, the same applies to Mr Biggs. It is far more virtuous to show compassion to those that have already been harmed by an act of evil.

Why we love the profit motive: Katine edition

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I have to admit to being fascinated by this development project that The Guardian is running in Katine, northern Uganda. Over a period of several years they're trying to see how and if it's possible to kick start development: a noble and worthy goal.

The fascination comes in part from my not quite understanding the mindset of those attempting to do the developing. There was one report about how there were not enough desks in the schools: not enough had been delivered by the Government apparently. But, umm, who would assume that in a poor country the Government ought to be delivering school desks? A table is not really all that high technology, a few burly blokes with machetes and a few days work in the woods would knock up something useable wouldn't it? Why this reliance upon the State, some hundreds of miles away over near impassable roads?

Another example is this piece about how a Coke (that's as in cola, not Charlie) is available in every village store but medicines are not. Or rather, medicines are indeed available in private stores, but not in the State run health care centres. The end of the piece is:

The new battle is now not just to get HIV medicines to people with Aids, but to get a consistent, affordable supply of essential drugs to all who need them. That means that governments in the west, as well as in developing countries, need to make money available, and turn their attention to supply systems. It can't be left to Coca-Cola barons. It's too important to leave to the market. Not just for Uganda, or Africa, but for all of us.

Excuse me, but given that the market does indeed get a consistent supply of drugs to those who need them, surely that means that it's too important not to use the market?

The demise of defined benefit pension schemes

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In recent years, many leading private sector companies have either closed or curtailed their defined benefit pension schemes. Just a handful of large companies, including Shell, now offer participation in a defined benefit pension scheme.

In part, this is due to pronounced changes in employment trends. Nowadays, there are comparatively few ‘lifers’, who join a company shortly after leaving school or university and remain in post until retirement beckons in their 60s. In previous generations, working for 40 years for a single private sector employer was not particularly unusual.

However, the cost of financing defined benefit pension schemes has become increasingly challenging, especially since people generally are living longer. Moreover, under recent changes to accounting rules, the net liabilities of defined benefit schemes are now effectively treated as debt in company balance sheets. Certain former publicly-owned companies, British Telecom (BT), British Airways (BA) and BAe Systems, are particularly exposed in this respect. Indeed, in recent years, both BT and BA have seen their share prices seriously impacted by their burgeoning pension liabilities – notwithstanding their own poor trading figures.

The drag on share price performance of sizeable defined benefit scheme liabilities is such that many companies are sharply scaling back pension entitlements. BP recently announced that new entrants would not be eligible to participate in its defined benefit pension scheme whilst Barclays plans to go further by closing its defined benefit scheme to existing members.

Perhaps not surprisingly, generous defined benefit pension schemes still prevail in the public sector – but for how long? Given that the unfunded pension liability of the public sector may exceed a staggering £1 trillion, it seems inevitable that the next government - of whatever political persuasion - will be forced to take aggressive action to reduce very substantially these liabilities.

Privacy for parliamentarians

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Recently, the pseudo-celebrity MP, Lemit Opik, called for stronger privacy rules protecting MPs. No doubt many would highlight the irony of an MP with a string of celebrity partners calling for greater levels of privacy, but let's leave cheeky girls aside for now. There is a moral issue here regarding the fine line between political transparency and the right of those in public life.
 
Mr Opik said "For a long time I believed the cost of public life was public attention, which at times does not please the subject of the coverage, but which nevertheless goes with the territory." This is a crucial point in the debate. There needs to be a culture within politics that MP and Lords are working for us, that they are employees of the people. As such, those entering politics need to accept that parts of their life will be on public display because it could eventually impact on us.
 
The expenses scandal has revealed and emphasised the need for greater transparency with financial matters. Essentially, the MPs proved that they could not be trusted with our money – this intrusion into our representatives lives by the media only had positive outcomes. It gave the MPs a warning that they couldn’t continue living unchecked at our expense, whilst it gave the electorate the wake-up call that we need to play a role in seeing where our money goes.
 
But there is a valid case that the intrusion of the media into the lives of MPs has gone too far and is inflicting upon the rights of MPs. Granted, if MPs were left with so little privacy that it severely impacted on their lives, we would put off the best candidates from entering politics, resulting in a sub-standard system.
 
There needs to be a fine balance struck regarding privacy in public life. In my opinion, there can never be too much transparency when it comes to financial matters, we must know where our money is being spent. But, everybody should be entitled to a degree of privacy – I don’t need to know where an MP goes on holiday.

The environmental dark ages

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To hear some environmentalists speak you would think that we are currently in the environmental dark ages. The ever expanding economy (current hiccup exempted) means that we are using up ever more resources, spewing out ever more pollution and generally leading the way to Hell in a handcart.

That they say this when the air and the waters are cleaner than they have been for many centuries, when resources, judged by their price, are cheaper and thus more abundant than ever, causes no little amusement.

However, it is their next step which is so dangerous. We must localise all production, not eat food from outside our own region: depending upon who you talk to it might be from outside your own garden, town, county or bioregion but international trade is certainly very naughty indeed. In fact, we shouldn't be getting anything at all from other countries, let alone the other side of the world.

Localism in government is to be admired, localism in production and consumption rather less so.

A new book on the end of the Roman Empire points to this as the defining economic mark of that age:

An emphasis on "localization" as the fundamental change following the fall of the Roman Empire, and numerous micro-studies of exactly how that localization occurred.  Cities shrank, trade networks dried up, etc.

Not for nothing do we decribe that time as The Dark Ages. Last time around it came about because of the collapse (for whatever reasons) of a political power. Let's not inflict it upon ourselves in the name of environmentalism, eh?

Letters from the Lakes

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One problem with being on holiday (although, clearly, I'm not really complaining) is that you get much longer to read the papers. And for someone with libertarian leanings, that means that every leisurely breakfast is inevitably accompanied by news of countless new government initiatives – most of which are pointless, intrusive, expensive, or all of the above. Deeply depressing stuff.

If I had a shorter fuse I'd probably end up hurling my cornflakes at the wall. As it is, I just feel compelled to write letters to the editor. Below are a couple of unpublished ones I sent to The Times while wandering around the Lake District.

On the idea of 'minimum space requirements for new housing...

Sir, Rebecca O’Connor reports that new-build British homes are among the smallest in the world. I can well believe it. But couldn’t this have something to do with our planning system, which forces developers to meet minimum density requirements and obliges them to set aside land for loss-making ‘affordable housing’? Whatever the Commission for Architecture and the Built Environment might think, we don’t need more regulation to fix this problem. We just need to free developers to build the sorts of homes that people actually want to live in.

And on Mexico's drug war...

Sir, Your leading article of August 11 is misguided. Decades of bitter experience have shown that no amount of military might can win a ‘War on Drugs’. Indeed, all such interventions actually achieve is to raise the market price of these substances, and give the cartels an even greater prize to fight over. The human cost of this failure is enormous. Surely it is time to accept that the only sensible solution is to take narcotics out of the hands of gangsters, and legalize, licence and regulate their production and sale. As well as depriving criminals of a lucrative market, this would have considerable health and social benefits, reducing the incidence of overdoses and poisoning, and making treatment of addicts much easier. Empirical evidence from Portugal, which decriminalized drugs in 2001, bears this out.

In future, I think I'm just going to stick to the sports pages.