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]
|
On some, if not all issues, Rod Liddle is a man of sound views. He loathes the nanny state; he is unconvinced that we need to crack down on freedom of speech in order to avoid giving offence to religious groups. He is a patriot. In this week’s edition of the Spectator, where other authors rant away splendidly, Liddle rails against the six-month-old government ban on smoking in all public buildings, including privately owned ones (apart from private homes), such as pubs and restaurants. He makes a good case and some of his paragraphs are cheer-out-loud material:
Of course, one shouldn’t drop a policy simply because the pubs are having a rather hard time of it as a result. But in which case, don’t bother to pretend that they’re not, that actually there are queues all down the street consisting of shiny, happy people who wish nothing more than to drink in a new, healthy, smoke-free environment. Stop lying. Say, instead, that the smoke ban is putting pubs out of business but actually we couldn’t give a toss. Truth is, the government — and the health charities — are caught by their previous, gerrymandered poll findings which purported to suggest that the entire country was in favour of a complete ban on smoking everywhere, when — and again, do a quick vox pop if you doubt this — the reverse was true. People would like to see genuinely smoke-free areas of restaurants and pubs, for sure — but only chose a complete ban on smoking when the alternative on the poll sheet was ‘or would you like your testicles sawn off?’.
Or this:
Perhaps it is true, though, that because of the ban, I shall live for ever, for which many thanks, Dawn. But I doubt it; we will have recourse to one or another means of killing ourselves, such as driving a car (4,000 deaths per year), drinking more (40,000 deaths per year) or visiting a doctor (30,000 deaths per year through negligence or incompetence: never forget that figure. It exceeds the numbers killed through smoking-related illness. And it really, really hacks off the doctors).
But as always with Mr Liddle, the carelessness with which he chucks around numbers makes me wonder if any reader will want to get past his first paragraph:
I am still not sure what I hate the most about this government: its decision to invade Iraq and thus either effect or facilitate the murder of 500,000 Iraqis, or its decision to stop me from smoking in pubs and restaurants.
500,000 Iraqis? Is that correct? Liddle gives no source for this or attempts to do so later in the piece. Now Rod may be right to suggest that the overthrow of a power-mad, dangerous dictator was even worse than letting him stay in power (I occasionally wonder why a certain type of right-winger is so indulgent towards evil men like Saddam). But if he is going to make an argument with statistics as part of his core argument, it is probably not a great idea to kick off an argument with a massive figure based on, whatever.
Oh, in case anyone asks, I don’t smoke, except on National No Smoking Day.
The European Union has its uses. While rootling around for stuff to link to from CNE Competition, I came across this:
Left-wing Labour MPs are girding themselves for a rebellion over a European Union plan which they say could spell the end of the National Health Service.
When left wing Labour MPs rebel, I at least hope for possible goodness.
The European Commission will publish its health directive next week and it is meant to make it easier for people to travel to get specific medical treatment in another EU country.
Ah, the age-old dilemma of the EUrosceptic. What do you think if the EU imposes something sensible?
British diplomats say that this is NOT the same as making sure that if you fall sick in Slovakia or have an accident in Austria you can get treatment straight away.
When British diplomats say that something is NOT something else, it means that they have been told to say that by their political masters and that the small print of their argument will be about a very small difference. The feathers on the other something will definitely NOT be the exact same colour, but the other something will otherwise waddle and quack in an identical fashion to the original something, and will in fact be just another duck. For “NOT”, read ” “, in other words.
It is what some people call “health tourism” and both critics and fans say it will allow people to shop around for health care.
Sounds great. So what if it is just a plan to sell Eurostar tickets; I still like it.
In the end, there is nothing like people preferring something else to whatever bogus nirvana is being peddled by the bogus nirvana peddlers. The one argument against the much vaunted Soviet Communist nirvana that the vaunters could never wriggle free from was the fact – for fact it was – that this was a nirvana that millions wanted to escape from, through minefields if need be, and with only the clothes they were wearing at the time of their escape if that was all they could take with them. A similar process is now under way with Britain’s similarly vaunted NHS, the best healthcare system in the world except for all the others.
