Jun 032012
 

Punk is dead,’ asserts Chris Dillow today.

In this, music reflects a wider social fact—that today’s young people are much less gobby than we were. Last summer’s riots, for example, contained less political motive than their 1981 equivalents. And much as I love them, today’s “voices of their generation” are pretty tame…This is not because of a lack of cause. Today’s youngsters have the same grievances as my generation – youth unemployment and police harassment—and then some.

So why are young folk so passive?

He presents a number of possibilities: today’s oldsters are more tolerant, today’s youth are the captive slaves of mega-materialist capitalism, etc.

At no point does he consider that today’s youth are passive because that’s how Chris Dillow’s generation taught them to be.

I’ve written about this before…

But we live in a curiously dishonest world, wherein baby-boomers hold all of the power and then complain that the youth are disaffected and disengaged, unlike themselves when they were ‘the youth.’ In fact, most of the policies advocated by the baby-boomers in power seem deliberately designed to keep ‘the youth’ dependent on them, which is a perfect recipe for further disaffection and disengagement.

Let us consider recent proposals in Britain dealing with ‘the youth.’

(a) Compulsory education or training to age 18. This keeps ‘the youth’ under the control of the state (read: baby-boomer run) education system until legal adulthood.

(b) Sending more of the population to university. This keeps ‘the youth’ under the control of the state (read: baby-boomer run and operated) education system until well into adulthood.

(c) Government-provided work and training for graduates who can’t find jobs. This keeps ‘the youth’ (who are now into their twenties) dependent on the state (run by baby-boomers) for sustenance and the acquisition of skills.

(d) Parent training courses. This sends the message to ‘the youth’ who have dared to reproduce that despite their biological fitness for the job, they are mentally and emotionally unfit to raise offspring without guidance from the state (i.e. baby-boomers, those proven experts in child-rearing).

All of these policies could not make more perfectly clear the belief of baby boomers that ‘the youth’ of today are unfit to make decisions for themselves, support themselves, or support other humans; and yet still the baby boomers complain that ‘the youth’ don’t take responsibility for themselves and agitate for their own benefit.

…more than once:

Mind you, our ex-hippy [ex-punk?] overlords seem particularly distraught that the voice of the new generation is a weak one. A couple of days ago, I wrote that it was a key feature of the baby-boom generation to strangle the life out of today’s youth and then demand to know why it wasn’t trying to breathe.

And lo, what should be in the newspaper on Monday but the results of a poll showing that today’s youth are ‘more boring’ than their parents.

Having been told from birth to shun smoking, drinking, sex, drugs, and pretty much anything else that could be interpreted as either exciting or ‘interesting,’ the yoof turn out to be rather hard-line Puritans. Quelle surprise. And for this, the baby-boomers have the nerve to complain that their kids are no fucking fun.

If you want angry, empowered youth, then don’t spend the first 25 years of their lives teaching them that the bland, unquestioning, isolating conformity which suits your desire to retain cultural and social dominance is for their own good.

Your methods of upbringing are what created today’s 23-year-olds who fret over whether they can afford to buy a house in Barnes. Your parental indulgence is why others of your children still live in your council house with three kids of their own, no spouse, and no job.

You didn’t teach them to see the value in standing up for their future because you didn’t want them to do that—because it might hurt yours. You’ve told them all of their lives that somebody else would sort out their problems, take their part, and make the world right for them; you’ve taught them that dependence has no cost and entitlements have no price and one’s desires are automatically others’ debts to pay—why should they not believe you now? You have no right to complain. You promised them the earth; they’re just waiting patiently for you to provide it for them.

Mar 272012
 

I’ve been reading the transcripts of and commentary about the US Supreme Court arguments taking place this week about the constitutionality of the “individual mandate” and associated penalty contained within the provisions of the Patient Protection and Affordable Care Act (2010).

Before I get into any analysis, a seeming triviality: many of the news reports about this case are noting the fact that its opponents refer to the act as “Obamacare,” as if this were some kind of novel piece of slang. It’s not. What’s new is that, ahead of these oral arguments, the Act’s supporters have started embracing the term instead of discouraging its use, as if Barack Obama himself has delivered this manna to the unhealthy. Frankly, I don’t think Obama has even read the full text of this legislation, so I refuse to give him sole credit (or blame) for it, and will refer to it by its acronym PPACA, which is the norm when referring to legislation of the American Congress. (What, did you think PATRIOT Act was capitalised because it’s a big deal? No: it’s because it’s the Uniting (and) Strengthening America (by) Providing Appropriate Tools Required (to) Intercept (and) Obstruct Terrorism Act of 2001. American politicians are nothing if not massively cheesy.)

