The battle, sir, is not to the strong alone; it is to the vigilant, the active, the brave . . . Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death.
- Patrick Henry, March 23, 1775, at the second of the Virginia Conventions.
The full speech is available here It’s not long so, as Glenn Reynolds would say, “read the whole thing.”
I used to know a little girl with severe mental and physical disabilities. She had to be lifted and moved dozens of times a day as she was unable to walk or crawl. It was a source of great worry to her parents how they would cope when she grew up and could no longer be lifted easily. More distant, but greater, was their fear concerning how she would be cared for when they died. Their fears did not come to pass for the saddest of reasons; she herself died when she was still quite small.
I thought of that family when I read about Ashley. Ashley is another little girl with severe mental and physical disabilities; even more deeply disabled than the child I once knew. Ashley is fourteen, but is described as having the cognitive abilities of a three month old baby – in truth, if the description of what she can and cannot do is correct, a three month old baby is better able to communicate than she is. Her parents share the same fears as those of the parents of the girl I knew. They have taken drastic action: they have had her treated surgically and with hormones so as to ensure, within the limits of the technology, that she remains a child for the remainder of her life.
“It was carried out in the belief that her quality of life would improve as it would save her from physical discomfort and pain”, reports the Telegraph. The Guardian, which ran opposing comment articles on Ashley’s case, suggests that another motive was to reduce the effort of lifting her and hence extend the time for which her parents could care for her. I wonder if an unmentioned further reason – one that sounds ghastly but might make sense given human nature – was to try to ensure better care for Ashley when her parents are gone by keeping her cuter. It is a sad fact that many people will find their protective instincts aroused by the sight of a mentally disabled child (or apparent child), yet flinch at the sight of a mentally disabled adult.
Ashley cannot consent and cannot withold consent. This procedure might help – no, it very likely will help to give her the best quality of life possible, for as long as possible in the care of those who love her. Yet the potential for abuse is horrible. Her body is being irrevocably altered for the convenience of those who care for her (but that convenience is no small thing, and convenience is too weak a word; whether they can cope is a major determinant of her quality of life.) If we can do this to Ashley, what else can we do to future Ashleys? More severe modifications to more severely disabled people? To less severely disabled people? To any people?
Even as supplied by an unscrupulous underground market and taken blind by consumers in a variety of unsuitable ways, they really aren’t very dangerous:
According to the ONS data, in 2010 there were more helium deaths  than cannabis, ecstasy, mephedrone and GHB related deaths put together.
‘Helium?’ you may ask… It’s classed as a drug but no, it doesn’t do anything. But it is so hard to buy anything reliably lethal in the UK that helium is a sophisticated means of self-asphyxiation for suicide. So even those 32 cases should not be classed under malign side effect of drug-use. Death in those cases was a positive result.
A disenfranchised population becomes an untrustworthy population, since it loses the habit of making its own decisions. The majority become childish in hundreds of ways, looking to the State as parent, complaining without displaying a willingness to any form of self-determination. The more liberty one has, the more indvidual responsibility is required of one to make rational, well-considered decisions in the context of one’s social and personal life. Most of us are educated to think we are not capable of this when, in fact, most of us are thoroughly capable but simply lack either the circumstances or the determination to test ourselves. An authoritarian, paternalistic State encourages us in this belief, by its actions as well as by its rhetoric. By its very nature it creates a morally enfeebled, child-like population. This population in turn ‘proves’ its inability to control its own fate and consequently ‘proves’ the need for the paternalism which created it in the first place. There is no fundamental difference between Tory and Socialist paternalism.
- Michael Moorcock, The Retreat From Liberty, 1983
One Catherine Bennet has yet another article in the Guardian about that jam experiment. Hers is called Since when was giving people a choice a good idea?
It is not merely the chorus from anguished parents (and patients), that they cannot exercise choice where there is no spare capacity, that might give a rational education secretary pause, but a growing body of research indicating that too much choice is overwhelming. Gove will know of the much cited experiment with jam, by the US academic Sheena Iyengar, which found consumers were more than six times more likely to buy a pot if they had to choose from six varieties, rather than 24. If uncertainty about preserves is a problem one can probably live with, or possibly enjoy, a similar helplessness in the face of big, irreversible decisions is, to judge by a new study, State of Confusion by Professor Harriet Bradley of Bristol University, something that should worry a government that advertises choice as an unmitigated good.
