We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.

Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]

The strange mental softness around the NHS

UK Prime Minister and Conservative Party leader Boris Johnson has made much of how he would shower “our wonderful National Health Service” with money (from we lucky taxpayers and future generations, no doubt) in this election campaign. Cynics will say that he probably does not mean it all that much but such statements are the price one must pay for persuading wavering Labour voters into switching from the Red to the Blue team, etc.

But I wonder. There does seem to be a deeply rooted attachment to the NHS that goes beyond all logic and reason. A service created in the late 1940s, run as a monopoly (private healthcare in the UK is relatively small versus the NHS), paid for out of tax and delivered free at the point of use. Result: its services must be rationed. Some of its actions are pretty good, some far less so. I got treated for water on the knee last year and was dealt with reasonably well, although the diagnoses given were so wide and contradictory that in the end I learned more by surfing the internet and talking to some medically savvy friends. Many people’s experiences with NHS treatment vary from excellent to terrible. It does certain things very well, but in my view is poor at area such as tracking patients after their initial encounters to make sure they are keeping on a regime, etc. I think that the UK could and should move towards private healthcare provision for the bulk of the population, via a mix of healthcare accounts that one builds up over time (people will tend to draw from these funds more as they enter middle age), insurance (for large, catastrophic spending) and some public provision for those in serious poverty. The Soviet model that we operate under seems not just anachronistic, but dangerously resistant to innovation and change. (James Bartholomew had good thoughts on the NHS in this article.)

And yet the NHS is, as former UK finance minister Nigel Lawson once said, rather like a state religion, such as the Church of England. Criticise it at one’s peril. The other day on Facebook an acquaintance of mine, a senior nurse on a good salary, bleated about the hours she has to work. I pointed out that as a small business owner I have put in 60-plus hours a week, but accepted that as part of my choice to work in this way. The meltdown, and the sarcasm, that I received from this person’s friends was something to behold.

The NHS is, like the BBC, one of those institutions that seems to defy all logic, no matter what it does and how ropey its output is.

38 comments to The strange mental softness around the NHS

  • Paul Marks

    I do not believe that the public attitude towards the BBC is the same as the public attitude towards the NHS.

    A lot of people fear, quite understandably, not being able to pay for medical care if they, or a loved one, become ill – I do not really think that many people fear (really fear) waking up one morning and finding the BBC has gone bust. These are very different things.

    By the way – I see no evidence that news and entertainment shows in Britain on the independent television are less slanted to the left than they are on the BBC. Ditto in the United States – where, apart from some of Fox News and Fox Business, the commercial television stations are all controlled by the left.

  • Mr Ed

    I got treated for water on the knee last year and was dealt with reasonably well

    For some reason, my mind ran on with that and added, before I could read on “by the leeches“, my view is that the NHS employs over a million people, and operates hospitals, publishes data and cuts people open regularly and usually safely, but I do not perceive it as providing healthcare, but a simulacrum of it, approximating to 50% of what could be obtained for the cost on a quantum meruit basis, but lots of agitprop for the State.

    I do not regard myself as having healthcare available, apart from repeat prescriptions, just as having a wild stab at a chance of treatment if I get noticed and lucky.

    I believe that the NHS myth is an internal understanding of the political class, their dogma being that it is wonderful and above criticism. Until a Gorbachev comes along, calling for glasnost and perestroika, then to be eventually replaced by a Yeltsin, it will carry on killing.

  • Fred Z

    Your analysis fails to apply the Instapundit criterion, which is always a major criterion for a politician considering a public enterprise, namely: Does it provide sufficient opportunities for graft?

    To me graft includes the ability to reward friends with cushy and lucrative non-jobs, which is why the BBC and the NHS will last forever.

  • Itellyounothing

    My mum who is otherwise positively Thatcherite seems to live the NHS.

    I think it’s psychological, the when you are sick, you will be treated without much fuss is emotionally comforting, like an omnipotent merciful God.

    The idea that God is stupid, wasteful and in some ways evil if you pull back the curtain is too terrifying for many to contemplate without good reason.

  • Paul Marks (November 17, 2019 at 8:31 pm) is right. The BBC is not the force it was and it could be abolished without costing anyone an election – most people would just change channels. Those people who most depend on the NHS are well able to notice when it performs poorly but if it vanishes, they have a problem. The opinion of Cummings, and I’m guessing of Boris and others, is than only several years of gaining trust will allow the Tories, in the next election, to propose reform of it.

