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.
The language we use matters - it provides clarity to our own thoughts and enables…
It is now generally acknowledged that the structure of the NHS needs to be overhauled…
In the film Apollo 13, a loss of oxygen causes the crew to start inadvertently…
There's an idea out there which seems intuitive but then so many ideas do seem…
When we think about the darkly opaque goals of modern central bankers as they relate…
As the papers recently filled with the distressing images of desperate souls looking to escape…
View Comments
To see that economic levelling doesn't lead to happier lives, we need only take the Soviet Union with its epidemic alcoholism, as life sucked and there was nothing the individual could do about it.
But in a market economy, the real discriminant is attitude. Some people ("surprisingly") just aren't happy no matter what we gift them. Some benefit from unequal treatment and just get even less civil. As a test case, we have capitulated to the unhappy LGBTQ "community," even mandating that others join their pretend games. And all they want is more.
It is sometimes observed that many political battles are driven by people who care deeply about an issue even if there aren’t many of them. People who are unhappy about economic inequality are deeply unhappy and inclined to do something about it, even if they are minority.
Most surveys show that the British people are very happy overall with the NHS. What they are happy about is the equality of access, pretty much what the WHO measures. They don't seem to care about outcomes, excess deaths or long wait lines for elective surgery. Don't know why but as you say, Tim, the peeps are the ones who decide what they want and they are getting what they want.
There is also no contradiction between wanting access to mental health and wanting equal access. Here, the people with mental issues want better care but overall they are quite happy with the NHS.
As Canadians also seem to define themselves through their "free" health care, though it's a shame Mum died in the queue.
There are 3 tricks to keeping people happy with the NHS or Canadian system. The first is hiding the cost - it appears free if you're oblivious. The 2nd is that since most people are healthy most of the time they have no idea if the system actually works worth a damn. The 3d is that they have nothing to compare it to, a 3 month wait for an MRI is normal, innit? It also helps that you have a population that has been largely broken to the saddle.
It's true that most people have no direct experience of the NHS, but most of us know someone who has, and their experience is often very poor. I've just had to give a eulogy for a good friend lost to cancer, whose GP failed to take prompt action on "sudden and unexplained weight loss" - which I, as a medical layman, would have thought to be a big, flashing, red, warning light.