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]

Other ways of providing health care

Whenever I have attempted to discuss health care, I am always told about how the US health system fails people. I am sure that this is some combination of untrue (my own experience of US health care was walking in unannounced, paying $100 and being seen and fixed straight away) and unfair. US health care is not wholly private or even very free-market at all, and suffers a high level of regulation. But I do not understand enough about the details.

I occasionally hear good things about other health care systems, such as Australia’s method of having people pay and then possibly having the government refund them. While I can understand that it will be hard to convince people that anarcho-capitalist health care is best, it is interesting in the UK that no changes to the structure of health care at all will be considered. Private companies must not be allowed to make a profit! Such profit can only be gained from killing patients.

However the IEA have recently made an interesting strategic decision to counter-attack the knee-jerk reaction that the only alternative to the NHS is US-style health-care. What if the NHS and the US system are both weird and there are other sane and functional systems in the world? Kate Andrews has appeared on the BBC pointing this out. Guido covered it. Kate Andrews wrote a piece for the Spectator. All this is to publicise the IEA report Universal healthcare without the NHS.

One thing they keep pointing out is that the NHS ranks in the bottom third of the world’s health care systems in terms of outcomes. That will need a lot of repeating if anyone still thinks it is the envy of the world.

It is also, perhaps, a much more effective strategy than attempting to convince people of the benefits of free markets up front. “Let us try to learn something from nice country X” does not require breaking down as many mental barriers as “please abandon a lifetime of carefully cultivated opinions about the unfairness of capitalism”.

Our god requires sacrifices

Tim Worstall says that Hayek’s much-derided argument that government health care would make us serfs of the state is supported by an astonishing piece by Nick Cohen which appears to argue that so it would, and so it must. Part of me hopes that Cohen, who has often been one of the more principled voices on the British Left, is writing tongue in cheek or trying to provoke a reaction. But the commenters nearly all seem to take it quite seriously and only berate him for not going far enough.

Here’s the piece from Cohen: “Saving the NHS means forcing us to change the way we lead our lives”.

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

Speaking as a base creature myself, I do not believe it would be a healthy future at all to be ruled by people with such contempt for me.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

A commenter called “erikus” put their finger on what all this was reminding me of:

Stardate 21327.5. Captain Picard & the crew of the Enterprise arrive at a world where the local inhabitants are suffering the apocalyptic consequences that fell upon them after they tried to re-engineer themselves in order to meet the expectations they believe are placed upon them by the institutions that were created by their ancestors and which they’ve come to regard as sacred & inviolate.

Picard’s final speech: ‘They killed themselves for this. They died because they believed that they had to sacrifice themselves in order to preserve in perfect form the institutions left to them by their ancestors: Institutions that were themselves originally created with one simple purpose: To preserve their lives:

We must remember that the institutions that we create exist for our well-being & that once we begin to worship them & think their well-being transcends that of our own, they lose their reason for existence.’

Samizdata quote of the day

One of the great tragedies of the NHS is that it has unnecessarily turned health into a Zero Sum Game. Because it has a limited budget, money spent on one treatment means that it cannot be spent on others. It therefore has to make life and death decisions based on what those running it perceive to be its priorities.

Madsen Pirie

Sometimes you just gotta liver little

Today’s weird Guardian story is not directly political:

Surgeon admits marking his initials on the livers of two patients

A surgeon has pleaded guilty to marking his initials on the livers of two patients while performing transplant surgery.

In a hearing at Birmingham crown court on Wednesday, Simon Bramhall admitted two counts of assault by beating relating to incidents on 9 February and 21 August 2013. He pleaded not guilty to the more serious charges of assault occasioning actual bodily harm.

The renowned liver, spleen and pancreas surgeon used the gas argon, used to stop livers bleeding during operations and to highlight an area due to be worked on, to sign his initials into the patients’ organs. The marks left by argon are not thought to impair the organ’s function and usually disappear by themselves.

The 53-year-old was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after a colleague spotted the initials “SB” on an organ during follow-up surgery on one of Bramhall’s patients.

As one might expect, this is being treated as a crime:

Elizabeth Reid, of the Crown Prosecution Service, said Bramhall’s actions were an abuse of the trust placed in him by the patients.

