Friday

No politician will tell people the truth. No doctor is allowed to.

I have recently spoken to an Australian doctor who told me things that are going on in Australian medicine and then told me that if it were revealed that he had told me these things,  he could be sacked.

Since he was telling me about the ways in which Australians are missing out on first class medical care, there is a Stalinist aspect to this. Those people who are in the best position to tell the truth about medical care are, by the terms of their employment contracts, not permitted to say it. The truth is not good so the state, instead of making medical care better, outlaws revelations about it.

The truth the doctor is not allowed to tell centres around this. His unit – and to protect him I will not even say which state he is in – does bone marrow transplants. He and his fellow doctors could do “at least” twice as many as they do at the moment. But the necessary money is not made available. The beds and the money to pay for the other staff are both limited by the government so the ability of the doctors to do these life-saving procedures is circumscribed.

Does anyone suffer as a result?

Yes. People who should have marrow transplants are kept waiting. He has known a number of those who have been waiting for transplants have relapses. After they have relapses, they are often weakened to the extent that they could not take the chemotherapy that is part of the process. So inevitably some of them die. In this business, delay can mean death. The system causes delay so inevitably it must cause unnecessary deaths.

“It is rationing,” he said. He remarked that no politician would admit it was rationing but that is what it amounted to.  No politician will tell people the truth. No doctor is allowed to.

Posted by James Bartholomew Indexed in Healthcare and the NHS
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Thursday

Paying a backhander to get a sick note

When I was in Poland last month, someone there remarked how Poland had been one of the ‘disability capitals’ of Europe. The numbers of people claiming to be unable to work through illness were apparently enormous. Today I had a conversation which perhaps helped explain why.

A Polish man told me how it had been  very normal for a backhander payment to be paid to a doctor in order to get extra days of being certified unable to work. You went to the doctor with your national insurance book which showed that you were to be treated under the national insurance scheme. Inside the book you put, say 100 zlotys. You placed the book on the table before you went into the cubicle to be examined for whatever illness you were supposed to have.

The doctor came in and it was agreed that you would need an extra three days of being off sick and then you would probably be ‘cured’. You would go out and, on the way, collect your national insurance book which no longer contained the 100 zlotys.

My Polish contact does not know how much the prevalence of this has changed in the post-Communist days. He says though that because of the efforts of special anti-corruption police, it now tends to be done through a third party. You make a deal with a friend of the doctor, let’s call him Robert, and you give him some money. You then go to the doctor and remark, ‘by the way, I saw Robert yesterday and he sends you his best wishes’. You then get the certification that you want.

My same source told me about how himself was treated in a Polish government hospital about five years ago. He was in a bad way but there were no beds available and he was left in the corridor and not treated well. His partner went to see the doctor in charge of his treatment. She said, “I live in England now. I don’t know how I should do this. My partner needs to be in a bed and he needs to be back in Britain within two weeks. I will give you £500.”

The doctor said ‘no’.

She said, “OK” but put the cash under a magazine and left the room.

When she returned the cash had gone. Her partner got a bed and was able to leave within two weeks as she had asked.

How much is now the going rate to get an extra three days of sick leave? According to a colleague of my source who still spends a lot of time in Poland, it is ‘at least 100 zlotys’.

And what conclusions should be draw from all this?

I am not sure. Obviously we can conclude that the truth about how welfare systems work is not always to be found in policy documents, government declarations or academic studies. Important things are going on that are hard to measure and which many people prefer to pretend do not exist.

Even more important, though, is the point that systems should be designed to minimise these sorts of things. The incentives need to be aligned with good behaviour, not bad, corrupt or wasteful behaviour.

Which reminds me of another corrupt practice my Polish source mentioned. He instanced a doctor in Poland saying that a patient he is seeing privately needs some tests. There is a long wait for such tests. But the doctor gets the person into his national health hospital the very next week and has the tests done. He then charges the individual extra for having got the tests done. But neither of them actually paid the cost of the tests. The individual effectively paid money to jump the national health queue.

Posted by James Bartholomew Indexed in Healthcare and the NHS, Welfare benefits
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Wednesday

A notice board of photos of children who should get special attention

A former teacher gave me an insight last night about how schools react to targets. One of the key targets in Britain is to get as many children as possible obtaining GCSE passes rated at between A and C.

What is the consequence of measuring a school in this way?

It is quite remarkable. In two schools she had worked in, there was a board in the staff room with the names and photographs of the 20 or 30 children, out of a year group of about 270, who were borderline between getting grades C and D. The clear idea was that the teachers should be able to identify these children and should concentrate on helping these children to get C grades instead of D. That way the school would be seen to be doing well.

The teacher told me that, consequently, there was no similar effort to help those expected to Bs to get As, let alone to stretch and develop those expected to get As to go beyond the syllabus.

It is extraordinary to imagine this board of photos in the staff room – it is reminiscent of those television police dramas in which the suspects and other people connected to a crime are put up on a board.

The story may also help explain something about Finland. Finland is one of the top performing countries in the world in educational attainment, according to the PISA study of the OECD. But when I met a Finnish young woman she told me that she had been very frustrated at school. All the efforts had gone onto getting students up to a certain level. As one of the brighter children, she had been bored and her abilities were less developed that they could have been. Apparently the Finnish system has been to assess schools by their results and I guess the assessment is based on something like the A to C grades that exist in Britain.