Mr Eugenides says,
So, just to recap: a woman who used to live with a lord in a 365-room mansion, now in a household with a combined income of some quarter of a million pounds a year, has read a PR puff commissioned and paid for to advertise a price comparison website, and uses this as evidence that we should all just take what we’re given by the state and shut up.
Ironically, price comparison websites are themselves a market mechanism for making choice easier.
I say, to Catherine Bennett and the next fifteen journalists to go into an ecstasy of servility when pondering this little demonstration that some people find shopping boring, shut up about the jam already. It’s jam. The process of choosing it has no deeper meaning. Unless one is a connoisseur of jam, in which case one probably finds choosing between 24 varieties a pleasing experience, as people usually do when shopping for something that interests them.
Look at it this way, Ms Bennett. You have twice to my knowledge chosen a man as mate and helpmeet. Was making that choice from all the prospective partners you could have had ever stressful? There is some literature – like about half of it – to suggest that some people find it so. Some people regret their choice. The evidence suggests that you have at least once. Can we assume that if by any sad chance you find yourself seeking a man again you are willing to let a civil servant choose for you?
… so I would advise anyone of an even vaguely libertarian inclination who gets stressed easily to read no further.
This article by Felicity Lawrence, Nanny does know best, Andrew Lansley, displays the ideology of the Nanny State in an unusually pure and unapologetic form:
Can it be too that Lansley is not aware of all the literature about how individuals’ “free choices” are shaped by marketing and advertising. Perhaps we should recommend some urgent remedial reading for his homework, starting with…
The Andrew Lansley for whom Felicity Lawrence is setting homework is the Secretary of State for Health. The fact that he consents to hold this position means that he too must be something of a statist, but nonetheless he recently said, “If we are constantly lecturing people and trying to tell them what to do, we will actually find that we undermine and are counterproductive in the results that we achieve.” It is a measure of how deeply Nanny’s rule has been accepted that even this pragmatic, rather than principled, objection to government health lectures aroused fury.
Iain Dale, the UK blogger and wannabe Tory MP, gets himself into a fearful mess in arguing as to why owners of privately owned businesses, such as hotels and the like, should be forced to accept any type of client, even if that offends the moral sensibilities of the owners. Much as I share Mr Dale’s dislike of bigotry, he’s just plain wrong when he writes:
“This is not about property rights. If you open your house to paying guests, it is no longer just your house. You are running a business, just the same as anyone else, and you should be subject to the same laws as anyone else. If you do not wish gay people, black people, Jews or anyone else in your house, don’t open it to the public. Simple as that. No one would accept a shopowner refusing to serve a particular type of person, would they?”
He’s wrong here. So Mr Dale imagines, does he, that as soon as a person sets up – at their own risk and cost – in business, and chooses to make money in a particular way, that they suddenly forfeit any right to choose with whom they wish to make a living if the powers that be decide that such reasoning is prejudiced in some bad way? How the expletive deleted does that work, Mr Dale? Does this mean, for instance, that a business owner should be forced to serve anyone? Suppose a nightclub, say, insists on a dress code for its clientele (as happens). Does this mean that the scruffy are being discriminated against?
I don’t like homophobia any more than Mr Dale, but as a supposed Tory, he ought to realise that the best protection any group of persons have against bigotry is competition and several ownership of private property. In a free, robust market unimpeded by state privileges and taxes, bigotry carries a significant economic cost to the bigot. And I think it was Voltaire back in the 1740s who observed, how people of all faiths, for example, could and did transact in the early London Stock Exchange of the time. Filthy lucre is often the most corrosive solvent of bigotry that there is.
There is also an ancilliary point here. As a free marketeer in favour of honest money and competition in currencies, I think it should be the right of any businessman to refuse to accept payment in certain currencies that he, rationally or otherwise, does not trust. If we adopt Mr Dale’s line of reasoning on how a business owner’s property rights go up in smoke the moment a client comes through the door, he’s all in favour of forcing people to accept payment in whatever the state decrees is the “proper” form.
Sorry Mr Dale, but you just don’t accept the concept of free association as it applies to commerce. Property rights is most definitely what the issue is about.
