60 years of NHS- time for a rethink

The past week has seen the BBC and the UK, celebrating the 60th anniversary of the founding of the nationalised health service - the NHS. The system based on the openly socialist philosophy that the state should provide health care free at the point of use to all.

The reality of the risks of that system was largely ignored by the Labour Party at the time it was introduced. Britain was bankrupt from World War 2 and the Atlee Labour government used ample funds from the Marshall Plan supplied by the USA (and the UK got more than any other country in post war Europe) to fund its socialist plans of the NHS, iron/steel, coal, railway, bus, truck, airline etc nationalisations. The point that the NHS would result in over demand (with some going to doctors when they had little wrong with them), few incentives for healthy living (you pay the same regardless if you smoke, exercise and eat fatty foods or not), and a lack of accountability for any failure to perform as promised

Now the NHS is probably the UK's biggest sacred cow - it shouldn't be. For years the argument was that it needed more money - Labour did that, increasing NHS spending by 80% in 11 years. Improvements are difficult to see, as most of the extra spending has been sucked up by increased demands and increased pay. Another argument was that there needed to be administrative tinkering, which also has sucked in more money.

The Sunday Telegraph's editorial rather boldly proposes something else - an insurance based model which includes the private sector.

It states that the original vision of the NHS was that it would require less money over time as people became healthier, but ignored that people would expect more over time:

"It was assumed that, as the nation's health improved, so demand for medical treatment would diminish.

But the opposite has proved true. Increasing life expectancy means more people live to an age where they contract diseases that are expensive to treat. People are also less inclined to queue than they were in the austere days of the 1950s.

In a consumerist age, people compare their healthcare with the provision of other services and expect to have the same choice and speed of delivery.

Yet, while the NHS has evolved over the years, its structure and the way it is financed still owe more to a 1940s belief in the efficacy of state monopoly than to the realities of the modern world."

The paper continues, pointing out that both Germany and France have insurance based models with larger private sectors:

"Insurance schemes that let people decide how much of their own money to spend on healthcare and top up what they contribute in taxes are the way to bring greater investment into the system. Politicians must prepare the country for the realities that need to be faced; yet the totemic power of the NHS to stifle debate seems undiminished."

Indeed, the incentives of insurance could assist in encouraging people to look after themselves, and manage the costs of healthcare, in particular exposing people to the costs of what they expect. However, it is difficult to see the Tories (much like National in NZ) making any worthwhile change.

"Proposed Conservative reforms risk replacing Labour top-down targets with their own. The party must be willing to take on producer interests in the NHS and give greater choice to patients by embracing new ideas such as easier access to specialist doctors.

People no longer see the NHS as the property of its practitioners, but of those who pay for it. The NHS must respond to that mood - or voters will want to put their money into something that delivers the care they expect"

People will complain and moan about public health care and fail to recognise the simple truths, that the price of socialised healthcare is queuing, not always getting what you want, and paying the same regardless of your good or bad behaviour. It is time to put healthcare in the hands of those paying for it, by moving towards insurance, private provision and competition. The status quo has failed, and will fail more as the population ages and biotechnology pushes the cost of the best treatment beyond a socialised system. People will simply not tolerate ever increasing taxes for a system that produces ever increasing queues.

Drug addict? go on a benefit and don't get treatment

One of the arguments given for the welfare state is how caring and compassionate it is, and how mean, greedy and nasty are the people who actually would rather have their own money back, and then choose to spend it as they see fit, including charity or other acts of genuine benevolence.

The left would argue that the state is best trusted to care for those in need, and those who want tax cuts are less compassionate and moral that they.

So you may ask yourself why, according to the Dominion Post, 5270 drug and alcohol addicts can be on sickness and invalids benefits, defined as those who identify their addiction as the reason they cannot work - AND that none of them are required to engage in any form of treatment as a condition of receiving your money.

Imagine a single charity giving out money to addicts and saying "go on, come back for more every fortnight, and we don't care whether or not you go to treatment".