Now let’s address why I’m writing this blog post. This case is an extraordinarily big deal, and you will have a hard time understanding why if all you read is the news media accounts of the arguments. The American media does not want to go into any great analysis of the issue, for fear that you might draw your own conclusions, and the British media does not understand the significance. In the British media in particular, you will find reporters utterly baffled by what appears, to them, to be a sneaky, underhand challenge of the president himself under the pretext of a legal technicality.

Whether or not a law, or a part of a law, is constitutional is simply not a legal technicality. The Constitution is the basis for all federal government in the United States. The federal government simply may not make laws that contravene, or surpass, what the Constitution allows it to do. The law, or the provision within the law, cannot be imposed upon the American people if it is not constitutional. And one of the basic rights Americans have is to challenge the federal government about the constitutionality of its laws. That British journalists don’t seem (or want) to grasp this, simply because they personally think the PPACA is a good thing, makes them shitty journalists.

So. What is the issue at stake?

The challenge to the PPACA is about the provisions in section 5000A, which require Americans to be covered by health insurance (whether purchased individually or through their employer) or incur a penalty. These parts of the law are collectively referred to as the “individual mandate” or the “minimum coverage provision.”

The challengers, in this case, are a number of American states and some associated individuals. Their basic contention is that the US Constitution does not permit the federal government to compel people to purchase health insurance when they are not purchasing health care services.

In this case, you have two participants: the challengers, and the US federal government (as represented by the Solicitor General). This case has gone through the federal courts already, and the Supreme Court agreed at the back end of 2011 to hear it. This is significant: the Supreme Court can choose not to hear cases, so the fact it has chosen to hear this one means the Court believes that there is enough doubt about the matter, or enough importance about the question at hand, to make it an issue worth settling. The Court’s decision is binding and, in this case, may also be precedent-setting. (This is kind of what puzzles me about the position of many British journalists; if the high court of the US thinks it’s important enough to discuss, who are you to call it a trivial technicality?)

But enough about British journalists. Part of the reason reportage about this case is so crappy is that there are lots of different strands of argument involved, not all of which make a lot of sense if you consider them in isolation.

For example, yesterday’s arguments centred around whether or not the Court could even hear the case. Here’s the background: as the case has made its way through the lower levels of courts, the government’s position has been that the penalty for not purchasing health insurance is, effectively, a tax, and taxes do not come under the jurisdiction of any court until the complainant has paid the tax, requested administrative redress, and been refused. Then, and only then, can the complainant bring suit. (Challenges to tax are covered under a law called the Anti-Injunction Act.) The government’s argument has been that, since the mandate and penalty/tax do not come into force until 2014, the law cannot be challenged on those grounds in 2012, because nobody has yet paid the tax and therefore nobody can at this point bring suit.

Interestingly, once the Court agreed to hear the case, the government switched positions, and yesterday argued before the justices that the penalty is not a tax subject to the Anti-Injunction Act. Because the challengers were making the same argument, the Court had to appoint independent counsel (the amicus curiae) to argue that the penalty is a tax. Ultimately, yesterday, the Court appeared to accept that the penalty is not a tax subject to the Anti-Injunction Act. Nobody was surprised by this; why would the Court schedule three days of argument about the matter if it envisioned recusing itself after the first day?

So. We proceed to today’s arguments, which were about the constitutionality of the mandate itself. I have read the transcript, but I am not a lawyer, so take what I am about to describe with the understanding that I am both ignorant and naive to a certain extent. However, you can read the stuff yourself on the SCOTUS website; the arguments were very accessible to the layman.

The government argued as follows. In the Constitution, the federal government is allowed the power to regulate commerce, and issues affecting commerce, between the states (the “Commerce Clause”). There are two commercial markets at issue: one is for health care services, and one is for health insurance. All people in the US are participants in the health care market, because all people in the US will require health care at some point. Health insurance is the method by which people finance their health care in the US, and therefore all people are technically participants in the health insurance market also. Ergo, Congress has the right to regulate both, as both constitute interstate commerce, even to the point of requiring people to purchase health insurance at a given point in time, because their failure to do so is an issue that affects commerce within that market.

(There is also a whole bunch of stuff about how the penalty for not buying is a tax, but I didn’t follow that part too well, and since the government argued yesterday that it is only kind of a tax, I’m not sure how germane the point is anyway.)

What it is important to understand about the government’s position is that, in the US, even if you do not have health insurance, you cannot be refused health care. So what happens is that people without the means to pay for their health care nevertheless receive it, which drives up the cost of care, which in turn drives up premiums for those people who are insured. So the government is arguing that because some people’s failure to insure themselves affects the price of everyone’s health care and insurance, Congress has the right to interfere in the purchasing (or not) of health insurance under the justification of the Commerce Clause.

