This is not exactly what Richard Layard and Gus O’Donnell say here but it is the obvious implication of what they do – bugger the inequality.
These arguments are not just hunches. They are based on decades of serious research about what matters most to people, and about how their lives can be improved at least cost to the exchequer. People vary hugely in their satisfaction with their lives, and this is the fundamental inequality that calls for “levelling up”. Research shows that surprisingly little of the variation in wellbeing is due to economic inequality. Very much more is related to the huge variation in mental and physical health, and in the quality of relationships at home, at work and in the community.
We can therefore forget all that worry about economic inequality as it doesn’t matter. Capitalism doesn’t need to be overturned, socialism instituted, because neither – or severally – are the things that make people unhappy nor make them happy.
However, we can go further than this. Take the mental health issue just as an example. What matters is that people gain efficient mental health care. Not fair health care, not health care righteously paid for by other people, but decent mental health care.
OK, that’s fine, but that then answers our efficiency versus equity argument.
The argument in favour of the National Health Service is that it’s fair and equitable. In those varied rankings (WHO, now discontinued, Commonwealth Fund and so on) of health care services up to 75% of the ranking comes from how “fair” is access to treatment – ie, not based upon income – and how “fair” is the source of the financing – say, a progressive taxation system. Only a small minority of said rankings derives from how good, effective, is the actual treatment at the point of consumption.
So much so that the NHS does very well in such ranking systems. And also comes bottom of the usual measure of effectiveness, “mortality amenable to health care”.
In a socio-political sense this may be what is wanted. I don’t think so, you might not, but the British polity as a whole does seem to think so. Shrug.
But this now changes. Our policy is to be ensuring decent mental health care. Nor fair such, not equitable such, we have to move from equity to efficiency as our measurement of desirability.
This means delivering mental health care through a system other than the NHS. Through, as those places which do the stuff better than we do, more markets, more private supply, more insurance possibly.
This also applies to health care more generally of course.
That is, the clarion call here is bugger the inequality and abolish the NHS. Which ,to be honest, I’m fine with. No doubt Richard Layard will be too given that it’s an ex-student of his that is able to read between the lines to his real and proper proposal.