    There is also the basic point that the Brexit referendum promised some of the Brexit dividend to the NHS as part of their campaign – perhaps crucial to getting the extra votes that carried them over the top to victory. The line of Boris, Cummings and others has always been that keeping their promise is as important as keeping their immigration and other promises in fulfilling the Brexit promise – in showing that they, unlike the remoaner establishment, are not just making promises they’ll betray after they get your vote. I can relate to that.

  • Bruce

    Are the stats for deaths and injuries due to “medical misadventure” actually available, “un-redacted”, or are they a state secret?

  • bobby b

    ” . . . the price one must pay for persuading wavering Labour voters into switching from the Red to the Blue team, etc.”

    This always throws me off for a minute until I remember that y’all have reversed the Blue/Red assignment.

    “The NHS is, as former UK finance minister Nigel Lawson once said, rather like a state religion, such as the Church of England.”

    As the CofE seems now to be a state anti-religion, this quote would make me wonder about the true goals of the NHS. 😉

  • Julie near Chicago

    bobby,

    Far as I can see ’tain’t the bloody Brits wot got their colors mixed up. ‘Twas the bloody Murrican Left that thought it would be too too cool to take over the natural color of the True Blue Americans and leave this exemplary fraction with nothing but the color of the Hammer & Sickle — like, Red, don’t’cha know. The color we all learned to hate since around 1950.

    Grump.

  • Expatnik

    This always throws me off for a minute until I remember that y’all have reversed the Blue/Red assignment.

    Dude, pretty much the entire world: Red means Left & Blue doesn’t. We’re the one who have that revered, not everyone else (I’m American) 😆

  • bobby b

    Someone (NiV, in another thread) recently pointed out that ” . . . everyone regards their own vocabulary as “ordinary” and the vocabulary of other cultures as “strange”.”

    This was my subtle play off of that (very true) comment.

    Sometimes things work. This one flopped.

    🙁

  • Michael Taylor

    I think you should recognize that the alternative is, as perceived, extremely unattractive: an industry organized around a carve-up between Big Pharma and the insurance industry? Really, two less trustworthy industries would be hard to imagine.

    In fact, faced with a Big Pharma industry who’s entire raison d’etre is to create and preserve monopoly positions, and who have legions of lawyers to fight for that aim globally, it might just make sense for Britain to have a monopoly buyer on the other side of the supply/demand equation.

    For most industries and situations, letting supply & demand discover the otherwise undiscoverable information is very useful. For life & death situations – not so much.

    BTW, the analogy with the BBC is bizarre: I can honestly think of no case whatsoever for public provision of ‘broadcasting’. Indeed, the concept of ‘broadcasting’ looks to me like only the product of a superseded technology.

  • Itellyounothing

    Michael,

    The problem in the NHS is Doctors acting like 1970s Mining Unions and making UK medicine commensurately rubbish.

    Also, the obvious place to raid (besides a BREXIT dividend) is the Public Health England budget. Just shut the damn thing down and give the money to the NHS.

    Once you can play pointless civil servants off against lazy Doctors, the Tories could actually build public support for downsizing the pointless bits of government to put more into NHS which if shit objectively is at least valued by a big chunk of the electorate.

  • Ben David

    Brits can reform the NHS along the israeli model.

    Israel started out with socialized medicine. It was no doubt a comfort to the penniless refugees of the early years, but quickly became one of the sore points used to challenge the socialist hegemony.

    Reform has resulted in a hybrid system that works very well:
    Taxpayers underwrite a basket of basic services available to all, and the private HMOs and doctors can charge for additional services. The free market encourages efficiency and doctors with ambition and expertise can do well by introducing new techniques or services. As these become more mainstream their price drops and they are added to the HMO plans, and eventually to the subsidized basket.

    So anyone who needed eyeglasses could get them for a reasonable co-pay, but you could take your prescription to a private shop for fancier frames and lenses (which typically are discounted as the HMOs cut deals). As in all free markets the gap between options has closed as a wider choice of lenses and frames becomes affordable and hence covered.

    This is now happening with cosmetic dentistry and laser eye surgery, which used to be completely private and are now at least partially covered as vendors cut deals with the HMOs. Similarly the HMOs largely farm out ultrasound and other imaging to private clinics, maximizing use of the equipment.