By compelling people to purchase insurance (and penalising/taxing people if they don’t), the government’s aim is to reduce the free rider problem and thus lower the cost of care and insurance premiums.

If you read the transcript, Solicitor General Verrilli does a lot of waffling about the “40 million Americans who don’t have access to care,” but the upshot of what he’s saying is this: actually, these people can get care, they just don’t pay for it. So in order to cover the cost of people who can’t pay for the care they definitely do get, everyone has to be insured. That way, the insurance companies can use the premiums paid by the healthy to subsidise the cost of the care for unhealthy people who can’t pay for it themselves. Thus, because everybody is affected by this way of ensuring poor people can still get health care, Congress can do what it chooses, including compelling purchase, to deal with the problem.

So far, so clear. The system envisioned in the PPACA is one of the healthy subsidising the unhealthy.

The challengers argument was somewhat more complicated.

First, they disputed the “everybody is a participant” claim. Many of the Americans who do not have health insurance are young, healthy people who choose to spend their money on something else, believing themselves to be at low risk of requiring health care. Thus, these people are not, at a given point in time, participants in either the health care or health insurance market. The Commerce Clause, they say, does not give the government the right to compel people to participate in these markets when they otherwise would not choose to do so.

Second, they disputed that the health care and health insurance markets are so intertwined as make eventual participation in the one the justification for forced participation in the other. There are, they said, other means of subsidising the unhealthy who cannot pay for their care than compelling the purchase of health insurance. Social Security was brought up: a general tax, linked to income, levied on everyone, which the federal government then disburses to those requiring the payments, would be constitutional in a way the mandate is not, because the Constitution does give the federal government the right to levy taxes. (This is, in fact, how Medicare and Medicaid work at the moment.) The challengers also pointed out that the problem the provision is attempting to solve is one created by the government in the first place: namely, the government forces emergency rooms to treat those who cannot pay, and it forces insurance companies to insure high-risk individuals. If it did not do those things, there would not be a free rider problem, and so there are other solutions than the mandate imposed by the PPACA.

During the arguments, the justices focused particularly keenly on two problems with these issues: (1) are the health markets unique, and if so, what specifically is the limiting principle that will stop the federal government from engaging in compulsory purchase in other markets? and (2) if the challengers concede that the federal government can force people to purchase health insurance at the point of purchasing health care itself (which, apparently, they do concede), what is the problem, precisely, with moving that point of compulsion forward in time, when it will have the most beneficial effects?

A lot of today’s commentary was along the lines of “Obamacare in danger of being struck down,” because the justices seemed particularly pointed and hostile in their questioning, but I think this is premature. The mandate may be ideologically horrific to the average American mindset, but that does not mean it is unconstitutional. And the role of the justices is to pick holes in the arguments and expose the weaknesses; that doesn’t mean those weaknesses are fatal. The most aggressive questioning came from Justice Scalia, and I admit the Solicitor General didn’t seem particularly articulate in his answers—at one point, Justice Sotomayor summed up his argument for him much better than he had done, and he didn’t seem to notice—but that doesn’t mean his points are invalid.

There were a lot of other issues and sidelines in the arguments, but there was one point that came out pretty strongly to me, and it was made by Michael Carvin for the challengers. What he argued, in effect, was that the government’s own argument is self-contradicting. At the moment, people with insurance effectively subsidise those without. Under the PPACA, people with insurance will effectively subsidise those without. There is no difference in where the cost is borne; it is always borne by the people with insurance. What the PPACA proposes to do is to increase the pool of insured people to pay the subsidy, thereby spreading the cost over a larger base. The PPACA itself, and the government, admit this is the entire purpose of the mandate: to make healthy people who do not currently purchase health care purchase insurance in order to cover the cost of those people who cannot pay for the health care they purchase.

Therefore, the government is implicitly admitting that there are some people who are outside the market, who need to be drawn into the market in order to spread the cost of subsidy around—and since that is the whole purpose of the mandate, the existence of the mandate demonstrates that not everybody is a participant in these markets, and therefore are not engaging in commerce that can be regulated in this way by Congress.

It’s a neat little argument, and I wish he’d been more explicit about how circular it is. He does call it “bootstrapping,” though, and it’s true. If everyone was a participant in these markets, which is the government’s justification for this falling within the power of the Commerce Clause, there would be no need for the mandate; but because the point of the mandate is to make everyone participate, it is itself an admission that not everyone does, and therefore it can’t be justified by the claim that everyone is already a participant, because if they were, the government wouldn’t need to mandate that they participate.