A story on the UK news last night gave statistics on trauma patients. Those are the seriously injured who must be transported from an accident site to a trauma centre. The percentages of trauma patients who die are:
UK – 43%
US – 16%
Draw your own conclusions.
I happened to be near a TV last night and was so stunned by the numbers that I pulled out my clipboard and wrote them down. The news feature also noted that ambulance first responders were insufficiently trained and often did not carry out measures such as clearing air passages. It also discussed the idea of having specialist regional trauma centre’s. If any one else was watching last night, their inputs on this TV report and the data behind it are welcome. The only thing I have found so far on the net is this
The smoking ban was a mere tasty morsel. It has roused the appetite of the beast without bedding it back down again. The hungry beast has drawn blood and it wants more:
Government ministers should shrug off media accusations that they are running a nanny state and introduce tougher public health measures, experts say.
The Nuffield Council on Bioethics said the time had come to consider a whole host of interventions in the UK after the introduction of a smoking ban.
Its proposes raising alcohol prices, restricting pub opening hours and better food labelling to fight obesity….
The report by the panel of experts, which include scientists, lawyers and philosophers, said there was a balance to be struck between individual freedom and wider public protection.
Welcome to the latest phase of the old ‘public choice’ paradigm. You have to choose between freedom and prosperity. You have to choose between freedom and fairness. You have to choose between freedom and safety. And the wheels of the world turn round and round to the music of the rhythm of history.
Okay. let’s gird our loins, saddle up and prepare for battle again but, this time, let’s make sure that we don’t go charging off in the wrong direction. It would be easy to lose this stage of the war and, as always, the odds are stacked against us. But lose we will for sure if attempt to fight it on the enemy’s ground and what I mean by that is accepting that there is a such a thing as a choice between freedom and health and then attempting to persuade people to choose freedom and to hell with their health. If the public believes that this is the choice they must make, then they will choose to be healthy and, before we know it, we’re standing around scratching our arses and wondering what went wrong while the triumphant, braying beast tramples everything in its path.
We must not make the mistake of arguing that health does not matter. It does matter. As every exhortatory elderly relative has croaked at one time or another, health is the most important thing. But that is exactly why we need more freedom and less compulsion. The healthiest societies are the the most liberal and prosperous ones, while the unhealthiest are invariably the poorest and most statist and centrally planned prescriptions for health will be no more successful than centrally planned prescriptions for the economy. The public must hear, again and again, that the “choice” being presented to them by the likes of the Nuffield Council on Bioethics is vexatious, counterfactual and perverse.
The beast will not stop. It will not change its mind, grow tired, get distracted or give up. The stakes are too high. But that is not the same as saying that it is unstoppable. We just have to make sure that we shoot its legs from under it. Nothing less will do.
Who’d’a thought we’d see two shout-outs to King Canute in as many days in the health care arena? Yet there he is, popping up again in Business Week in the service of opposing more government intervention in health care.
According to legend, King Canute of Denmark facetiously tried to stop the rising tide by simply raising his hand and commanding the waters to roll back. The tide, of course, kept rising. Yet policymakers throughout history have followed Canute’s lead. From Hillary Clinton and John Edwards to Mitt Romney and Arnold Schwarzenegger, politicians across the spectrum have tried or vowed to solve America’s health-care woes by enacting an individual mandate – a law requiring every adult to purchase health insurance. Despite its bipartisan support, the individual mandate is bad policy, a vain attempt to command a better result while doing nothing to achieve it.
An excellent discussion of the folly of individual mandates follows. Of some interest is the way the estimate of the size of the problem meshes with that made below.
According to an Urban Institute study released in 2003, uncompensated care for the uninsured constitutes less than 3% of all health expenditures. Even if the individual mandate works exactly as planned, that’s the effective upper boundary on the mandate’s impact.
If you do the math, I think you will find that Mark Steyn’s number of the poor uninsured comes out to about 3% of the population.
More importantly, Whitman points out the major flaws in the individual mandate proposal – it would not work (people will still refuse to buy health insurance), and it will make the problem worse by driving costs even higher.