Policy Exchange has just published a “research note” purporting to show that the tax on cigarettes in the UK should be increased, and that “that every single cigarette smoked costs the country money – 6.5 pence each time someone lights up.”
If you read the paper [pdf], you will find it is an astonishingly dodgy dossier. Here is how the figure is made up:
Taxation of tobacco contributes £10 billion to HM Treasury annually; however, we calculate that the costs to society from smoking are much greater at £13.74 billion. Every cigarette smoked is costing us money. These societal costs comprise not only the cost of treating smokers on the NHS (£2.7 billion) but also the loss in productivity from smoking breaks (£2.9 billion) and increased absenteeism (£2.5 billion); the cost of cleaning up cigarette butts (£342 million); the cost of smoking related house fires (£507 million), and also the loss in economic output from the deaths of smokers (£4.1 billion) and passive smokers (£713 million).
The notion of “cost to society” is a pretty weird one.
Leave that aside for a moment. Add up costs and revenues to the state, which might be one semi-logical way of determining whether the smoking in some sense “runs a deficit”, and using Policy Exchange’s own figures you get a big surplus for the Treasury. Even if you assume all house fire costs are borne by the state and not partially by insurers and householders, and there are no errors in the headline figures, then you can only get to £3,549 million. (Have you noticed how public policy research generally involves implausible numbers of significant digits, and at the same time utter absence of error estimates?) On that basis smokers are contributing roughly £6Bn annually towards public spending.
But what are we to make of the suggestion that counting “lost output” is meaningful? To my mind the idea that an economic aggregate represents a collective wealth that may be politically attributed and redistributed is repulsive even if it is coherent (which I doubt). The state’s royal We, which Policy Echange is channelling here, may in turn choose to impersonate you and me and everyone else, but it only controls the taxed margin of other’s outputs. Output and taxation are apples and oranges. It is meaningless to add them together. Unless you want (or deserve) a punch.
And even were it not meaningless, there’s an accounting fraud here. If you count output putatively lost to smoking, then you must also count the gains. There is the output of the tobacco industry, distribution and retailing in the UK to consider. Imperial Tobacco alone had a gross profit for the year ending September 2009 of approximately £5.3 billion. The CTC industry consists of tens of thousands of small shops. Honest research, however dubious its theoretical basis, would attempt to estimate the value-added, too. It would also be clear – without referring to a paper cited in the footnotes we cannot tell whether the cost-of-illness measure used in determining those “lost outputs” also includes the gains to third parties in pensions unpaid and public services unused by people dying early. If you are going to add apples and oranges, you should also tell us explicitly whether you have subtracted pears.
But what set me off on this chase was actually just one of those headline figures. Most of the margin of costs over gains in this strange sum is covered by the £2.9 billion allocated to the “output lost to cigarette breaks”. How do they know? “[A] number of studies have investigated workers taking breaks in order to smoke, and have tried to quantify this time at between £915 million and £3.2 billion per annum.” Hm.
Read through to p13, and you discover that the number of studies was… two. Er, no. It was one… Or some sort of strange interpolative hybrid… I cannot decide. Make your own mind up:
McGuire et al. estimated that £915 million annually is lost on the basis that average smokers spend tenminutes a day smoking, while light smokers and part-time workers would use approximately half of this
time. The Royal College of Physicians (RCP) used similar initial assumptions on average smoking time to
calculate that some £2.6 billion would be saved through the introduction of smoke-free legislation. Using
McGuire’s estimates of 5.2 million working smokers, with the RCP’s estimates of ten minutes a day smoking
reveals an intermediary figure of £2.9 billion.
I think that is ‘intermediary’ in the sense that a magician is an intermediary between a rabbit and a hat.
However they get there, if someone thinks that cigarette breaks ought to be a determining factor in public policy, rather than a matter for negotiation between employer and employee, then I suggest that it would be a good idea if they are kept as far as possible from the levers of power. This lot are said to be influential on the presumptively incoming Cameron team. Oh dear.
The Royal Society for Public Health no doubt sees itself as a worthy collection of people who are axiomatically on the side of the angels. I mean, who could be against public health?