The only other interesting thing to point out is that, although everyone involved seems keen not to get into the merits of the law as a whole, with the whole, y’know, making sure people don’t bankrupt themselves in order to stay healthy, the people who are most prone to talking about the merits of the law appear to be the justices themselves. This is why I think the commentators are premature: while it’s nice to think that Supreme Court judges are impartial, they’re not. They’re perfectly capable of allowing their approval of the aim of the PPACA to bias their views on its constitutionality—and by the same token, of allowing their repugnance at the methods of the PPACA to affect their judgment of its intention.

And that’s true of a lot of people right now, I think. Health care in the United States is totally fucked up, and I don’t think it’s really possible to dispute that. However, the PPACA is not the only possible solution to the problems, and my personal view is that it’s about the worst one, in fact. But people on the right are in danger of defending a really shitty situation when they attack this law, and people on the left are in danger of defending a really shitty law when they attack the current situation.

This is why, going back to the beginning, the label “Obamacare” is so pernicious. Would people really be as blindly and tribally partisan about this law if it didn’t involve a cult of personality and were, instead, the boring old PPACA?

Read the transcript for Monday’s arguments.

Read the transcript for Tuesday’s arguments.

Feb 042012
 

Other libertarian bloggers have written about this phenomenon already, that there have been a spate of attack pieces in the media about the follies of libertarianism, probably as a result of Ron Paul’s popularity, but not necessarily. We like to see this sort of stuff, because nobody bothers fighting against an unsuccessful opposing ideology. You don’t tend to see polemics against Nazis these days. If fatuous left-wing commentators are attacking libertarianism, it means we’re winning!

This is not to say there isn’t always anti-libertarian guff from the left wing, because that would be to deny the constant, low-level contempt thrown at us by Rousseauistes whose goal for humanity extends no further than meeting the animal instinct for a full belly. But I digress. To see high-level anti-libertarian guff is rarer, and therefore more meaningful when it shows up. It’s just a shame that our first instinct is to interpret this attention as victory.

***

Exhibit A: George Monbiot, that second-rate St Paul for the Guardian (motto: “Comforting the afflicted, afflicting the comfortable”), took on libertarians twice in two weeks. His first piece, “How Freedom Became Tyranny,” might as well have been nicked wholesale from the Brer Fox playbook.

Modern libertarianism is the disguise adopted by those who wish to exploit without restraint. It pretends that only the state intrudes on our liberties. It ignores the role of banks, corporations and the rich in making us less free. It denies the need for the state to curb them in order to protect the freedoms of weaker people. This bastardised, one-eyed philosophy is a con trick, whose promoters attempt to wrongfoot justice by pitching it against liberty. By this means they have turned “freedom” into an instrument of oppression.

Oh, no, Mr Monbiot, please don’t throw me in the briar patch!

Monbiot’s whole piece leads up to that conclusion with the standard dodgy rhetoric and facetious analogies that are no stranger to any libertarian. We’re argumentative creatures, so it’s tempting to fisk this pile of manure, but if I’ve done it once, I’ve done it a hundred times, and I credit Monbiot with enough sense to know he’s just putting libertarians into their comfort zone with this one. No, this article is merely the set-up. Draw libertarians into making their usual tasty rebuttals about negative freedom, property rights, and the non-aggression axiom, so that you can deliver the blow with this: “Why Libertarians Must Deny Climate Change.”

Look at the libertarian, trapped by his own arguments!

Let us accept the idea that damage to the value of property without the owner’s consent is an unwarranted intrusion upon the owner’s freedoms. What this means is that as soon as libertarians encounter environmental issues, they’re stuffed.

Climate change, industrial pollution, ozone depletion, damage to the physical beauty of the area surrounding people’s homes (and therefore their value), all these, if the libertarians did not possess a shocking set of double standards, would be denounced by them as infringements on other people’s property.

How neatly Monbiot skewers us. Either we care about property rights as a form of freedom, and we reveal ourselves as blinkered anti-science tribalists; or our denial of climate change exposes our devotion to property rights and freedom as a flimsy pretence for poor-hating selfishness. Either way, he’s happy, and we’re “stuffed.” You see, children? Don’t be seduced by the libertarian, after all. The puppet-master has just made him put a bullet through his own foot.

Or not. Good little libertarians have read their Rothbard, unlike Monbiot, so instead of shooting our own feet, we feel like we’ve patted our own backs. Well done to us, anticipating this trap by 30 years! Well done indeed. When the public at large gets round to reading Rothbard too—surely just around the corner, any day now—they’ll see we were right all along.

Exhibit B: Jeffrey Sachs, jumping on the bandwagon, holds forth in the Huffington Post with “Libertarian Illusions.” Unlike Monbiot, Sachs is writing to reinforce the average HuffPo reader’s herd instinct. (Take a look at the article’s tags, too: they’re hilarious.)