“It was an intentional application of unlawful force to a patient whilst anaesthetised,” she said. “His acts in marking the livers of those patients, in a wholly unnecessary way, were deliberate and conscious acts on his part.”

But not everyone agrees.

Following reports of Bramhall’s suspension, his former patient Tracy Scriven told the Birmingham Mail that the surgeon should be immediately reinstated. “Even if he did put his initials on a transplanted liver, is it really that bad? I wouldn’t have cared if he did it to me. The man saved my life,” she said.

She has a point. As was discussed here yesterday there is a push (it’s called a “consultation” but no one is in any doubt what the desired answer is) for England to follow the example of Wales and institute a system in which unless a person objects in advance to their organs being donated after death their consent will be assumed.

Why, then, should Mr Bramhall not say that he assumed that his patients were OK with him putting his graffiti tag on their livers? They didn’t sign a form objecting, did they?

Be a trendsetter not a follower

It is always nice to be reminded that history has no direction. The Times reports,

Austria will scrap ban on smoking in restaurants, Freedom Party declares

Austria is to break with a global trend in health policy by abandoning plans to ban smoking in bars and restaurants.

Full smoking prohibition was due to come in next May but will be shelved at the insistence of the far-right Freedom Party as a condition of joining a coalition with the Austrian conservatives.

The Freedom Party (FPO), which came third in elections in October, is in talks to form a government with the Austrian People’s Party (OVP).

Heinz-Christian Strache, leader of the FPO, made overturning the ban, agreed in 2015, a top campaign pledge.

“I am proud of this excellent solution in the interests of non-smokers, smokers and restaurant owners,” Mr Strache, 48, a smoker who has tried to quit, said.

“The freedom to choose lives on. The existence of restaurants, particularly small ones, has been secured. Thousands of threatened jobs have been saved,” he said.

Some of the Times commenters say that their dislike of smoke is so strong that they will not be returning to Austria as tourists unless the ban is reinstated. That is their choice, although it does seem to me that their understandable preference for a non-smoking restaurant could be satisfied at a more local level than that of an entire nation.

This is why we can’t have nice things

To be precise this is why we can’t have politicians who try to explain concepts from economics in a relatively grown up manner. When they give the more highminded strategy a go, along comes the Daily Mirror and the “pan-disability charity” Scope – whose Wikipedia entry is graced by one of those template messages saying, “This article contains content that is written like an advertisement” – to remind them why when attempting to discuss economics with the Great British Public the wiser course is to mindlessly repeat one pre-prepared soundbite. Daring to suggest that some groups might be on average be less productive than others, even in the context of saying that their participation in the labour force is a good thing, only brings on another mass bout of indignation dysentery. All one can do then is try not to breathe in too deeply until people have got it out of their system.

Quoth the Mirror:

Philip Hammond blames Britain’s low economic productivity on working disabled people

“The consequences of high levels of unemployment, particularly youth unemployment, will be felt for many, many years to come.

“It is almost certainly the case that by increasing participation in the workforce, including far higher levels of participation by marginal groups and very high levels of engagement in the workforce, for example of disabled people – something we should be extremely proud of – may have had an impact on overall productivity measurements.”

Quoth Scope:

Anna Bird, Director of Policy and Research at disability charity Scope, said: “These comments are totally unacceptable and derogatory. They fundamentally undermine the Government’s policy to get more disabled people into work, and the ambition set out by the Prime Minister just a week ago.

“The Chancellor must urgently withdraw them and offer a full apology.”

Quoth Mirror commenter “DiAne”:

Didn’t Hitler say something similar?

Samizdata quote of the day

One claim by campaigners is that this will ‘help the poor’, who are disproportionately more likely to suffer from alcohol-induced ill-health. How making poor people poorer will improve health is a real head-scratcher. This is typical of the missionary attitude of public-health zealots – imposing policies that poor people don’t want ‘for their own good’. Neither will minimum pricing do anything to solve the problem of weekend revellers ending up in A&E – bars already charge way above the minimum price. Instead, this new policy will target those trying to relax with a cheap drink at home.

Rob Lyons

“Bringing that choice into the equation”

“Ban smoking at home, say Scots campaigners”, reports the Sunday Times. This headline is followed by the breezy standfirst,

Move to save kids from second-hand exposure

That’s “kids” like wot the Times is down wiv.