    Introducing a co-payment to even the most basic services caused some squawking but was key to changing the mentality.

  • David H Bolton

    The NHS is very very good at some things. I speak from personal experience having had a heart attack 12 days ago and was treated (had a stent fitted) at 4:00 am in the morning. It happened Tuesday night. I was released home on the following Friday with a cocktail of different drugs. Had I been in the USA I suspect I’d have run up a bill well above $50,000 for all that and I doubt anyone could have done it any better than the NHS at Lincoln hospital.

    But my step-daughter had to see a Doctor at the local surgery. It took 168 phone calls to get an appointment. For my post-release review last Wednesday it took 110 phone calls. In this case the surgery only had one doctor on duty; the owner (another doctor) was away doing private medicine which seems wrong. In my case I saw a Nurse practitioner who is excellent.

    So there is still much to be done.

  • jmc

    The NHS must be great. Absolutely no one else has copied it.

    There is a very simple way of reforming the NHS. That is, replacing it with something better. Make its actual taxpayer cost visible. Split out the actual tax cost of the NHS and show it as a separate item in everyone payslip. Like NI. Once people realize that the NHS is not “free” but actually costs them a few hundred quid a month in tax to support then the group think adoration of the NHS will soon crumble.

    And even better, add a voluntary “NHS Solitary Tax” of say 3%, and just see how many are willing to pay extra tax that would purely go to fund the NHS. Not many.

    The NHS is a shibboleth of modern Britain because so many people are economically illiterate on the subject. And deliberately kept that way.

    A bit like the fact that failure to pay the BBC license is the biggest single cause of poor single parent women getting caught up in the criminal justice system. First heard this very interesting fact from a J.P.

  • llamas

    At the risk of becoming repetitive . . . . .

    In a nutshell . . . . .

    https://www.youtube.com/watch?v=x-5zEb1oS9A

    llater,

    llamas

  • Johnathan Pearce

    I mentioned the BBC because it’s one of those 20th Century creations that have become part of the fabric of our lives. Challenging either of them gets you into the “mad libertarian” bracket.

    The BBC isn’t as essential as surgery or pain relief. I still resent having to pay for something where the quality is so patchy.

  • Ian Bennett

    Once people realize that the NHS is not “free” but actually costs them a few hundred quid a month in tax to support then the group think adoration of the NHS will soon crumble.

    I’m not so sure. Many of my lefty friends (which means, alas, most of my friends) see no irony in telling me that we must not let Boris sell “our” NHS because “we pay for it”, then immediately praising it to the skies because “it’s free”.

    My junior nephew delights in telling me that if not for the NHS, he would have died (of a serious infection he acquired some years ago). My reply is either, “And without the AA, my car would still be sitting on the hard shoulder of the M42”, or, “Why? Are you too stupid to get health insurance?”

    The fact is, of course, that the NHS is not, and never was, “ours”; precisely the opposite, in fact. “Our” hospitals, many of them built, as was the one in my hometown, largely by public subscription, were stolen en masse in 1948, and during the succeeding decade and a half the caring state closed or merged many of them and failed to build a single new one.

  • Michael Taylor

    Itellyounothing,
    Were you around to witness the unions in the 1970s? I don’t think there is even a remote similarity between the miners then and doctors now – the comparison is, frankly, silly.

    That said, I’ve no doubt that the NHS is badly managed, because, let’s face it, most of the UK civil service is pretty poor. But I’m absolutely not convinced that the great private sector behemoths are much better – the level of mismanagement of, for example, our utilities suppliers is quite astonishing. The answer, I think, is that we have to force all levels of government to embrace better management technicques, better information flows, better technology, and stop trying to run it using the equivalent of parchment and goose-quills.

  • bobby b

    “Once people realize that the NHS is not “free” but actually costs them a few hundred quid a month in tax to support then the group think adoration of the NHS will soon crumble.”

    Out of fairness, my last quote for a $5000 deductible medical insurance policy here in the USA was $870 per month, which I think comes out around 675 quid. Obamacare killed off affordable insurance unless you qualify for subsidies. So, your “few hundred quid a month” seems quite affordable.