You see, children? Don’t be seduced by the libertarian—not because he is wrong, but because he is, like, unenlightened, man. His conscience is less exquisitely sensitive than yours, and in his quest for justice (a fine thing, to be sure), he overlooks the infinitely more spiritual delights of forgiveness.

It’s beguiling to focus one’s activist energies on something as unopposable as liberty (and it is a good thing, to be sure), but… what about all that other stuff, you know? Stuff like compassion, and help for the weak. Those are all good things too, as you already believe: don’t they deserve your energy too? Freedom isn’t the only unassailable good thing.

By taking an extreme view—that liberty alone is to be defended among all of society’s values—libertarians reach extreme conclusions. Suppose a rich man has a surfeit of food and a poor man living next door is starving to death. The libertarian says that the government has no moral right or political claim to tax the rich person in order to save the poor person. Perhaps the rich person should be generous and give charity to the neighbor, the libertarian might say (or might not), but there is nothing that the government should do. The moral value of saving the poor person’s life simply does not register when compared with the liberty of the rich person.

Most ethical and political systems find the libertarian position abhorrent, indeed preposterous. Most would hold that the government can, should, and indeed must, tax the rich person to save the poor person. That’s because most ethical and political systems hold that liberty is only one value among many important values, and that the value of the indigent’s life takes priority over the liberty of the rich individual.

For all of you philosophers out there (and there are many, you’re all such enlightened thinkers), libertarianism is unethical: it is a rejection of deep spiritualism!

This view is the opposite of Christian charity and Buddhist compassion, according to which moral worth is achieved by helping others.

For the economically-minded, remember that even the great free-market thinkers didn’t think liberty was the finest thing in life! You don’t have to be a Marxist to believe libertarianism is wrong.

The affirmative role of government includes public education, promotion of science and technology, environmental protection, and the provision of infrastructure. Friedman and Hayek both championed a state guarantee of basic needs for all citizens.

And for the political activists, well, you and I both know that government doesn’t have to be the enemy of liberty, any more than it is the enemy of compassion or helping the vulnerable.

Modern history has shown that activist democratic governments, ones that provide public goods and help for the poor, do not really threaten liberty. In Scandinavia, for example, where the governments are much more activist than in the United States, democracy is very vibrant and far less corrupt than in the U.S.

So while it’s tempting to be a libertarian and simplify everything to questions of freedom, the only people who really do this are vulgar materialists whose limited horizons prevent them from joining you in working toward a world of the impossible good. After all:

America has achieved it greatness not through a single-minded ideology but through pragmatism and the wisdom to embrace several important values. A vast majority of Americans today embrace liberty, civic responsibility, and compassion, and seek a government built upon all three. We are the better individuals and a much stronger society for it.

Good little leftists: the libertarian may have one or two ideas, but you were right all along!

***

Do these kind of attacks represent a victory for libertarians? I don’t know. It’s difficult to counter something like Monbiot when your vindicating text is fringe literature most people are never going to read, and with people like Sachs blowing smoke up the enemy’s backside, you need a much bigger prick than Ron Paul to pop that smug self-satisfaction.

This is what I always wonder about libertarianism: we have the tactics to advance, sure, but do we have the strategy to win? Somehow I doubt it. When, as a group, your dearest-held moral values are non-aggression and individual agency, you tend to eschew the Monbiot-Sachs Plan of ambushing your enemies and brainwashing your allies.

Feb 042012
 

In the NHS, there two main activities. One is helping sick people. The other is measuring, improving, correcting, extending, and promoting how well sick people are helped. Much energy is expended on the first activity: technical advances, new pharmaceuticals, further training for doctors and nurses in new ways to help sick people. But the more you read about the NHS, the more you get the feeling that a lot more energy is expended on the second activity.

There’s nothing particularly wrong with this; even in a business, delivering the product or service to customers is straightforward, if not always easy, and the bulk of business energy is expended on how to improve the product or service, how to measure whether or not it’s good, strategy for getting it in front of the market, selling it, and so forth. Large numbers of people are employed to do these things, and a lot of money is spent in doing them—money that is generated by the delivery side, both by delivering the goods and by finding new ways to reduce inputs and increase outputs. Greater productivity means greater profits, which can be taken home as pay or ploughed back into the rest of the business.

The difference between a business and the NHS, however, is that issue of money. Money is the simplest metric for business success: how much are we making? Allocating money in a business is also fairly simple: wages, tools, marketing, infrastructure, tax, in varying proportions, and what’s left over goes to the shareholders. And if the metric drops—we are making less money—the allocations drop too. Therefore business responds to money.