Anti-smoking campaigners in Scotland are seeking to stop people lighting up at home as part of a drive to reduce the harmful health effects of inhaling secondhand tobacco smoke.

Last week, Dr Sean Semple, an academic from Aberdeen University, said restrictions on smoking at home may have to be imposed to protect children.

Odd how campaigners against passive smoking so often seem fond of the passive voice. Dangerous things, these restrictions imposed by nobody in particular, you can breathe them in without realising it and then you get cancer.

Meanwhile, Ash Scotland, the charity that helped to bring about a ban on smoking in public places in 2006, believes more could be done to protect residents in social housing.

There is concern that despite existing laws, hundreds of thousands of people in Scotland are still at risk from exposure to secondhand smoke in their homes.

Each week, dozens of children across Britain are taken to hospital through inhaling secondhand smoke, which is known to increase the risk of asthma, as well as ear and chest infections.

Extraordinary claims require extraordinary evidence. Failing that, as the Times does, any evidence at all for the claim that “dozens of children a week” are taken to hospital through inhaling second hand smoke would be nice.

Sheila Duffy, the chief executive of Ash Scotland, said the charity was seeking a meeting with the Scottish Federation of Housing Associations to discuss the possibility of a smoking ban.

A smoking ban in social housing has proved immensely popular in the US, in California and cities such as New York and Philadelphia.

So a ban on Group X getting the limited supply of rent-controlled social housing proves immensely popular with social housing tenants not in Group X, not to mention potential social housing tenants for whom the chances of getting it have just increased. Colour, or as they say in the US, “color”, me surprised.

“Tobacco companies often talk about choice in smoking. However, for many people the choice to live free from breathing in tobacco smoke is just not there,” said Duffy.

“The Ministry of Peace concerns itself with war, the Ministry of Truth with lies, the Ministry of Love with torture and the Ministry of Plenty with starvation.” One day soon we will have a Ministry of Choice so Sheila Duffy can concern herself with giving everyone the choice to live in a world free from choice.

“We are keen to explore ways of bringing that choice into the equation for new social-housing tenants and increasing protection for those living in buildings with shared common spaces.”

The bleeding obvious

Frances Ryan’s Guardian article, “Period poverty is leaving women such as Kerry isolated and ashamed” started off with a call for sympathy which I can answer. It described how a woman called Kerry, bringing up three children (two of them autistic) alone and unwaged, sometimes found herself without even £2 for a box of tampons, and could not bring herself to ask the people at the food bank for them. That is sad. Let us be aware that women can find themselves in this position, and help them in a sensitive way.

Then it got stupid.

It isn’t hard to see why sanitary products are often out of reach. Research shows pads and tampons cost women around £13 every month. Add another £8 for new underwear, and then almost a fiver for pain relief. That means women need to find more than £300 each year for periods – or the equivalent of a fortnight’s rent.

The “pads and tampons” link takes you to that well known scientific journal, the Huffington Post. It claimed that respondents to a survey (I saw no mention of who carried it out or how the sample was selected) on average spent the following “on different areas relating to their period”:

· Pads/tampons/panty-liners/menstrual cups – £13

· New underwear (due to spillages) -£8

· Pain relief – £4.50

· Chocolate/sweets/crisps – £8.50

· Other (magazines/toiletries/DVDs etc.) – £7

Honestly, I could have filled up the remainder of this post without moving my finger from the ? key. “Research shows”?? Chocolates?????? Yeah, I do kinda see that a new DVD, a glossy magazine and a box of choccies can be a comfort when suffering from period pain, but really, we are not talking about desperately needed sanitary essentials here. I also fail to see exactly why one needs new underwear every time there is a spillage. Every time and every month? I mean, sorry to be icky, but things can be washed. Even if there is a substantial group of women who find it unbearable to do anything other than bin bloodstained underwear (heaven knows how they toilet train their kids) they don’t have to spend £8. Tesco sells four pairs of knickers for £4.50. That’s just over a quid a pair.

While we are at Tesco’s, let us look at some of those other prices.

Pain relief £4? Pain relief thirty pence, actually.

