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Will the catalysmic implosion of the market ideology now move onto the NHS?



This week, David Cameron MP mocked Ed Miliband MP for sounding like a person who’d rung up a radio show whingeing.

Cameron replied, “And your problem is caller?”

The problem is a complete collapse of ideological position which has lasted decades.

Ed Miliband keeps up the moment today with the market failure of the energy oligopoly (see article by Patrick Wintour in the Guardian.)

It is argued that one of the precursors of Thatcherism was a revival of interest in Britain and worldwide in the work of the Austrian economist and political philosopher, Friedrich Hayek, who won the Nobel Prize for economics in 1974.

Alongside Milton Friedman, who won his Nobel Prize in 1976, Hayek lent great prestige to the cause of economic liberalism, helping to create the sense of a rightward shift in the intellectual climate, complementing the approach of Ronald Reagan across the pond.

These principles of dogma have seen successive Conservative and Labour governments reaching for the drug of privatisation and outsourcing.

But these drugs are not only failing to work. They are having devestating side effects which are killing the patient.

The markets have been outed for being far from liberalising. They create inequality. It is alleged that the austerity-based policies have led to a marked decline in mental health and rates of suicide even.

But it’s not the shocking Gas bill which has delivered the knock-out blow for the Conservatives’ religion.

“Here is the reality. This is not a minor policy adjustment—it is an intellectual collapse of the Government’s position.”

This was Ed Miliband’s verdict in Wednesday’s Prime Minister’s Questions.

Only a day previously, BBC Radio 4’s had played a voxpop of various members of the public speaking about ‘payday loans’ as a prelude to interviewing George Osborne MP.

“I don’t accept it’s a departure from any philosophy. The philosophy is we want markets to for people. People who believe in the markets like myself want the market regulated. The next logical step is to cap the cost of credit. It’s working in other countries. In fixing the banks, we need to fix all parts of the banks and the banking system. It helps all hard-working people.”

During the time of the previous Labour government, the King’s Fund was head-over-heels promoting competition.

It was known that, by shoehorning competition as a policy, private providers would make a killing.

All you had to do was to bring in a £3bn ‘top down reorganisation’, a 500 page Act of parliament containing no clause on patient safety apart from the abolition of the National Patient Safety Agency, and beef up a new consumer regulator (“Monitor”).

But meanwhile back to payday lending, an evidenced case of market failure.

“We’ve always believed in properly regulated free markets, where there’s competition, but where the market is properly regulated. That’s why we created a new consumer regulator.”

Far from being a loveable buffoon Boris Johnson, Johnson has revealed himself to be the toxic political mess he is.

Suzanne Moore, at the risk of being hyperbolic, called out Johnson as ‘sinister’.

Johnson had launched this week a bold bid to claim the mantle of Margaret Thatcher by declaring that inequality is essential to fostering “the spirit of envy” and hailed greed as a “valuable spur to economic activity”.

In an attempt to shore up his support on the Tory right, as he positions himself as the natural successor to David Cameron, the London mayor called for the “Gordon Gekkos of London” to display their greed to promote economic growth.

He qualified his unabashed admiration for the “hedge fund kings” by saying they should do more to help poorer people who have suffered a real fall in income in recent years.

And what’s wrong with greed being good if this improves patient care in the NHS?

The issue always remains ‘zero sum gain’. It’s a problem as it diverts tax-funded resources directly in the coffers of the private sector.

Arguably, it’s not just the failure of the market which is the problem, but ‘the undeserving rich’ who have never ‘seen it so good’ since Tony Blair’s New Labour period of government.

In August 2009, the then leader of the Opposition and Conservative leader, David Cameron, MP defended a shadow health minister for advising a firm which offers customers an alternative to NHS doctors.

Lord McColl was on the advisory board of Endeavour Health, which promised a quick and convenient access to a network of “top” private GPs.

It was claimed then that Endeavour Health is a company set up by two hedge fund advisers which purported to be Britain’s first comprehensive private GP network.

In a video yet to be deleted off You Tube, David Cameron argued that there was nothing ‘improper’.

This was interpreted at the time that the Conservatives “favoured private alternatives”.

Nonetheless, David Cameron claimed that the Conservatives was ‘totally dedicated to the NHS’, but he wished ‘to expand the NHS so that people don’t have to use the private sector’.

What actually happened was the Health and Social Care Act (2012).