The NHS, on the other hand, doesn’t respond to money, because it doesn’t make any. You can argue whether this is an intrinsic function of what it does—healthcare—and you can even argue the ethical toss about measuring something as important as health by looking at money, but you can’t get away from the fact that the NHS has something to do with money, because helping sick people has a cost.

The NHS is sort of halfway in the market. It doesn’t directly charge its customers for its services, so it can’t respond to the “how much are we making?” money question. But it still has to answer “how do we allocate it?” and “what do we do if we have less to allocate?” Doctors and nurses don’t work for free, so it still has to think about wages. Medical supply manufacturers don’t manufacture for free—they are businesses, so they have to worry about how much money they’re making—and infrastructure has to be paid for as well. The NHS has all of the business problems of spending money, and none of the tidy business solution of earning it.

So when, in the NHS, the costs grow and/or the pool of money to spend shrinks, the sector has to find pseudo-business solutions to deal with this problem. “Pseudo” because what businesses do is frequently not an option for the NHS. For instance, a business could produce more goods or services. The NHS can’t do this, because it’s really unethical to go round trying to make people sick so that you can cure them more, but also because the NHS’s primary service—helping sick people—is actually a cost, and doesn’t make them any money. For the same reason, they can’t look for new markets like a business would, but also because the market for the NHS is already every person in Britain. Other solutions are simply odious. The NHS can borrow money, but their collateral isn’t private, so they end up mortgaging the public good. The NHS can ask patients to pay—private patients, or foreigners—but this invalidates the ideology that health shouldn’t depend on wealth. They can ask the government to raise taxes, but that’s a PR nightmare, and the existence of the NHS depends on people’s loyalty and goodwill.

So the NHS has only one option, and that is to reallocate its spending. Reduce the number of doctors and nurses treating the sick people, and thus lower the wage bill. Find cheaper suppliers, and thus lower the tools bill. Hire cheaper builders to patch up the estate, and thus lower the infrastructure bill. Use what you’ve saved to increase marketing healthy lifestyles, and hopefully the number of sick people will drop, and through all of these increases in productivity (in the NHS, it’s called “efficiency”), maybe you can break even, or even turn a profit (in the NHS, it’s called a “surplus”).

In the NHS, you can also do rain dances, make offerings, and perform collective prayer rituals that the UK economy flourishes enough for tax receipts to go up, giving the government the power to increase your budget again.

Unfortunately, all of these things make for a cumbersome and difficult-to-run healthcare system. Sacking nurses looks evil, and makes life harder for the other nurses. This, and using cheaper supplies, can literally endanger people’s lives. Infrastructure creaks as it gets older, and the population rapidly outgrows the limited space. Paying staff, suppliers, and contractors less reduces tax receipts. And public-health marketing is notoriously ineffective.

So what the hell do you do, if you’re the NHS? Do you say, “Fuck it, this half-business life is no life at all—let’s act like a real business and charge people money. Then if they pay us, we know we’re doing a decent job”? This doesn’t even have to mean that poor people die in the streets, because the government could just give them the money to buy their healthcare.

No. Instead, you bitch and moan and look for Rube-Goldberg-esque solutions to act as proxies for normal market behaviour. And then you can see why helping sick people is the least of what goes on in the NHS.

Let us consider, for example, the Health Service Journal, the premier trade journal for non-medical NHS staff. Does it have anything to do with awesome new and better ways of helping sick people? Does it fuck. It is Rube Goldberg literature for the Rube Goldberg system.

This week’s stories include:

(1) The way to improve the NHS’s effectiveness and efficiency is to set up an independent standing commission to look into the matter.

(2) Outsourcing middle management can, in ideal circumstances, reduce “overspend” (in the business world, “losses”).

(3) Medical unions are concerned that competition will lead to health “inequality.”

(4) A government quango will judge who is allowed to help sick people.

(5) The same quango prioritise patients over creditors when it puts private providers out of business by disallowing them from helping sick people.

(6) The same quango shouldn’t give NHS bodies credit ratings for borrowing purposes, because credit ratings are not an appropriate proxy for how well sick people are helped.

(7) Another government quango will measure how well sick people are helped by a series of inspections centred on 100 performance metrics.

(8) Another government quango will judge which GPs are allowed to buy healthcare from the NHS for sick people, but it will need management consultant help to do this.

(9) The GPs will also need to be helped to create a QIPP strategy. (QIPP stands for “quality, innovation, prevention, productivity.”)

(10) Publication of how well these 100 metrics are met may lead to health “inequality.”

(11) However, not publishing these data, because they are impossible to collect and monitor, is also unacceptable.

