Wednesday, March 12, 2008

Why do we think state provision of anything is superior?

Faceless bureaucracy costs lives


"I've paid my taxes"

"Yes, I'm sure you have. Have you ever thought that this might be exactly why you are getting such a disappointing service?"


It’s becoming ever more obvious that many in Britain are wedded to a model of “State provision is better” It’s becoming ever more obvious that these people are wrong.

Whether in fields of health or education the cry goes up “private provision is wrong” “it’s unfair” “it’s unequal” “it’s immoral” “unfair advantage” “exclusive” “divisive” and so on.

Let’s first be clear about the word better. Something can be better than something else either in terms of effectiveness (does it work?) or in terms of morality. However morality comes in many guises and for too many in Britain equality has become their totem of moral good, not effectiveness.

So in both the health divide and the educational gradient are bigger now than they ever have been. The policy of valuing equality actually succeeds in worsening inequality.

The life chances (Lifetime trajectory if you want the academic work for this) of a child born in a poor family in terms of illness risk and educational attainment are far less than those of a child born to a richer family. The health and education systems are achieving an increase in the gaps of wealth and health between rich and poor in the UK. Currently social class one have an average life expectancy about 10 years longer than social class 5. This is not a desirable outcome, nor is it inevitable. It is an inevitable result of a flawed morality of envy and equality that aims at bringing everyone down to a certain level.

Nothing can be achieved ever by levelling down. Brunel was not average, he was awkward, and a genius. Great Western Railway worked. The bureaucratic monster now running trains out of Paddington doesn’t.

Nelson was a maverick, who disobeyed commands, and thereby won the battle. He’d have been dead or court-martialled if he had lost, but he came from a time when people could take risks, and accept consequences. He didn’t think about health and safety, he though about leadership and his men.

Throughout history the people who have excelled, and made a difference have never been motivated by equality. They have been motivated by excellence, curiosity, awkwardness, joy of innovation. The seeds for this behaviour are good health and good intelligence, in all its multiple varieties. (Howard Gardner)

So we need a school system that nurtures these qualities, with freedom to explore, and to make mistakes. And we need a health system that treats people as it finds them, not as they should be.

And for human flourishing we need associations of individuals, not central diktats and blueprints. The current bureaucratic sclerosis destroying the NHS and British education are symptoms of the malaise in British public life. The democratic association of free agents needs to return. Rules should only be enacted for safety purposes, to protect us from others, not to protect us from ourselves, and not to try and make us or our offspring better.

Running parallel to this people must grow again, and accept consequences from their actions. Smoke all you like, but realise you run the risk of COPD, lung cancer, IHD, stroke, gangrene, impotence etc.

Secondly equality is not good for anything except mediocrity. The NHS consumes a world class amount of resources for a very mediocre service. It has pissed off providers and customers. And demoralised bureaucrats who frantically pull levers, and hold meetings, but realise the whole lot is full of sound and fury but signifies nothing.

The education service has bureaucratic games being played out. Baptism should be celebrated for what it is, not as a means to get your kid into the church school, which isn’t quite as bad as the others in the area.

Teachers need to be able to teach, and we need to tell the idiots on review panels that heads exclude kids for good reason, and for all our sakes- BACK YOUR HEAD-do not try to second guess him or her.

At present we have a very unequal and very unfair world. We have this because so much effort goes into equality, and to generalising this via centralised bureaucratic means.

The Left’s ideology of equality is at present a tattered rag. It can only achieve its goals by getting rid of the opposition, so there is no comparison. That’s why Labour look so hopeless, and why the NHS and education are going downhill. Dumbed down A levels in soft subjects, do not make for good doctors, engineers, physicists, historians, or linguists. They do make for a homogenous group of customer services managers who can smile, but cannot actually do anything, unless the protocol or policy allows it.

The right’s alternative discourse- local provision, the intelligent individual agent respected as him or herself, local adaptations, market trading, free movement of goods, skills and labour, is not yet fully articulated. It needs to be. Its results are actually fairer and more equitable, than trying to impose equality.

And maybe GPs leaving the NHS, and dealing directly with patients as customers, would actually be a good start on this process.

19 comments:

davoz said...

Is it April 1 already?

Can't believe that "The bureaucratic monster now running trains out of Paddington doesn’t. " is a booby trap

Rahere said...

Dr Rant, this needs copying to Tory Central office ASAP! I come to this blog for antidotes to health-related idiocy, but I'm delighted to see you extend the range of your brief - the best sort of "mission creep". This and your item on the Deaf below are just the sort of thing that sadly can now only be articulated on semi-anonymous blogs. They should be in the mainstream press, but they too are increasingly subsumed into the political mediocracy.

All a bit depressing, really...

Devil's Kitchen said...

I knew we'd get you!

Signed,

The Evil Right Wingers.

P.S. My father writes occasional twiddles and one of his said warblings includes one of my favourite lines:

"Politicians bestride a stage
Where mediocrity's all the rage..."


DK

Anonymous said...

and how would most people be able to afford healthcare in this brave new private world? What about people like myself who would never get health insurance (40 years old with lupus, bronchiecstasis, etc)and work for a very small company that could never afford to prove this as a job perk?

The people who would be worst affected by this I suspect wouldn't be people on benefits, as they would be covered by a state insurance scheme, but people like myself.

I have family in America and my Aunt who is in her late 50's has diabetes. Her insulin is covered by her insurance but she gets no other checks or medication to prevent strokes, etc that peopel in Britain get via the NHS.