    (We do have the option of using pay-as-you-go ala carte clinics, thankfully, which works out better for me as I don’t seem to get sick. Just injured. 😆 And injuries are usually just a once-in-and-done sort of thing – no repeat visits, no complicated meds.)

  • Stonyground

    The notion of “our” NHS reminds me of the eighties when all the nationalised industries were said by Labour types to belong to all of us and that the evil Tories were selling off the family silver. Why I should want to own a steelworks that was losing millions of pounds a day every day was never explained to me. Surely giving it away would have made sense in those circumstances.

  • Mr Ed

    Stonyground

    the nationalised industries were said by Labour types to belong to all of us and that the evil Tories were selling off the family silver.

    It was Harold MacMillan, later Earl of Stockton and Marquis of Yalta who said that, a former Conservative Prime Minister, although the context wasn’t quite as it is put in media legend. And he didn’t point out that the silver had been stolen in the first place, as were the hospitals, many a creaking Victorian hospital had been set up by charitable trusts, and were simply seized and put under government control. The point is not that they were stolen (we all should know that) but that the hospitals were already there, without the State.

  • Fred Z

    Michael Taylor: “a Big Pharma industry who’s entire raison d’etre is to create and preserve monopoly positions”

    Just like you have a monopoly over the things you own.

    Or can I declare that your monopolistic, selfish right to exclusive use of your home ends 17 years after to bought it and I can move in?

    I’ll be in the UK in Autumn 2020, send me your street address, I’m taking your place over for my 3 week visit. I’ll get a compulsory license order against you. What’s the usual royalty rate on that? 3%? You want cash or credit?

  • Sam

    I see variations of Michael Taylor’s argument when discussing the American “system” and I never see the defenders of communist medicine acknowledge that the healthcare industry (which includes doctors/nurses, hospitals, licensing, insurance, equipment, treatment practices, pharmaceuticals, etc etc etc etc etc etc etc)
    is perhaps the most government-regulated industry in existence, maybe second to energy production.

    And when elective surgery is brought up as a counterpoint showing how free markets work then it’s back to the trusty “but government MUST regulate life and death medicine, it’s too important for people’s individual choices!”.

    So after government thoroughly ruins the incentives for a given market, then spend half a century or longer salting the fields to ensure no flowers bloom collectivists can say, “See! We need [terrible gov’t program X], look how messed up the private sector is!”

  • Natalie owns a book illustrating how Labour’s late-40s propaganda for what their new NHS would do implicitly admits how much was already done. It would be an eye-opener for today’s Britons to realise what was there before the NHS – but almost none of them will ever read it. How to convey that information so many decades later?

    To get rid of the NHS (‘reform it’) you have to have a plan for ‘what next’ – not a plan for people like us but a plan for the people who would in fact have a financial issue if it suddenly disappeared and they were suddenly ill. Obviously the hospitals, doctors and nurses will no more disappear than they did when Labour stole them in 1948, but you need a story for the day after.

    Easy to say, I know, but I’m just explaining that it is not just a case of “once people realise that the NHS is not free but costs them…”.

  • Derek Buxton

    Mr. Ed, I am getting on a bit, well OK a lot, but can remember when during a War, our hospitals were very good, presided over by a Matron who kept the staff on the job. Even during the War, my mother was ill and taken straight into the local hospital and operated on very quickly and returned home well again. No long term wait, the doctor came immediqaltely and rang for an ambulance and away they went. Of course, for 10 or more days we slept in the Anderson Shelter all that time until we got bombed. But all went well. Now I have trouble getting a GP appointment!

  • Duncan S

    Niall Kilmartin

    Is this Natalie’s book? James Bartholomew’s The Welfare State We’re In

  • Derek Buxton (November 18, 2019 at 9:59 pm), yes indeed – that is very much the point of the book I mentioned in my comment above. Good, dedicated healthcare – for the poor as well as the well-heeled – was available in the years before Labour created the NHS. That is why their propaganda for the NHS could not help inadvertently conceding this in its descriptions of how the NHS would be better still.

  • Runcie Balspune

    Instead of proposing a flat and rather meaningless* budget for the NHS, which everyone knows will just go on administration, diversity officers, mobility scooters and conversion to gender neutral toilets, just state you’ll give nurses and junior medical staff an immediate £5,000/year rise followed by guaranteed above inflation increases for the next 10 years, this will (a) gain a lot of public support, (b) gain a lot of public sector worker support, (c) encourage nurses to stay in the profession, and (d) encourage more natives to become nurses, thus solving several problems all at once. And then do the same for police and teachers.