(12) PCTs can close down their competition but only if they don’t ask doctors whether or not they should do it.

(13) A commission will investigate whether imposing fines for making people sick with C. difficile will hurt hospitals.

(14) Some middle managers are unhappy about spending money, time, and energy on healthy lifestyle programmes for staff.

(15) Patients need a better way to complain about the quality of help they received when they were sick.

(16) In order to do all of this stuff, there needs to be a strategy for staff engagement.

(17) There also needs to be a strategy for adopting helpful technology.

And my personal favourite:

(18) “Salford Royal Foundation Trust’s clinical leaders development programme is part of an emerging organisational development strategy to engage senior medical staff in the business of clinical leadership and develop their talent.”

So there you have it. Because the NHS cannot measure how well it provides its service—helping sick people—by the money it makes from its customers, it has to invent Byzantine proxies, implemented and assessed with great energy and at enormous cost, none of which have anything to do with helping the sick people.

And why? Because this tremendous waste of time, money, talent, and human capital is preferred as a more humane outcome than letting sick people hand over money directly in order to get better.

Dec 302011
 

As if its appeals process weren’t bullshit enough already, the UK Border Agency has recently announced policies to make it even worse.

First, even more payment required:

People who want to appeal against a decision notice dated 19 December 2011 or later will need to pay a fee. The appeal fee will apply to most categories of visas and decisions.

It already costs hundreds, sometimes thousands, of pounds to apply for a UK visa or work permit in the first place, an obvious money-making scam the British government uses to supplement its “revenue”. Now, if a would-be immigrant feels he or she has received an unjust refusal, that person will have to pay the UKBA more for the privilege of watching it judge its own decisions. Or rather, lie about having judged its own decisions, glorying in shutting down appeals without even investigating the case or leaving a paper trail of so doing.

Who wants to bet with me that in 2012 we’ll see the number of dodgy visa refusals rise astronomically for the purpose of hoovering up these appeal fees?

Second, this catch-22:

Also, from 19 December people will need to lodge their appeals at the tribunal in the UK. We will no longer accept appeals at any of our overseas visa application centres.

So if you want to lodge an appeal against refusal of a visa to enter Britain, you have to lodge it…in Britain?

Good one, guys.

The UK Border Agency and Home Office are shining beacons of fascism. Seriously. And before anyone leaps in to accuse me of racism against the British and tell me to fuck off back to wherever—yes, I know it’s worse in the US, and no, I didn’t vote for them.

Dec 282011
 

Somewhat strangely this year, I find myself in possession of a vote of higher value than normal. Allow me to elaborate:

  • In 2008, the presidential popular vote in North Carolina was extremely close. Obama won the state’s electoral college votes by a margin of 0.32%, the equivalent of about 19,000 votes.
  • The current US Senate has 51 Democrats and 47 Republicans. Of these, North Carolina supplies 1 Democrat and 1 Republican.
  • The current US House of Representatives has 193 Democrats and 242 Republicans. Of these, North Carolina supplies 7 Democrats and 6 Republicans.

All of which means that, for the first time I can ever actually remember, North Carolina is an important swing state, where candidates are suddenly bothering to campaign—the Democrats have even chosen North Carolina’s biggest city to host their national convention this year. North Carolina might therefore just become a deciding factor in this year’s federal elections, and my vote, historically puny and pointless, this year carries some weight.

(Although not in the primaries, thanks to the NC General Assembly’s long-standing and well-attested tradition of constant gerrymandering.)

I thought I might bring this up for the purpose of drawing attention to a basic and amusing irony: I, suddenly possessed of an important vote, nevertheless don’t care; while many foreigners, possessed of no votes in the American elections at all, would give their eye-teeth to have it. What the United States political class does, so the argument goes, affects the world, so the world should have a vote. And yet it doesn’t, but I do.

And this is likely to be a dirty-fought and close-won election, in both legislative and executive branches.

I have therefore decided to offer my federal vote to one non-American person who gives a shit that is statistically significant from zero. I will vote the way you want in the presidential and congressional elections, whether it be for specific candidates or a straight-ticket party or not at all, or even spoil my ballot with amusing sayings. I stress that this is a gift, not a trade; I am conversant with North Carolina general statute 163-275 making it a class I felony to accept any thing of value whatsoever in return for my vote.

Therefore, any person who would like to take up this offer of mine must be scrupulously conspicuous in offering me no value for it at all; in fact, it might even be better if such persons were to cause me a loss of value somehow, for example by kicking me in the shins or making me buy them pints.

Takers in the comments, please.

Dec 122011
 

Seriously? No, seriously?

Just cut out the middleman and let rich people sponsor a poor person. There would be less waste in the long run, jobs for council workers (the OKCupids of wealth patronage!), and a powerful social impact.