In truth they are a terrifying and truly totalitarian outfit who operate with a presumption that the state has super-ownership of the physical bodies of everyone in Britain. Now I am of the view that defence against infectious plagues is a legitimate role of the state because it is a collective threat… a plague, like a fire or an invading army, does not respect property lines and so this is the whole reason to have a ‘nightwatchman state’.
But that is not the view of people like the Royal Society for Public Health. No, they take the view that ‘public health’ follows on naturally from state run medical care and gives the state the right to decide pretty much anything that can impact on an person’s health, regardless of that individual’s preferred choices, even if those choices are personal ones that do not place other people at risk.
They have issues a manifesto for nothing less than the nationalisation of your body and the intrusion of the state, on grounds of protecting your health from yourself and others who agree to be around you.
- A minimum price of 50p per unit of alcohol sold
- No junk food advertising in pre-watershed television
- Ban smoking in cars with children
- Chlamydia screening for university and college freshers
- 20 mph limit in built up areas
- A dedicated school nurse for every secondary school
- 25% increase in cycle lanes and cycle racks by 2015
- Compulsory and standardised front-of-pack labelling for all pre-packaged food
- Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
- Introduce presumed consent for organ donation
- Free school meals for all children under 16
- Stop the use of transfats
Of all these statist policies, number 1 is particularly invidious, with our technocratic masters seeking a sumptuary law on alcohol (i,.e. a tax to stop poor people drinking), number 12 seeks to regulate our choice of what we eat.
But by far the worst of all is number 10, this is the one which tells you everything you need to know about these people and the profoundly, unabashedly thugish nature of their world view… the state can help itself to your body parts by default. Post mortem conscription. Frankly I am all for organ donation, but at the moment, I carry a card expressly forbidding my organs to be harvested post mortem as the very notion these people are presumptive owners of any of my mortal remains is simply intolerable.
But then as they demand the right to regulate everything about your physical existence prior to death, I suppose it is no surprise they think nothing of helping themselves to your carcass after you die.
These people are the very worst kind of self-righteous technocratic curtain twitchers, the true spiritual heirs to the folks who in the first half of the twentieth century had people with birth defects sterilised or has troublesome people lobotomised, on ‘scientific grounds’ of course ‘for the public good’. Naturally such Guardian reading caring sharing folks would see drawing such analogues as a grotesque calumny, but in truth they exhibit the same intrusiveness and obsession with controlling the lives of others, it really is the same psychopathology, just repackaged for the 21st century with the current notions of ‘best practice’.
These people must be opposed… but not just politically, they need to be seen socially for what they are and abominated for their desires to regulate the lives of everyone around them. They presume to occupy the moral high ground but they do not and the more people who openly and publicly reject their axiomatic presumption of state controls over the very bodies of people, the sooner we can start to reclaim the culture of people who belong on a psychiatrist’s couch to help them deal with their abhorrent desires to use force against those who wish to live their lives without interference and according to their own judgements, with the positive and negative consequences of that accruing to themselves alone, like real adults.
The people behind this manifesto are detestable and they need to be told that to their faces.
Helen Evans, who runs Nurses for Reform, a campaigning organisation dedicated to free-market options for healthcare in the UK, got to meet Conservative Party leader David Cameron a couple of weeks ago. The Daily Mirror [here, here and here] and the Daily Telegraph found out about the meeting and offered their own take on it.
Broadly, I agree that the proposals are in the right direction, although I have concerns about some of the tactics suggested and their formulation, which I deal with later. The bit that was not previously familiar to me was the idea that a barrier to entry should be at least lowered, by amending local planning rules to make it easier to open a new healthcare facility. I’m told the Conservative Party already favours this for schools, so the extension to clinics should not be difficult.
Having read the briefing document presented to the Leader of the Opposition, I disagree with one element of the strategy being proposed, specifically this passage: “the [National Health Service] NHS should be renamed the National Health SYSTEM and that under its auspices patients should benefit from a universal right to independent hospital care and treatment.”
A “universal right” is something that a government could be justified in declaring war to defend, like “freedom from slavery” or freedom from the use of confessions extracted under torture in criminal trials. It could certainly be a pretext for new taxes, a new bureaucracy, more regulations, and the restriction of other “non-universal” rights. Sadly, this call for declaring that privately-provided healthcare is a right could become the very instrument for imposing regulations (such as US Medicare-style price controls, or French-style government control on where doctors can practise [link in French]) that violate patient and physician freedom. To give a specific example: could a private clinic be fined for not providing 24-hour accident and emergency access? I would expect a government agency to do just that. Meanwhile, of course, government facilities which operate “in the public interest” would be excused.