Even now, every state has a list of benefits that any health-insurance policy must cover – from contraception to psychotherapy to chiropractic to hair transplants. All states together have created nearly 1,900 mandated benefits. Of course, more generous benefits make insurance more expensive. A 2007 study estimates existing mandates boost premiums by more than 20%.
If interest groups have found it worthwhile to lobby 50 state legislatures for laws affecting only voluntarily purchased insurance policies, they will surely redouble their efforts to affect the contents of a federally mandated insurance plan. Consequently, even more people will find themselves unable to afford insurance. Others will buy insurance, but only via public subsidies. Isn’t that just what the doctor didn’t order?
His prescription for incremental policy reform strikes me as being pretty sound, as the fundamental shift that needs to be made in health care insurance is away from first dollar coverage, low deductibles and copays, etc. and toward catastrophic insurance. First dollar coverage has proven to distort if not destroy any semblance of financial responsibility on both sides of the health care transaction, and is one of the primary drivers of high costs. Catastrophic coverage fulfils the true function of insurance – protection against risks you can not afford – without creating the disastrously misaligned incentives that our current system has.
Our theme for today comes from George W Bush: “Freedom is the desire of every human heart.”
Whether or not freedom is the desire of every heart, I think it is abundantly clear that most people are indifferent or hostile to their neighbor’s freedom, which is why a mere democracy, unencumbered by principles of limited government, is assured of devolving into some sort of Total State in short order. But the inimitable Mr. Steyn is not content with observing that most people think of freedom as “fine for me, but not for thee.” No, he has in mind the apparent eagerness of so many to give up their own freedom.
A year ago, I wrote that, “The story of the western world since 1945 is that, invited to choose between freedom and government ‘security,’ large numbers of people vote to dump freedom — the freedom to make your own decisions about health care, education, property rights, seat belts and a ton of other stuff.”
This is what makes being a small-government libertarian so frustrating. Our patron saint should be King Canute, for it often seems like we are standing on the shore, trying to stop the tide. The reply to Mr. Steyn, if it is not couched in shallow democratism (“we are just giving the people what they want”) is usually couched in terms that imply that freedom is not possible, or at least can not be enjoyed, without material security provided by the State. This inversion of real freedom (the freedom of self-ownership) was perhaps best catechized by FDR, the man most responsible for freeing demagogic democracy from the strictures of the constitutional republic, as “freedom from want.”
FDR’s heir is Hillary Clinton, and she is pushing (again) for nationalized health care in America. The battlecry this time is that there are “45 million uninsured” (or whatever spurious number is trotted out).
My first response is “so what?” Anyone in America can get health care simply by walking into the nearest hospital, as all hospitals are required to give an exam and emergency treatment regardless of ability to pay.
But, as always, one should not let the factual assertions of the advocates of the Total State go unexamined. Mr. Steyn continues:
So, out of 45 million uninsured Americans, nine million aren’t American, nine million are insured, 18 million are young and healthy. And the rest of these poor helpless waifs trapped in Uninsured Hell waiting for Hillary to rescue them are, in fact, wealthier than the general population. According to the Census Bureau’s August 2006 report on “Income, Poverty and Health Insurance Coverage,” 37% of those without health insurance – that’s 17 million people – come from households earning more than $50,000. Nineteen percent – 8.7 million people – of those downtrodden paupers crushed by the brutal inequities of capitalism come from households earning more than $75,000.
In other words, if they fall off the roof, they can write a check. Indeed, the so-called “explosion” of the uninsured has been driven almost entirely by wealthy households opting out of health insurance. In the decade after 1995 — i.e., since the last round of coercive health reform — the proportion of the uninsured earning less than 25,000 has fallen by 20% and the proportion earning more than 75 grand has increased by 155%. The story of the last decade is that the poor are getting sucked into the maw of “coverage” and the rich are fleeing it.
At a conference on health law last week, I predicted (only half in jest) that Hillary would be signing the bill nationalizing health care at the beginning of her second term. The more I think about it, the more likely it seems. The tide of the Total State never sleeps.
Edward Paul Brown was a premature baby whose birth and death took place within minutes of each other on February 23rd 2007 in a lavatory in Queen’s Hospital, Romford.