In July 2013 in the British Medical Journal, it was reported that the private sector is in line to secure hundreds of millions in NHS funding from services placed out to the open market under the UK government’s latest competition regulations, a study has shown.

Research by the pressure group the NHS Support Federation found that contracts for around 100 NHS clinical services totalling almost £1.5bn (€1.7bn; $2.2bn) have been advertised since 1 April 2013, with commercial companies winning the lion’s share of those awarded to date.

Data from official tenders websites showed that only two of 16 contracts awarded since the government’s section 75 regulations of the Health and Social Care Act came into force have gone to NHS providers, with the remaining 14 going to the private sector.

A few days ago, it was reported tonight that David Cameron is intending to ban branded cigarette cartons, having originally decided last July not to proceed with the plans.

In the summer the Government said it was waiting to see how plain packaging worked in Australia, which introduced the measures a year ago, before making any changes. It has since maintained it is monitoring the situation.

That is the spin. Behind the scenes, it is well known that tobacco corporates have throttled public health policy.

In the third volume of Law, Legislation and Liberty, Hayek argued that there are not two but three kinds of human values: those that are “genetically ordered and therefore innate”; those that are “products of rational thought”; and values that had triumphed in the course of cultural evolution by demonstrating their suitability to the successful organization of social life.

Hayek believed that these values were a cultural inheritance, survivors of a competitive struggle, and essential conditions for the successful evolution of our society.

David Cameron is indeed right to be worried.

There has been a collapse of the ideological position that he and his predecessors, Margaret Thatcher and Tony Blair, stood for.

This is in relation to the markets.

This fundamentally changes the terms of reference for a market-based NHS.

Contagion is likely politically.

If payday lending or the energy markets are anything to go by, there could be trouble ahead.

So what’s the issue? The caller’s problem is that “the markets don’t work”, “they only make you feel worse again”.

And now the caller’s finally worried about the NHS.

 

 

My blog on dementia is here: http://livingwelldementia.org

Ed Miliband's #Lab12 conference speech: a need to define the markets and community



 

I am looking forward to Conference, this time in Manchester (like it was in 2010). I know Manchester Central Hall very well from previous meetings there of the Fabian Society, and again I am hoping to go to all of LabourLeft’s events and some of the events of the Fabian Society predominantly.

I am not sure what to expect of the ‘Fringe’ this time – no doubt it will feature some regular talking-points such as whether we should renationalise the railways or the NHS, whether the left-or-right debate still serves any function in modern politics, and what Ed Miliband really meant in his conference speech. I feel it would be less helpful for Ed Miliband to set out details of policy, which can wait for the outcome of our policy review, but it would be very helpful for him to establish what sort of society he is striving for and why.

I think ‘top of the list’ must be a need to define the relative importance of the markets. Coincidentally in timing, Stephanie Flanders is mid-way through a series on the BBC called ‘Masters of Money’, and so far the analysis has centred around a comparison of those titans John Maynard Keynes and Frederick Hayek. Unfortunately, our view of the markets is as relevant now as it was in the run-up of the Great Depression in the autumn of 1929, and Ed Balls is or was aware of that. There has always been a notion of the ‘free market’ as liberalising people, ‘unchaining workers’, and this idea had been bastardised by Margaret Thatcher. The language of liberalisation is still seen in the supporting documents for Monitor, the new sector-specific regulatory body of the NHS. However, there are inherent problems with this approach, taken by Dr David Bennett from Monitor, from the Tony Blair ‘stable’ from the perspective of an advocate of a free market. A true market advocate would simply let private entities fail (this in fact has been the criticism of the global response to the financial crisis, describing the Keynesian stimulus of adding more credit to credit as being akin to pouring petrol on the fire); however, part of Monitor’s functions is to bail out failing trusts, in as much European law allows it (it is unlawful for the State to provide state-subsidies in such a way that competition in a private market is distorted.) The other problem of this approach is that  it is an approach which most favours accounting technocrats; rather than looking at value in pricing in a sophisticated behavioural economics fashion, the discussion is heavily based in number-crunching and methods such as activity-based costing.