    * meaningless because once you get beyond a certain figure or order of magnitude it doesn’t matter.

  • Michael Taylor

    FredZ: I’m not impressed with your comment. It doesn’t require much thought to realize that your analogy fails because there are other homes you can live in. The problem with Big Pharma is precisely that, very often, there are no alternatives. This is the difference between a market and a monopoly. You should up your game.

    Sam: There are many many fields of human activity and choice where the price structure is essential – I’m a big fan of Hayek’s core point – that markets are justified only because they discover information which can be discovered in no other way. The problem is that there are circumstances in which the argument fails. Mortality is, I think, the limit of the applicability of that argument. If you ask me how much I’d be prepared to pay to save my life, the answer will usually be . . . . ‘everything’. At which point, you don’t have a ‘market’, you have a highwayman with a gun at your head.

    Now, that’s not to say you should abandon all the insights which commercial management can give you. For example: the ‘correct’ answer to what sort of hours a massively expensive piece of medical ‘kit’ should be in operation is obviously ‘as many as possible’ because getting asset turns up is obviously crucial. You don’t need a market to determine that – just a working knowledge of Dupont analysis.

    Oh, and a final point: whether your treatment is determined by ‘the market’ or by (your phrase) ‘communism’, you’re certainly going to die in the end. Nature includes a ‘death panel’. Sorry.

  • The Fyrdman

    The prime problem as I see it with the NHS is that the customer is the state, not the patient. Free at the point of use isn’t synonymous with centralised provision. If you kept the branding and emphasised that it will remain free at the point of use, you could switch to a combined health account & insurance model. As much as the libertarian in me galls at the state demanding money is taken from your account to put into a health account plus insurance, it’s better that I control the fund and therefore become the customer.

  • Johnathan Pearce

    Michael Taylor, you say that because healthcare is in some cases a life/death matter that the sort of consumer choices and pressures that competition provides for better service don’t work as well as in some other sectors of the economy. That can only really be tested as an assertion by looking at the empirical evidence.

    And it is not clear to me that healthcare today is, for instance, an order of magnitude less likely to benefit from the disciplines of market competition (you refer to Hayek, so you are clearly familiar with the arguments) than, say, food. We don’t – thank the Lord – have a nationalised system for producing/distributing food, like a National Food Service. (A lot of those of an authortarian cast of mind would like to have one, as we can see in some forms whenever there are demands from TV celeb chefs such as Jamie Oliver to impose their ideas on what kids eat in school).

    With healthcare there is a bit of an information asymmetry in healthcare. Doctors know a lot more than patients (well, that’s supposed to be the case) and they have access to lots of diagnostic equipment, labs, and so on, whereas a private citizen has far less (in future that might change). A patient typically is in a situation where they have to respect the authority of a doctor. Doctors’ ability to advertise their services, get reputational scores and ratings to guide patient choices, are very limited in the UK market, and in some cases, impossible. The patient basically has very limited consumer power.

    I can remember when I did quite a bit of research into knee problems and put forward the idea to a doc. that I might help my knees by doing more, not less, weight training and various routines. The doctor looked at me as if I was mad and impertinent.

    There would, if there was a genuine market, be a development of a market for reputation in healthcare, and consumer-information organisations would sprout to track the best doctors, rate them, etc, in the way that one gets with other important financial/personal decisions one might make about lawyers, buying a property, a big car, finding out about a company, etc. At the moment we find it increasingly normal to do due diligence on some of the professionals we engage with, such as a builder or investment manager. That needs to happen with doctors, but in the UK, with our system of healthcare, it rarely ever does.

    So yes, the healthcare world has its challenges when it comes to a market, but to reiterate, are they of an order of magnitude different to anything else, and would they not present big opportunities for business and entrepreneurship?

  • Paul Marks

    One must also remember that “reform” is not automatically good – the performance of “Medicaid” (where the government pays for private sector treatment for the poor in the United States) is not good.

    I am not a coward, I think recent events prove that, but I would only speak for changes that actually made medical care better for ordinary people – just using the word “reform” is not going to win me over.

  • Sam

    Michael Taylor:

    At which point, you don’t have a ‘market’, you have a highwayman with a gun at your head.