Eighteen weeks into her pregnancy, his mother, Catherine Brown, was told that there was no amniotic fluid surrounding the baby in her womb. This meant that the baby’s chances of survival were minimal and her own life was threatened. Catherine Brown took the “devastating” decision to abort. Even those (such as I) who generally oppose abortion, will see this as a hard case – and I hope that any comments do not get sidetracked onto that issue.
So. We have a woman in hospital waiting for the procedure that will abort her baby, a child she had wanted to bear and raise. Not a pleasant situation at any time, but what followed next was disconcerting to read about even for those who have grown weary of NHS “war stories”.
I first saw this in the Times (Baby’s birth and death in lavatory of hospital with no trained staff), but there is a considerably more detailed account in This Is London (Mother forced to give birth alone in toilet of ‘flagship’ NHS hospital) (A very similar account appeared in the Daily Mail.)
Both headlines understate the peculiarly modern horror of what happened. The reader gets a picture of nurses trying to help, but out of their depth because Queen’s Hospital did not at that time have a proper maternity unit. That picture is wrong. The part of it that is wrong is the “trying to help.” The nurses declined to help.
→ Continue reading: Loss of nerve
In his defence of classical liberalism and critique of 20th Century state welfarism, F.A. Hayek argued that one of the dangers of socialised medicine (Michael Moore, please note) is that if health care is not rationed by price and expanded by the freely chosen actions of patients and doctors, then some other means of allocating scarce resources, and making them hopefully less scarce, will be needed. That “other” way is state coercion and control. Because healthcare is delivered in Britain free at the point of use – of course it is not free at all – the individual patient does not directly see the price of the health care he or she receives, such as in the form of an insurance premium. There is no price incentive, therefore, for a person to, say, cut out smoking, cut the beer and the beef burgers, get in shape by frequenting a gym, etc.
I wrote some time ago about the scarcity of human organs such as kidneys and livers, and how much of the western world suffers from a strange form or hypocrisy: we say it is great that people volunteer to donate organs (the libertarian writer Virginia Postrel has done just that by donating a kidney to a friend) but we recoil in horror at the idea that a person might ever be persuaded to sell an organ or be paid for such a donation, even though there is, in some countries, a commercial market in the business of using such organs and the related human tissue. (There is some legitimate worry that very poor people who do not realise the health implications might undergo surgery to sell their body parts, to be fair).
I thought again about such mixed attitudes when I saw the front page of the Sunday Times this morning:
THE chief medical officer wants everyone to be treated as organ donors after death unless they explicitly opt out of the scheme.
Sir Liam Donaldson believes the shortage of kidneys, livers and hearts is so acute that the country needs a donation system that will presume patients have given consent for their body parts to be transplanted.
Those who wanted to opt out would have to register in a similar way to those who now carry organ donor cards. This could be done through a central NHS database or through other documentation, such as driving licences.
But ranting away about the presumptious tendencies of a state doctor is all very well for relieving a bit of blood pressure, but there clearly is a problem with shortages of organs and how to save the lives of people in desperate need. Donation, either for no money or for a payment (with safeguards, if need be), can work only so far. We need to encourage biotechnological fixes: and a good place to see what sort of fixes might be out there is this interesting study by Ronald Bailey.
The doctors are right to highlight that there is a problem, but how less depressing would it be if they could think about ways of solving it without recourse to asuming that your body belongs to the collective, just for once.
This comment was left by a person calling herself Jasmine, responding to Sam Leith’s fine piece bemoaning the attitude of mind that led to the UK smoking ban in privately-owned places:
Has it occured to you that this is a nanny state because we need nannying? I don’t think anyone can dispute that smoking is not good for you. I read somewhere that having a smoking “section” is like having a peeing “section” in a swimming pool. It’s just not enough to have a partial ban and wait for the natural goodness of people who simply don’t know any better, to stop. They need to be forced to stop.
A question I would put to this woman, and quite a few of the other control-freaks out there is this: what gives you the right to tell an adult that he or she should adjust their habits for “their own good”? Does Jasmine think of herself as being some sort of god? Has it never occurred to these people that their obsessive desire to regulate all aspects of existence is in fact a sign of a deep psychological problem, which needs to be fixed?