What is more alarming is the number has gone up so much in a short time "there are 2540 beneficiaries who have drug abuse listed as their primary reason for being unable to work - almost twice the 1297 listed in 2004."

Apparently "case managers could not force beneficiaries into treatment programmes". I would have thought if the government changed benefit eligibility so that if you refuse treatment you cease to get the benefit, it might be an effective way of incentivising them into treatment.

Work and Income deputy CE Patricia Reade has said though that "Many had other mental or physical health problems which prevented them from working, such as cirrhosis. Alcoholism in itself was not a reason to be off work." So presumably those problems should be listed shouldn't they, not alcoholism. Alcoholism if listed shouldn't be a grounds for the benefit if that is the case.

So what to do?

Now some on the conservative right may say that everyone getting the benefit who is a drug abuser should be incarcerated. That, after all, is what the war on drugs is about isn't it? It makes it a crime to ingest banned substances, so why should people get money for being an addict, and why shouldn't those receiving those benefits get a knock on the door from the cops with search warrants with pending charges? (Then for good measure, being tough on crime and all, if they find nothing, there is benefit fraud from NOT being a drug user!).

The better solution is that, while accepting these benefits exist for now, the system should use a carrot and stick approach to treatment. Addicts who are unable to work because of their addiction should only receive the benefit whilst they undertake treatment (and have been certified as having attended). Similarly, they should not receive the benefit whilst they use. That means testing. Whilst some of those receiving the benefits are no doubt trying on the system, others will be sad cases - feeling trapped and alone, and unsure what to do. Pulling the money away unless they undertake treatment is the only kind thing that can be done in those circumstances. You'll find the ones who are trying on the system will drop out, and maybe those who are in genuine need drop out after weeks and months of help (helping their families too).

You see it's how private welfare would ultimately work.

It is kinder than the mad Green idea of throwing more money at beneficiaries, kinder than Labour's "here's the money now you could seek treatment, but if you don't just see your doctor every 13 weeks and if you're still an addict, we''ll keep paying you", and kinder than the "throw you in jail for being a (drug) addict" of the "tough on crime" brigade.

Hitchens tries waterboarding

One of the most controversial actions of the Bush Administration has been the use of waterboarding as an interrogation technique at Guantanamo Bay for terrorism suspects.

Critics have described it as torture - and the use of torture by a liberal democracy is an abomination, it markedly weakens the moral position of those who wish to defend free secular society from the tyranny of dictatorships whether theocratic, nationalist, Marxist or otherwise. One of the dividing lines between civilisation and the barbarity of tyranny is the unwillingness of civilised states to inflict physical harm and pain upon those it incarcerates or to use the deliberate infliction of pain to seek confessions. It is not because it is always unreliable, at times it is not. Those enduring pain that would otherwise drive you mad are more likely to do what is necessary to avoid it continuing, than concoct some elaborate fantasy. Which is why some soldiers receive waterboarding as training to prepare in the event that they face the horrors of an enemy which wouldn't dare have this debate. The preparation is because of genuine fear that torture produces results.

However torture is wrong. Interrogations are not meant to be fun, they are harrowing, lengthy and can deprive the suspect of comfort and some sleep - but they should not cross the threshold of actually inflicting pain and suffering. To inflict such suffering upon one who may be innocent is simply sadism, to trust the evidence of one who confessed or revealed information under threat of pain is far more questionable than a confession given freely.

So what is waterboarding? Vanity Fair columnist Christopher Hitchens decided to find out first hand. His account is here. As far as he was concerned it was torture to go through with it, but he also gives the argument against it. He takes a considered view which gives me pause for thought, in both directions.

"a man who has been waterboarded may well emerge from the experience a bit shaky, but he is in a mood to surrender the relevant information and is unmarked and undamaged and indeed ready for another bout in quite a short time. When contrasted to actual torture, waterboarding is more like foreplay....On this analysis, any call to indict the United States for torture is therefore a lame and diseased attempt to arrive at a moral equivalence between those who defend civilization and those who exploit its freedoms to hollow it out, and ultimately to bring it down. I myself do not trust anybody who does not clearly understand this viewpoint."