A second concern comes in a later paragraph: “health censorship must be outlawed and patients must be empowered with greater access to information.” Outlawed? Must be empowered? By what agency, regulation, funded by what taxes or levies, with what powers of inspection and control?
These may seem like quibbles, but the law of intended consequences suggests that the wording of reforms can be as important as their spirit. Consider the US Constitution’s First Amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.
Does it say that Congress cannot give money to the Food and Drug Administration to hunt down anyone making claims about the alleged benefits to cancer patients of drinking grapefruit juice? No it does not. It means it, I think, but can I prove it to the US Supreme Court? Probably not.
It might be more boring to do, but the best way to remove censorship would be to revoke the clauses of those laws and regulations that allow it. As for “empowerment,” if this comes from the government it will mean a Department of Truth in Advertising demand for a quarterly report from all private providers as to how they inform the public, with fines for not reaching a wide enough audience.
On the positive side, Nurses for Reform finds that the ownership by a government department of most of the UK’s hospitals is a potential conflict of interest. There is the temptation to hide problems, to restrict information about alternative (often newer) treatments, the cozy relationship between the government employees in the NHS and those of the Department of Health who are supposed to watch them.
Dr Evans is therefore absolutely right to suggest the immediate transfer of ownership of NHS hospitals out of “public ownership,” and she is also correct that the “Secretary of State for Health must no longer have any say over when or where hospitals are built, opened or closed.”
On the issue of advertising, or freedom to communicate with the public in general, the major benefit would be that people could get an idea of which were the better brands (either cheapest, or best quality, or best balance between the two). If we think of how Aldi and Lidl can co-exist with ASDA, Tesco, Sainsbury, Waitrose and independent grocers, we can see how variety of branding can lead to beneficial competition: new treatments, more options and probably less queues.
Personally, I see no point whatsoever in delaying the reform of NHS funding: it merely prolongs unnecessary suffering and provides more opportunities for opponents of change to mobilise, like Gorbachev’s “perestroika” versus the liquidation of the soviet system. Having little expectation of any progress under a new Conservative Party government this coming year, it would be a pleasant surprise if Dr Evans’ proposals came to fruition. But at least no one can now claim that the case was not made.
[UPDATE: corrected link for Daily Telegraph article]
If you are rich enough, you will be able to circumvent the prohibition and obtain the right to select the sex of your child. The Human Fertilisation and Embryological Authority bans the practice here, though their grounds are weak:
Britain’s Human Fertilisation and Embryology Authority remains cautious, citing public opposition to sex selection. “In the US there is no official regulator to monitor clinics and no legal obligation to offer the counselling that is an important part of treatment,” a spokesman said. “Those who choose to go overseas for their treatment should make themselves aware of the laws and consider what impact there may be on any child that is subsequently born.”
Public opposition is cited, alongside a nannyish presumption of in loco parentis. Public opposition is not a sufficient reason for curbing reproductive freedoms and gives a veto to lobbies who invoke the ‘yuck’ factor. The HFEA model of regulation never succeeded and medical practices should be allowed, except in cases of safety.
If Parliament wishes to outlaw a reproductive technology,then let it do so: otherwise, the presumption of freedom should prevail.
Various forms of coercion, such as designation of the application process for identity documents issued by UK Ministers (e.g passports), are an option to stimulate applications in a manageable way. Designation should be considered as part of a managed roll-out strategy, specifically in relation to UK documents. There are advantages to designation of documents associated with particular target groups e.g. young people who may be applying for their first Driving Licence.
- ‘National Identity Scheme, Options Analysis – Outcome’, the Home Office document from the end of 2007 that succinctly describes its approach to the imposition of the national identity scheme onto the population.
The new Home Secretary, Alan Johnson, says “Holding an identity card should be a personal choice for British citizens — just as it is now to obtain a passport.” This is no change. It always has been intended that it should become the same personal choice, that any application for a passport (or another official document that you need to live a normal life) should entail an application to be on the national register for the rest of your life. As voluntary as sleeping.