Prof. Michael Sandel is a political philosopher who has been lecturing on the seminal ‘Justice’ course at Harvard. In the Reith Lectures 2009, Sandel gave his final lecture on “A new politics of the common good”. The governing philosophy for the last three decades both here and the US has been an era of ‘market triumphalism’, but both the UK and US have had difficult in reaching at a new consensus of what government should do. Sandel proposes ‘market mitigating governance’ at the first port of call where governments correct market failures through policy. You can easily apply this, for example, in measures to ‘correct’ excessive profits but poor value for shareholders and directors of privatised utilities companies. In fact, Miliband has latterly proposed a mechanism which could possibly do this, called “predistribution”.

Sandel, however, admits that these rather technocratic approaches fail to ‘capture value’ of what is really going on. For example, the Philip Morris study in the former Czech republic shows that smokers die early, pay lots of taxes, and do not need a pension, and therefore are of great benefit in a purely cost-benefit analysis. This caution could easily be applied to the newly privatised framework of the Health and Social Care Act, where public services have become commodified and monetised, in maximising consumer welfare. Sandel’s main objection is that such approaches do not lead to democratisation of services for the “public good”, and more ambitious goal of civil virtue through redistributive justice may be more welcome. The public appetite for this might be greater than we first suspect, in that the famous UK MP expenses scandal has led to a growing bitterness and resentment of voters towards their ‘political class’, and indeed the public are generally sick of examples of alleged corporate misfeasance in journalism through exposure in the Leveson Inquiry.

A better approach would therefore for people in society to be included and engaged in decisions about their society, with a general belief of solidarity and citizenship. Of course, a dichotomy between markets and society would be a false dichotomy, and this is appreciated by Prof. Michael Porter in his seminal article called ‘Strategy and Society‘ for the Harvard Business Review.  This thesis is more than familiar to Ed Miliband, who first described his thesis of ‘responsible capitalism’, a political version of corporate social responsibility, where all businesses contribute value to the rest of society. And yet this is entirely consistent with Ed Miliband’s concept of the UK economy as not being factional but being unitary. In such a framework, everyone contributes to the economy, not just the ‘wealth creators’ as bankers, but also less well paid people in the public sector doing extremely valuable jobs, such as nursing or teaching, who do need employment rights protection of the Unions.

In Sandel’s framework, we are less ‘consumers’ and more ‘citizens’. And this is a very practical problem. Consider for example excessive pay of some CEOs. It can be easy to criticise whether such salaries are justified, in other words the extent to which they are representative of a contribution to society, whether we should just allow the market to find an equilibrium for what people are willing to pay for, or the extent to which these people have ‘worked to get where they are’.  Politicians find it difficult to talk about inequality or redistribution, but you will never find that people with very incomes bringing up of their own accord topics of the ‘politics of envy’. Redistribution or social justice has become a taboo subject, but it may be necessary to revisit this if excessive pay can be tackled in the tax system. Whilst ‘punishment’ engenders a notion of a personal hate campaign, which is clearly undesirable, it may be ‘good policy’ that intervention against truly excessive salaries not only deters a trend of unreasonable undeserving salaries, but also encourages a marketplace where an appropriate salary can (for want of a better word) “incentivise” employees and workers appropriately.

As for the idea that people with excessive salaries will leave the country, it is worth noting that these people are often employed by multinational companies who can easily find replacements; therefore there will always be a corpus of such people contributing such taxes, even if a proportion of them emigrate (the point is that people who emigrate will be replaced.) Whilst aspiration has traditionally been a New Labour or Thatcherite policy plank, Ed Miliband latterly has cited aspiration as a reasonable goal of policy. I think that this is entirely consistent with aspiration that acknowledges an ‘equality of opportunity’.  Dr Tim Soutphommasane, a lecturer at Monash University, is also a political philosopher whose writings are clearly relevant here. Soutphommasane’s warning is probably more poignant here in the UK with a cabinet stuffed full of millionaires than it is in his home country, but he recently writes, “It is the mark of a good society that careers be open to all talents. Individuals should be able to transcend the position of their birth or upbringing through ability and effort. By the same token, the state shouldn’t reward those who have the fortune of being born into good circumstance.”