    So you point a gun at the doctor, nurse, staff, medical equipment provider etc etc etc etc etc etc etc in response? Or just to my head to pay all those people?

    As you said, in the end we all die so where’s all this assumed moral imperative to my labor coming from?

    Oh, and thanks for mentioning death panels as they’re a stark reminder that all that life/death highwayman virtue preening BS evaporates as soon as your ability to generate tax revenue is grossly outweighed by the state’s cost to keep you on this mortal plane.

  • Michael Taylor

    Sam: I’m at a loss to understand your response. ‘So you point a gun at the doctor’?? What are you talking about? I’m also insulted that you think I’m ‘virtue preening’.

    Jonathan Pearce: yours are substantial criticisms, but I’m going to take them on. In quite a bit of medical experience, I’ve no quarrel with you, except to suggest that you’re wrong to think that people don’t keep very close tabs on the reputations of their local doctors. They do in my town, though more by women than men, in my experience. Indeed, the various virtues and shortcomings of our various doctors are in frequent discussion among my wife’s friends, and they can and do change doctors on the basis of those judgements. In fact, I have fairly detailed knowledge of my local doctors, even though I’ve never met them! Those judgements are made, and the knowledge developed/discovered even without an overt price signal to guide them.

    But second, I think you’ve dodged the unique aspect of healthcare, and here I’ve got to choose my words carefully. In the end (sic) it is always (sic) about mortality. It is about how and when you die, as die you will. At that point, questions about choice rationed by price, or about informational asymmetries, are not the most crucial, or the most salient. The ‘information’ to be discovered is not how you live your life (as with your knee), but whether you live your life. It’s a different choice entirely. Getting to the bottom of the difference in mortal choices is not easy, but if you have the time I’d suggest as a starting point ‘Truth, Invention and the Meaning of Life’ by David Wiggins.

    It’s also where your ‘we don’t have a nationaized food service’ appeal breaks down. Because, of course, we do – we have various safety nets, with both public and private/voluntary provision to make sure that its very very very hard to starve to death in any developed economy, and in most lesser-developed economies. The fact is that humanity recognizes quite easily the difference involved in daily shopping decisions (shall I have sausages tonight) and mortal decisions (shall I let my neighbour starve to death). In the first case, the information price yields is useful; in the second, not at all.

  • Michael Taylor (November 20, 2019 at 10:24 am), Sam’s response seemed clear to me. I will summarise it my way in case that helps.

    You spoke of a gun being pointed at a head, so Sam contrasted the application of force of law to taxpayers to fund the NHS with the idea of applying force to doctors and nurses to work in it, e.g. conscripting them for periods of time by force of law as sailors were once conscripted into the navy, instead of taxpayers (or as well as, to reduce the burden on taxpayers). If, momentarily, for the sake of argument, Sam (or anyone) were to grant that healthcare did indeed have the unique gun-to-head property you describe, and so justified forcing others, why would these others be, for example, taxpayers instead of (or as well as) health professionals forced to work for reduced pay or longer hours or to retire as late in life as their health allows, or whatever?

    (BTW, before the 1997 ‘reforms’, I knew junior doctors who did work long hours ‘on call’, and while they were not ill-payed, Blair sure made its staff cost the NHS a lot more, some of that more going to the staff in their pay packets.)

    Sam can say if I have not explicated his meaning correctly.

  • Michael Taylor

    Niall Kilmartin,
    If that is indeed what Sam meant, then the argument is, honestly, bizarre, since the two ‘gun to the head’ situations are completely different.
    The ‘gun to the head’ situation I used is when a monopoly company is determining the ‘price’ you must pay for a treatment for an otherwise mortal disease. ‘Find the way to pay this bill, or die’.
    The ‘gun to the head’ situations which you describe seem to be a) me putting a gun to the head of medical staff. But why? I’m not forcing anyone to choose that career, or that employment. There’s simply no similarity between the two situations; and b) the more general proposition that paying any tax, under any circumstances, is similar to the ‘gun to the head’ of mortal disease.

    Well, I suppose it’s possible that you consider b) to be, necessarily, the description of any tax-raising under any conceivable political system for any conceivable purpose. But, frankly, I doubt even many soi-disant libertarians would want to venture so far down that path with you. If you want to go there, feel free to justify that position.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>