As a result of her diabetes she now has gangrene in her leg and has been told this needs to be amputated. Her insurance doesn't cover this and as she owns her own small house the state won't pay for this. She has been told by the state she should sell her house to pay for her leg to be removed. But her house is small and in a pretty poor area, so downsizing is not an option either. And it is people like this who work, but not on high wages who will invariably suffer if the NHS is fully privatised.

jayann said...

the health divide and the educational gradient are bigger now than they ever have been.

True


The policy of valuing equality actually succeeds in worsening inequality.

False. Successive governments beginning with Thatcher's have not valued equality. Nor, I add, habve they promoted the public sector. They have privatized aggressively.

And they have sold the pass on progressive taxation.

(Etc. -- perhaps it is April 1?)

Nutty said...

I see privatisation and the end of the welfare state coming and it frightens me. We will be back to the days where the chronically sick like myself will choose between asylums (except that they've all been closed down) or an early death, be it through hunger, cold (and we have pensioners now struggling to choose between food and heat) or through early death for untreated health problems.

In the meantime, in my case, inability to afford the medication I need will probably leave me in prison repeatedly after spectacular manic attacks (our prisons have nothing on American prisons for the proportion of people there with mental health problems).

T4 by the back door.

Anonymous said...

"The NHS consumes a world class amount of resources for a very mediocre service" and the USA consumes how much for life expectancy that's worse than ours.

I can see plenty of left leaning countries in Europe with narrower income distributions ie more equal, that are far happier places than the USA and UK.

Stick to medicine, right wing fascism doesn't suit you.

lost_nurse said...

I knew we'd get you!

What, joining the ranks of right-wing bloggers who specialise largely in moaning about stuff? Is that what you mean? I note that chain-smoking libertarians rarely have to deal with respiratory failure in other people. :)

Anonymous said...

What about the police and the military? What about the roads, railways, buses? Better off run by private companies than the state?

I don't think it's simply a matter of state bad, private good (or even the other way round).

It's how it's done that counts. This government runs public services for the benefit of private companies and lies about it. That's the problem.

Anonymous said...

I agree nutty - the erosion of the welfare state worries me too. I work full time in spite of having lots of health problems - lupus, lung damage, etc. If there wasn't an NHS, there is no way I could afford to pay for all the medical care I need. And there is no way anyone is going to insure me for existing conditions.

If in the future I couldn't access free healthcare I could imagine having to stop working so that I am entitled to whatever type of health care provision is in place for people on benefits.

Lots of people I find have no understanding of people like me who are still relatively young and able to work, but who have significant and chronic health problems. Lots of peopel when they think of peopel with chronic health problems assume everyone is on benefits or elderly.

Dr Xavier Ray said...

Giving people equal opportunities or even helping the disadvantaged to do better are noble aims but this government wants to impose a myth of equality by cutting the tops of the taller flowers while making sure they, their families and their friend enjoy the benefits power, influence and money can bring.
This is the problem with health and education and would not necessarily be better if replaced by a profit seeking system. Like someone else has said, the State does clearly have a role in providing some services such as the army and fire fighters but only an idiot would think they should be running banks or railways. Education and health are somewhere in between.

Idris said...

"only an idiot would think they [the government] should be running banks or railways"

So, the shysters at Northern Crock and the incompetents at Railcrap and Jarvis were your idea of trustworthy guardians of vital services were they?

Wake up man! You're sleepwalking towards the disaster of bad healthcare with plush carpets for the rich and nothing for the rest of us.

Residual said...

I am not going to make a judgement on this but I did find it interesting that Terry Pratchett was outraged not to get the drug Aricept for his early onset Alzheimer's on the Nash due to be too young, despite being rich enough to afford it.

Although to be fair to him, he is funding a study which will help more then him.

Anonymous said...

I'm a bit of a right-winger meself.
I like Grammar schools and believe they foster "social mobility," (which I believe has decreased under Labour.)

And while I usually wave my arms, clap and cry "testify, testify," whenever I read a Dr Rant posting I have to confess that I'm not to sure that increasing privitisation of the NHS is a good idea (though I'm not sure that is what your driving at anyway.)

You cite the book NHS plc by Alyson Pollock on your blog. Prof Pollock explains in detail why the NHS was better off funded in lump sums to regional authorities rather than having individual units competing for resources with the internal and external market forces you seem to be advocating. Can you clarify your position for me? I ask as I like to try and stay informed as possible about the organisation for which I'm going to work and establishing the positions of people such as yourselves who are in the know really helps my understanding!

Thanks,

A student

TotallyBushed said...

I'm sure DK and my grammar school teacher would agree this article is disgustingly centrally positioned. Please justify it properly next time. Ugh.

Anonymous said...

"So, the shysters at Northern Crock and the incompetents at Railcrap and Jarvis were your idea of trustworthy guardians of vital services were they?"

Are you a communist or something? Do statements with the phrase "the commanding heights of industry' in them appeal to you?

The management of Northern Rock made the false assumption that the economic situation would not change in the near future, namely that the cost of borrowing on through interbank mechanisms would not increase, it did. It is likely that Northern Rock would not have survived had the Treasury and the Bank not intervened. Which is a good argument against such poorly thought out intervention since it has insulated the risk takers from the consequences of their actions.

It is true that some banks are going through a rough patch, however, there are plenty that are doing fine, but you won't hear about them on the news, no news like bad news.

Anonymous said...

Are you turning to the dark side - poacher turned gamekeeper - looking for a gong.

You're previous ones have been right on bit and I look forward to them but you've kinda let the side done with this right winged bullshit twadle.

Everyone is entitled to have an off day.

Stick to what you are good at - defending the health service from the right wing privateers called the government.

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