The counter is a number of arguments, but ones that I find most compelling:

"It may be a means of extracting information, but it is also a means of extracting junk information. ... To put it briefly, even the C.I.A. sources for the Washington Post story on waterboarding conceded that the information they got out of Khalid Sheikh Mohammed was “not all of it reliable.”

It opens a door that cannot be closed. Once you have posed the notorious “ticking bomb” question, and once you assume that you are in the right, what will you not do? Waterboarding not getting results fast enough? The terrorist’s clock still ticking? Well, then, bring on the thumbscrews and the pincers and the electrodes and the rack."

If you could prove that a crime you had been accused of had been confessed by you because the Police tied you and shot water up your nostrils repeatedly, your confession would be meaningless. This is, of course, completely right and appropriate in our judicial system. However, even taking the argument that this is a form of war, the question of where you draw the line emerges.

Finally:

"One used to be told—and surely with truth—that the lethal fanatics of al-Qaeda were schooled to lie, and instructed to claim that they had been tortured and maltreated whether they had been tortured and maltreated or not. Did we notice what a frontier we had crossed when we admitted and even proclaimed that their stories might in fact be true?"

Read for yourself, there is little doubt that waterboarding has helped extract information of value in the war against Islamist terrorism. However, the line that has been crossed is a dangerous one, and one that must be subject to full, free and frank debate. It is not a debate between those who want to be soft on Islamist terror and those who are sadistic fascists - it should be a debate about what constitutes that behaviour which is acceptable for the governments of Western free democracies to undertake. Waterboarding is, as Hitchens said, foreplay compared to how Al Qaeda operates, or Iran or North Korea or China, or indeed many other countries. The moral equivalency some on the left, including Amnesty International, applies to this is repulsive, but somewhat inevitable. I look forward to our friends on the left waging an orchestrated protest and campaign against Camp 22 in North Korea for example. However, a line has been crossed which gives reason to say the US engages in torture.

Hitchens is not soft on terrorism or Islamists, neither am I. I believe it slightly undermines the moral authority we have against Islamists who seek to portray Western secular societies as corrupt and cruel - yet it also may well have saved lives. Do the ends justify the means?

Video shows the complete fraud of Zimbabwe's election

Shepherd Yuda has fled Zimbabwe with his family, but not before he secretly filmed the most recent election. Yuda was a prison officer who decided to film what he could covertly, with assistance from The Guardian.

The story is here, with the video. It graphically shows how the ballot was anything but secret, but was cast in front of one of the so-called war heroes - you know a bit like Japanese war heroes in Korea and China during and before WW2 - thugs. In other words, they know who you voted for and you are told that MDC will never win.

The UN Security Council is debating a resolution to freeze the financial assets of Mugabe and other top members of the regime and impose a travel ban. The International Herald Tribune says Russia and China are unenthused, but considering whether or not to veto, and South Africa is thinking about it.

Russia I expect little from, murdering kleptocrats as they are. China, ditto given how they treat dissidents. South Africa? Morality can't piss on this regime of capitulating sycophants to tyranny. Seriously, who else has had enough of the South African government, that acts the high mighty and moral, but feeds, powers and shakes the blood dripping hands of their murderous friend and comrade. After all, would you shake hands with someone protecting and friends with their murdering rapist neighbour?

4th of July

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness."

Beautiful words, thank you USA. For all the flaws, and the criticisms, you still are the repositary of the idea that government is the extension of the rights of the governed, not governing subjects.

Now to think simply this, can all the powers of government ever be legitimately more than the rights that the citizens have themselves? (self defence) and if so, why? How can government by the people, for the people have rights that the people themselves cannot delegate?

Without the Declaration of Independence, this question may not have been answered for some time - and that is why it is worthwhile to celebrate the 4th of July.