Pads/tampons/panty-liners/menstrual cups £13? A “Feminesse” menstrual cup was fairly pricy at £17.10, but the whole point is that it is reusable and lasts for years. When it came to the tampons and pads or towels most women use, and for which Tesco sell their own-brand products, the prices were as follows: Tesco regular tampons 20-pack: 95p. (A pack of twenty is usually enough for one period.) Tesco super tampons 20-pack: also 95p. Maxi regular sanitary towels 10-pack: 23p. Twenty-three pence. Cheap as chips, as the saying goes. Cheaper.

Tesco is not uniquely benevolent. The other major supermarkets and chains like Superdrug are much the same, or even cheaper.

Frances Ryan is supposed to be the Guardian‘s expert on the deprived, the disabled, those failed by the system. I am not one to demand that politicians or journalists know the price of everything in a shopping basket, but you would think she of all people would have looked at that claim of £13 per month as an average for sanitary products and £4.50 for pain relief, and thought, that’s obviously wrong.

Never mind. The average prices claimed for period products in some silly survey and silly Guardian writers believing them are not my point; the actual prices in the most widely used supermarkets are. Period poverty is not worth bothering about. Capitalism has already solved it. When forty sanitary pads can already be purchased for a pound the money the government would have to spend to make them widely available for free is wasted. Worse than wasted; the salaries of umpteen Period Poverty Support Workers will come out of budgets that could – conceivably – have been used to help the poor. Let me put it another way: someone who cannot afford to pay for sanitary towels also cannot afford food. They do need help, urgently. However passing laws and setting up programmes to supply only that small fraction of the help they need that relates to a couple of packs of tampons is incredibly inefficient. If women in crisis need to be given sanitary products, don’t campaign for the government to launch an initiative, take the initiative yourself. There are charities who specialise in exactly that form of aid and will accept donations in kind or in cash.

As a matter of fact although most of the stories I have read on this subject, including the BBC link from Ryan’s article, have headlines that talk as if the problem is period poverty, when I read the stories below the headlines, the real problem far more often seems to be period ignorance or period embarrassment. But the steps needed to help women and girls with these issues do not generate column inches for journalists, photo opportunities for politicians, or outrage for activists.

Samizdata quote of the day

“Excuse me. Would you like to defend the NHS?”

“No. I’d like to abolish it.”

(Incomprehension)

And

People in this country have no conception of how good they have it. Except with respect to healthcare, when they have no conception as to how bad they have it.

(Both these quotations supplied by the same anonymous donor.)

Health, safety and growth

John Noakes, who died today, was a children’s television presenter who would do things like climb Nelson’s Column without a safety harness. I have seen comments about health and safety rules preventing such acts of bravery today. Indeed, another presenter on the same programme had the advantage of scaffolding many years later. But in this case it is not that health and safety rules have gone mad, it is that working conditions have improved because it has become cheaper to improve them. Presumably modern scaffolding is cheaper to erect due to advances in materials and techniques. In other words, due to economic growth. Even television steeplejack Fred Dibnah himself pointed out, “to circumnavigate the wall of that chimney, which might be sixty-odd feet circumference, with scaffolding is going to cost a heck of a lot of money. That’s why steeplejacks can still earn a crust of bread.”

As admirable as Fred’s craft was, it is a sign of progress if people can no longer earn a crust of bread doing it because scaffolding costs a heck of a lot less.

My late night pondering aside, there are some good videos of people at height behind those links. I particularly recommend watching as much Fred Dibnah as possible.

Samizdata quote of the day

Can the NHS be reformed? Or is major surgery required if it is to make a full recovery? We need to come up with much more radical reform than is currently being proposed. And if that doesn’t work, instead of accepting the somewhat back-to-front NHS version of TINA – in which we are told that there is no alternative to a welfare-state-era model of provision frankly unfit for the 21st century – we need to replace the NHS with something better.

According to Benedict Spence, writing in the Independent, ‘pretty much all of our European counterparts have a universal and in many cases much better healthcare system than the UK – and, horror of horrors, most European healthcare is what we would call “privatised”’. The UK is unusual among developing nations, he says, whose often social-insurance-based systems often perform better than ours (for example, in cancer survival rates). And yet, the defenders of the NHS remain ‘aggressively insular’.

Dave Clements