Those idiots want health. But what we need is more life.
– Tattooed Marie, a Parisian barmaid, quoted Á propos smoking bans on Spiked.
“If Michael (Moore) thinks healthcare is expensive now, just wait when it’s free.”
P.J. O’Rourke, in a remark attributed to him in this nice takedown of Moore’s latest “documentary”, Sicko, a film making the case that we would all be better off in having tax-funded healthcare free at the point of use, like the magnificent British National Health Service that is the envy of the world (cue sarcasm alert, sounds of hollow laughter).
Arnold Kling has thoughts on the movie. Here is what I wrote about some of the issues arising when people want healthcare free at the point of use (ie, they want someone else to pay for it).
Do not misunderstand me: private healthcare in some countries, such as the US, is far from perfect. For a start, it does not have a lot to do with unfettered laissez faire capitalism, as anyone who has encountered the powerful American Medical Association will point out. The insurance system in the US encourages inflated prices for treatment, and there are other regulatory and legal costs which have become a lot worse in recent years. But if Moore thinks British cinema audiences will be wowed by his paean of praise for Britain’s Soviet model of healthcare, he needs to have his head examined.
Mind you, I have often wondered whether Moore is for real, or a sort of performance artist secretly working for Dick Cheney.
(Update: further thoughts on whether Moore is a clown damaging the already-weak case for socialised medicine can be seen here.)
When Perry referred to the recent comments of US Presidential hopeful Barak Obama, we had another example in the ensuing comment thread of how people lazily refer to the idea that healthcare should be ‘free’. Of course, unless Obama is a total idiot – and I doubt that – he realises that health care, like roads, clean water, defence or food is not free in any sense at all that matters in a world of scarce resources that have alternate uses (such scarcity and the fact they have alternate uses is a classic element of what economics is). Healthcare is not free – it must be paid for, paid out of the time and trouble of other people. The problem, however, is that a lot of people, not just socialists, think that some things in life ‘ought’ to be free although one often finds they are at a loss to say why. Indeed, if you challenge a person by asking, “Why should health, clean water or defence be free”? they will either change the subject, or go bright red with anger, or fail to understand the question at all.
To attack the idea that certain services and resources should be ‘free’ is not, alas, all that easy in today’s politically dumb climate. However, I think I have a partial solution in how to frame the point. If you ever encounter a person who says that healthcare should be free at the point of use, and it should be a ‘right’, then point out that this means that someone else has a corresponding duty to be a doctor, a nurse, a hospital orderly or an administrator. Unless people can be forced to perform these roles, then all talk of health as something that ought to be free is meaningless. Of course, at this point the socialist will blather on about incentives and so on, but what if no one wants to be a doctor or a nurse, regardless of pay? Does this mean that anyone who shows an inclination to like medicine should, at an early age, be conscripted into a hospital like a draft for the Army?
I ask these rhetorical questions because I think that when we try to frame our arguments, it is sometimes easy to lose sight of the fact that actual flesh and blood human beings are involved in talk about “the right to free health care”. Most people these days oppose the idea of military conscription so it ought to be possible to make the case against medical conscription. If we can point out that medical conscription would be a bad thing, then it would be a step in nailing the nonsense that healthcare is a ‘right’.
Here is a book I highly recommend about the whole noxious doctrine of ‘welfare rights’ and how they erode respect for the original, far more coherent rights doctrine of classical liberalism.
|
Who Are We? The Samizdata people are a bunch of sinister and heavily armed globalist illuminati who seek to infect the entire world with the values of personal liberty and several property. Amongst our many crimes is a sense of humour and the intermittent use of British spelling.
We are also a varied group made up of social individualists, classical liberals, whigs, libertarians, extropians, futurists, ‘Porcupines’, Karl Popper fetishists, recovering neo-conservatives, crazed Ayn Rand worshipers, over-caffeinated Virginia Postrel devotees, witty Frédéric Bastiat wannabes, cypherpunks, minarchists, kritarchists and wild-eyed anarcho-capitalists from Britain, North America, Australia and Europe.
|