By that virtue, the political philosophies of Sandel and Soutphommasane present Miliband with a serious problem. How can Ed Miliband realistically frame a policy for government which consolidates the relative positioning of the markets and the community? I think Ed Miliband’s best bet is to frame the question is to think what sort of society do we want to live in which brings greatest civic virtue and citizenship of all members? As it happens, the consumer clearly has not benefits as recipients of the privatised utility industries, but Ed Miliband has indeed challenging decisions to take about the future; for example one mechanism might be to bring some services under state control. There is much political appetite for repealing the Health and Social Care Act, which indeed nobody voted for as such. The last year or so has seen Conservative polticians and their management consultant friends engaged in a retrospective ‘policy-based evidence’ to justify their marketisation of the NHS, but the NHS could be just the trojan horse that Ed Miliband needs to bring the political pendulum back away from the totally unfettered market. It’s a tough balancing act, as he will be keen not to present the State as too bulky or interventionist, but likewise, if he can pull off a discourse about why ‘looking after each other’, i.e. solidarity, say for example in protecting the health and welfare of disabled citizens in society as well as further ‘individual choices’, Ed Miliband will have pulled off a remarkable political contribution.

 

Ed Miliband's #Lab12 conference speech: a need to define the markets and community



 

I am looking forward to Conference, this time in Manchester (like it was in 2010). I know Manchester Central Hall very well from previous meetings there of the Fabian Society, and again I am hoping to go to all of LabourLeft’s events and some of the events of the Fabian Society predominantly.

I am not sure what to expect of the ‘Fringe’ this time – no doubt it will feature some regular talking-points such as whether we should renationalise the railways or the NHS, whether the left-or-right debate still serves any function in modern politics, and what Ed Miliband really meant in his conference speech. I feel it would be less helpful for Ed Miliband to set out details of policy, which can wait for the outcome of our policy review, but it would be very helpful for him to establish what sort of society he is striving for and why.

I think ‘top of the list’ must be a need to define the relative importance of the markets. Coincidentally in timing, Stephanie Flanders is mid-way through a series on the BBC called ‘Masters of Money’, and so far the analysis has centred around a comparison of those titans John Maynard Keynes and Frederick Hayek. Unfortunately, our view of the markets is as relevant now as it was in the run-up of the Great Depression in the autumn of 1929, and Ed Balls is or was aware of that. There has always been a notion of the ‘free market’ as liberalising people, ‘unchaining workers’, and this idea had been bastardised by Margaret Thatcher. The language of liberalisation is still seen in the supporting documents for Monitor, the new sector-specific regulatory body of the NHS. However, there are inherent problems with this approach, taken by Dr David Bennett from Monitor, from the Tony Blair ‘stable’ from the perspective of an advocate of a free market. A true true market advocate would simply let private entities fail (this in fact has been the criticism of the global response to the financial crisis, describing the Keynesian stimulus of adding more credit to credit as being akin to pouring petrol on the fire); however, part of Monitor’s functions is to bail out failing trusts, in as much European law allows it (it is unlawful for the State to provide state-subsidies in such a way that competition in a private market is distorted.) The other problem of this approach is that  it is an approach which most favours accounting technocrats; rather than looking at value in pricing in a sophisticated behavioural economics fashion, the discussion is heavily based in number-crunching and methods such as activity-based costing.

Prof. Michael Sandel is a political philosopher who has been lecturing on the seminal ‘Justice’ course at Harvard. In the Reith Lectures 2009, Sandel gave his final lecture on “A new politics of the common good”. The governing philosophy for the last three decades both here and the US has been an era of ‘market triumphalism’, but both the UK and US have had difficult in reaching at a new consensus of what government should do. Sandel proposes ‘market mitigating governance’ at the first port of call where governments correct market failures through policy. You can easily apply this, for example, in measures to ‘correct’ excessive profits but poor value for shareholders and directors of privatised utilities companies. In fact, Miliband has latterly proposed a mechanism which could possibly do this, called “predistribution”. Predistribution, if called by any other name, is quite a nice but radical idea. It offers a practical solution for tackling poverty – for example a policy which restricts the amount of profits which a shareholder of a utilities (sic) company is allowed to make (some of this revenue could be ploughed back into returner better value for the customer), or effecting the national minimum living wage (the idea being that people who are being paid a decent living wage are in a position to invest for their futures more easily, and be giving an ability to further their own career.) This is potentially a policy which could be attractive to Unions, as indeed Prof. Jacob Hacker from Yale himself envisaged.