After all, why give your money to charity when you can give it to your own impecunious client?

I mean, it worked for the Romans.

Dec 012011
 

So. This time last year, London was under a blanket of snow. That was weather, not climate change.

This time this year, London is positively balmy. I haven’t even busted out the winter coat. This is climate change, not weather.

What’s what, you climate change types?

I know that, y’know, climate change is all about melting ice caps and polar bears and stuff, not about what the temperature is in any given place in any given time.

But on the one hand, I’ve got this message that unseasonable cold is not indicative of global warming, because global “warming” can cause unseasonable cold due to cold meltwater effing up the Gulf Stream.

On the other hand, I’ve got this message that unseasonable warm is not indicative of climate change, because climate change doesn’t cause meltwater to eff up the Gulf Stream, due to some Pacific weather pattern…?

Look. Either global warming is effing the Gulf Stream and therefore causing massive freezes north of the Tropic of Cancer; or else global warming is heightening the Gulf Stream and causing crazy warm weather north of the Tropic of Cancer; I don’t care, just make up your minds for more than a year in advance.

And when you do, I’ll bust out the winter coat or else the flip-flops, and become a convert.

But until your weather/climate/Gulf Stream/meltwater/Pacific current makes consistent sense, I’ll continue to believe in “mainly a multi-decadal natural fluctuation.”

Mmkay?

Nov 222011
 

From the Mail:

Some universities, such as London Metropolitan, have slashed more than 60 per cent of their courses, including philosophy, performing arts and history.

Much as I’m not in favour of direct state funding of university degrees, nor am I remotely in favour of the apparent belief, held by just about everyone in the western world, that the purpose of learning is to make one an economically viable unit.

‘Go to university so you can get a job and… pay taxes, god damn it!’

No, I’m sorry. That is not the purpose of knowledge, learning, or education, as far as I am concerned. It’s important to be ‘economically useful’ solely so that one can support oneself; whether this requires learning is a matter of circumstance.

It is particularly dreadful that the welfare state and the state funding of tertiary education, and the cost that involves to the taxpayer, has resulted in this pathetic narrative about education—learning how to think, process information, and make independent analyses—being reduced to the question of whether or not what you learn helps you get a job.

To the point where universities are axing degrees that accomplish precisely the goals a university degree should accomplish.

When the taxpayer doesn’t have to subsidise ‘economically non-viable units,’ one doesn’t have to be over-concerned with how people enlarge their brains and their understanding of humanity.

I would be interested to know what degree courses London Metropolitan University will be retaining. Presumably, given the jobs possessed by people I know, courses like ‘Working in the Public Sector’ and ‘How to Add No Value in Human Resources’?

But perhaps that’s uncharitable. I do know people doing productive work, who all seem to have degrees in, y’know, philosophy and history.

Or no degree at all—and have become complete humans all on their own, without the subsidy of the state, or the help of London Metropolitan ‘University.’

Jesus.

UPDATE: Okay, so I’m told that wasn’t the clearest post I’ve ever produced.

Here’s my deal.

Knowing various stuff and supporting oneself independently are separate things. State subsidy of knowing stuff, and state subsidy of those who can’t support themselves, have conflated these concepts.

You don’t always need to know some stuff in order to support yourself. Likewise, lots of people who do know some stuff can’t support themselves. (Cf. OccupyLSX.) The two do not need to be linked.

Axing history and philosophy degrees does not mean that university graduates will, therefore, be able to support themselves, even if they are paying £6k more for the privilege of studying. All it means is that a significant contingent of people will no longer know stuff to do with history or philosophy. Whether this assists in their economic viability is neither here nor there; what it does mean is that particular knowledge will be systematically lost.

Now, you can choose to assess the value of that knowledge economically, as everyone seems to be doing currently.

On the other hand, you can say, ‘Hey, people should be able to support themselves. Quite apart from that, at least some people should know some stuff about what it’s meant to be a human being up to this point. But being able to support oneself doesn’t mean one has to be completely focused on being able to support oneself.’

One of the greatest things about our society becoming ever wealthier is the growth of leisure (Cf. just about every blog post by Tim Worstall). Leisure is, essentially, the opportunity to think about what it means to be a human being. If we’ve reached the point where thinking about being a human is so devalued that we’re not even providing the opportunity to people willing to spend their money (i.e. leisure) on it, then we might as well all work ourselves into the grave right now.

Honestly, what good is having wealth and leisure time otherwise?

Disclaimer: I have two degrees in history. And yes, I work and pay taxes. The reason I got my job in the first place was, incidentally, due to blogging. Maybe universities should be offering that as a degree course.