Saturday, 28 July 2012

Can the NHS Stay in the Race?

In the wake of the heartfelt celebration of the NHS at the Olympics opening ceremony in Britain, it is vital to remind everyone that the goal posts for the survival of our public health service have been moved to favour private competitors.

The UK Conservative-led coalition Government has been telling voters that although they had previously promised they would not subject the NHS to another costly top-down reorganisation, they had changed their mind because they had come to believe that the NHS was too inefficient in saving lives and it would only improve if the private sector was given a much bigger role in delivering health services as it does in the US.

However, voters may have serious doubts about the government pressing ahead with reforms estimated to cost between £1.3 billion and £2.5 billion (Dept of Health and Treasury’s estimates respectively) when they learn two key facts.

First, Professor Colin Pritchard, whose research has been praised by the government, has undertaken a study (with his colleague, Mark Wallace), ‘Comparing the USA, UK and 17 Western countries’ efficiency and effectiveness in reducing mortality’ (published in the Journal of the Royal Society of Medicine Short Reports). Out of the 19 countries examined, the UK with its NHS system came 2nd in terms of cost effectiveness in saving lives. The US with its heavy reliance on the private sector came 17th. The UK has in fact a much more efficient health service when it is far less dependent on the private sector like the US.

Secondly, the Government’s insistence that injecting a much greater dose of profit-motive into the NHS would have positive rather than negative effects becomes less convincing when the widespread suspicion that profit-seeking would undermine healthcare is being confirmed. In its report, ‘Private hospital told doctors to delay NHS work to boost profits’, The Independent newspaper [ 22 July 2012] revealed the practice by a private hospital of deliberately delaying operations it has been contracted to carry out for the NHS in order to nudge patients towards signing up for private healthcare which would give the hospital a bigger profit.

As the Government pushes ahead with steering NHS hospitals to do much more private work, the profit-motive would spread faster and wider, and hospital administrators would increasingly weigh money-making opportunities more and more against caring for patients who do not pay. The only prospect of halting this is for the Government to have a change of heart, or for the UK to have a change of government.

[For a report on the unlikelihood that the substantial reforms costs would lead to any long term savings, see:; for a PDF version for Pritchard and Wallace’s study:]

Sunday, 15 July 2012

Pyramid Hockey

Welcome to pyramid hockey. The rules are simple. One team permanently occupies the top of the pyramid and hits as many balls as they please down the sides. The other team based at the bottom half has to try to stop the balls hurtling down with nothing but a teaspoon. If just one ball reaches the ground, then all those below lose and have to do the bidding of the winners. If anyone on the lower reaches should exhibit the rare but otherwise useless skill of catching a ball with a teaspoon, carrying it up the slippery slope, and throwing it through a 2 square inch goal, then that individual, not their team, would be rewarded with being moved to the top.

You may wonder who apart from those granted a top position would agree to play such a game. Wouldn’t people refuse to accept these patently lopsided arrangements? The odds are stacked against them, and however hard they try, the great majority of them would remain humiliated losers.

But the organisers of pyramid hockey have a few tricks up their sleeve. They tell the losers that the whole pyramid would collapse and crush them if they do not abide by the rules of the game. They impress on those low down that they should always defer to the winners who deserve all their advantages. And they encourage the lowly occupiers to play a mini-version of the game where they can easily defeat the even more marginalised groups stranded at the very bottom, who would then be at their mercy.

If the delusion takes hold, the majority of people will come to accept it as the only game in town. Many of them will form a deep attachment to it as ‘their’ tradition. They find it odd, if not irritating, that some people should question the basis of the game. Some may even become immensely hateful towards anyone who dares to try to replace pyramid hockey with some fairer sport where, on a level-playing field, the winner does not take it all.

Judging by the vitriolic attacks on the efforts of progressive reformists everywhere, the spirit of pyramid hockey is alive and well across the world (not least in the US in the run-up to the Presidential Elections). For people fearful of not having a mighty elite in whose reflected glory they bask on bended knees, and even more in dread of being denied victims below them to tread on, there could be nothing worse than the prospect of being deprived of their favourite game. Yet for their own sake, not to mention those who have already seen the outrageous rules for what they are, it is time for it to end.

Let us remind them that in every sphere of life, today and throughout history, allowing anyone to get away with having too much power – as military, political or business tyrants – is bound to end up with arbitrary commands subjugating everyone else to their whims. The only remedy is to share power out more evenly, democratically, cooperatively.

With wiser rules, we can produce more sustainable outcomes, and share the fruits of our labour in line with criteria everyone has signed up to. A better future awaits all, except for the few who want to hang on to their winnings in the unapologetically nasty game of pyramid hockey.

[Follow Henry B Tam’s updates on Twitter]

Sunday, 1 July 2012

Democracy's Debt to Young People

We’ve heard plenty about the nation’s financial debt (which in the UK the richest 5% can pay off by parting with just 5% of their wealth). What we never hear about is the democratic debt we owe young people.

Each new generation is told the story of the Second World War – how authoritarian oppression was defeated to make it safe for democracy to thrive. No more subjugation of the weak and vulnerable by anyone possessing such power that their commands were irresistible. All citizens would be equal. All would have the opportunity to work and earn a decent living. Where businesses fail to deliver, the democratic state would provide a safety net. Dignity is guaranteed for everyone, from cradle to grave.

The implication is that in far off countries where there is no democracy, people might have to resort to uprising and revolution to secure an equal say in how their life-chances are determined. But in an established democracy like the UK or the US, the young should be grateful for what has been put in place for them – a democratic system under which each counts for one and no more.

But has the promise of democracy been fulfilled? In the post-war period, there was for a time a sense of collective endeavour. A guarantee of the basic wellbeing of all was a universal badge of civilization, not a target of vilification by the ‘I’m alright Jack’ brigade. The needs of woefully neglected groups – women, gay, ethnic minorities, the disabled, etc – were addressed in the name of equal respect, not derided as a fringe obsession. But as plutocratic forces regrouped, power was once more concentrated in a tiny elite.

From the late 1970s on, the wealthiest 5% set about buying and exercising more influence over who would be elected to government; what laws would be passed or repealed; how an ever greater share of society’s resources would flow to them; how urgently required environmental actions would be held back to protect their profits; and how public services would be handed to profit-seeking bodies subservient to the priorities of those with the most money.

Democracy, far from becoming an integral part of our society, has been pushed further away from the reach of citizens. Most young people have no say about the key decisions affecting them in schools or universities. If they were fortunate enough to get a job, unless it is with a worker cooperative or partnership, they would have to go along with whatever their employer chooses. Their local government continues to lose power to large commercial interests (through privatisation and deregulation). At the level of national government, corporate wealth ensures candidates supportive of their agenda are more often elected than those who are opposed. And when the rich won’t pay their taxes, their friends in government respond with plans to scrap housing benefits for the under-25.

Plutocratic politicians never tire of telling young people they must be ‘work ready’ and eager to serve business goals. But if we are ever to have a true democracy, young people must be given what is owed them: the power and responsibility to have an equal say about decisions that affect them – one citizen, one vote, at school, the workplace and every level of society, with no distortion by wealth or status.

[Follow Henry B Tam’s updates on Twitter]