Sandel, however, admits that these rather technocratic approaches fail to ‘capture value’ of what is really going on. For example, the Philip Morris study in the former Czech republic shows that smokers die early, pay lots of taxes, and do not need a pension, and therefore are of great benefit in a purely cost-benefit analysis. This caution could easily be applied to the newly privatised framework of the Health and Social Care Act, where public services have become commodified and monetised, in maximising consumer welfare. Sandel’s main objection is that such approaches do not lead to democratisation of services for the “public good”, and more ambitious goal of civil virtue through redistributive justice may be more welcome. The public appetite for this might be greater than we first suspect, in that the famous UK MP expenses scandal has led to a growing bitterness and resentment of voters towards their ‘political class’, and indeed the public are generally sick of examples of alleged corporate misfeasance in journalism through exposure in the Leveson Inquiry.

A better approach would therefore for people in society to be included and engaged in decisions about their society, with a general belief of solidarity and citizenship. Of course, a dichotomy between markets and society would be a false dichotomy, and this is appreciated by Prof. Michael Porter in his seminal article called ‘Strategy and Society‘ for the Harvard Business Review.  This thesis is more than familiar to Ed Miliband, who first described his thesis of ‘responsible capitalism’, a political version of corporate social responsibility, where all businesses contribute value to the rest of society. And yet this is entirely consistent with Ed Miliband’s concept of the UK economy as not being factional but being unitary. In such a framework, everyone contributes to the economy, not just the ‘wealth creators’ as bankers, but also less well paid people in the public sector doing extremely valuable jobs, such as nursing or teaching, who do need employment rights protection of the Unions.

In Sandel’s framework, we are less ‘consumers’ and more ‘citizens’. And this is a very practical problem. Consider for example excessive pay of some CEOs. It can be easy to criticise whether such salaries are justified, in other words the extent to which they are representative of a contribution to society, whether we should just allow the market to find an equilibrium for what people are willing to pay for, or the extent to which these people have ‘worked to get where they are’.  Politicians find it difficult to talk about inequality or redistribution, but you will never find that people with very incomes bringing up of their own accord topics of the ‘politics of envy’. Redistribution or social justice has become a taboo subject, but it may be necessary to revisit this if excessive pay can be tackled in the tax system. Whilst ‘punishment’ engenders a notion of a personal hate campaign, which is clearly undesirable, it may be ‘good policy’ that intervention against truly excessive salaries not only deters a trend of unreasonable undeserving salaries, but also encourages a marketplace where an appropriate salary can (for want of a better word) “incentivise” employees and workers appropriately.

As for the idea that people with excessive salaries will leave the country, it is worth noting that these people are often employed by multinational companies who can easily find replacements; therefore there will always be a corpus of such people contributing such taxes, even if a proportion of them emigrate (the point is that people who emigrate will be replaced.) Whilst aspiration has traditionally been a New Labour or Thatcherite policy plank, Ed Miliband latterly has cited aspiration as a reasonable goal of policy. I think that this is entirely consistent with aspiration that acknowledges an ‘equality of opportunity’.  Dr Tim Soutphommasane, a lecturer at Monash University, is also a political philosopher whose writings are clearly relevant here. Soutphommasane’s warning is probably more poignant here in the UK with a cabinet stuffed full of millionaires than it is in his home country, but he recently writes, “It is the mark of a good society that careers be open to all talents. Individuals should be able to transcend the position of their birth or upbringing through ability and effort. By the same token, the state shouldn’t reward those who have the fortune of being born into good circumstance.”

By that virtue, the political philosophies of Sandel and Soutphommasane present Miliband with a serious problem. How can Ed Miliband realistically frame a policy for government which consolidates the relative positioning of the markets and the community? I think Ed Miliband’s best bet is to frame the question is to think what sort of society do we want to live in which brings greatest civic virtue and citizenship of all members? As it happens, the consumer clearly has not benefits as recipients of the privatised utility industries, but Ed Miliband has indeed challenging decisions to take about the future; for example one mechanism might be to bring some services under state control. There is much political appetite for repealing the Health and Social Care Act, which indeed nobody voted for as such. The last year or so has seen Conservative polticians and their management consultant friends engaged in a retrospective ‘policy-based evidence’ to justify their marketisation of the NHS, but the NHS could be just the trojan horse that Ed Miliband needs to bring the political pendulum back away from the totally unfettered market. It’s a tough balancing act, as he will be keen not to present the State as too bulky or interventionist, but likewise, if he can pull off a discourse about why ‘looking after each other’, i.e. solidarity, say for example in protecting the health and welfare of disabled citizens in society as well as further ‘individual choices’, Ed Miliband will have pulled off a remarkable political contribution.

 

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