A few other stories from the British teacher:

Following advice or guidelines or something of that sort from OFSTED, teachers spend an extraordinary amount of time assessing what level children are on. They devise tests and see what each child has mastered. You may think this sounds a sensible thing to do. But she says that the time it takes is entirely disproportionate and the kind of things they are assessing are often pointless. She would rather have been teaching.

Another facet of modern state education is well known, she said. A new head can come in and improve the GCSE results by 20%. How? By switching students to exams which officially are equivalent to GCSEs but which, in fact, are easier because they involve a lot of coursework (and presumably the teachers can ‘help’ a lot with coursework). The result is ostensibly better educated children. In fact, the result is probably children who are worse educated. She said that there were a number of other such tricks of the trade with no benefit to the children.

On the basis of what she said, state schools sound like a kind of game. The idea of the game is to reach targets. The idea is not to achieve the best possible education of children.

We talked about how some exam boards – as was exposed in a recent scandal – do all they can to make their exams easy to pass. In this way, the exam board is chosen by the schools and the board makes money.

But why, then, I wondered, do the better private schools go on the opposite tack? They go for the most difficult exam boards and often take the more challenging international GCSEs rather than the British ones.

She said that they go for the tough exams because these are the ones that the universities respect. Some of the so-called science taught in state schools is regarded by the universities as a bad joke. So the better private schools are playing a different game. They are measured not by the number of A to C GCSEs they get. They expect to get mostly As and A stars. The key thing for them is to show parents that their children go on to get good A level results and get into the top universities. In other words the better private schools – and indeed the very top grammar and other state schools – are playing a different game. They want to develop the top students. They also want to save the weaker ones since the parents also want even the less able children to get tolerable results. It is a different game. And the results are different.

Posted by James Bartholomew Indexed in Education
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Saturday

Discriminating against mothers who want to stay at home and look after their children

There was some controversy yesterday over the British Government’s intention to make some change to its removal of child benefit from higher rate taxpayers. This measure was manifestly unfair because it meant the benefit would be paid to a couple with two salaries just below the higher-rate tax level but would not be paid to a couple with the same total income but where one of them earned all the money. In other words, it discriminates against couples where one of the two decides to stay at home and devote more attention to the children.

In fact, there is already another way in which a married woman who stays at home with the children is discriminated against. The couple’s total income is taxed far more heavily than it would be if the same amount was earned by them both going out to work. If they both work and get moderate incomes, then they both get the advantage of the personal allowance the the lower rates of income tax. But if one of the two earns the same total amount, he or she will suffer the higher rate of income tax and only benefit from a single personal allowance.

David Cameron has suggested that marriage should be be favoured by government. There is also the suggestion, I suspect, that married women should not be discouraged from staying at home with their children if that is what they want to do. But at present, that is exactly what takes place.

Of course in some countries, such as Sweden, it is considered an article of faith that women should go out to work and should leave the care of their children to others. But in Britain and indeed other parts of the world, it is thought that a child benefits from having a loving parent for most of the time during the early years, at least, and having quite a lot of attention thereafter, too. Of course, one should look at the evidence. The evidence I have seen so far, suggests that children do indeed benefit from being more with a loving parent. It may be true that excellent child care from others causes no harm. But on average, a parent is surely going to take more care of a child that will someone who a) is not the parent and b) has other children to attend to.

I am cautious of the idea that government should favour one model or the other. But at present the British government discriminates against the mother who stays with the children and I suggest that that is wrong.

Posted by James Bartholomew Indexed in Parenting
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Tuesday

Extra education people pay for

It seems possible, as a minimum, that the supplementary private education that students have in Japan is one of the reasons that Japan does well in international assessments of standards. There was an article about these schools, the Juku, in a recent edition of the Economist. It seems that there is an expert on the subject of Juku. Here is his evidently knowledgeable blog posting on the Economist article. And here is the blog generally.

Here is an excerpt from his posting:

When Kenn refers to surveys in Japan that attribute juku attendance to shortcomings in education systems (an element of the article that has been picked up by some Twitter reactions to it already), I would offer a qualification – an important qualification, I think – that it is perceptions of shortcomings in Japanese education that seem to be driving parents and students to juku. Whether such shortcomings exist in an empirically demonstrable way is much less clear, and it is always interesting to note that it is not only perceived shortcomings in public education, but in private schools as well. Private school students in Japan also attend juku in large numbers after all.

I would suggest although it may not be possible with current means to demonstrate that the public education has shortcomings, it is worth considering the possibility that the parents have some understanding of what is going on!

It seems to me that so-called supplementary – nearly always private – education is quite a big story around the world. Huge amounts are written by educational experts, many of who are in mainstream public education and they normally write about public education. But there is another world out there and parents in many places are voting for it with their wallets.

Posted by James Bartholomew Indexed in Education
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Friday

strict rent control leads to’ lower quantity and quality of rental housing’

 

From an IEA posting.

 A recent OECD report on housing policy finds: ‘An illustrative correlation shows that across countries, stricter rent control tends to be associated with lower quantity and quality of rental housing, as measured by the share of tenants who lack space and who have a leaking roof.’

It is not a deregulated rental market that causes the abuses described above. It is an over-restrictive planning system that causes a severe shortage of homes, and within these constraints, it is thanks to a lightly regulated rental market that things are not even worse. The fairly light level of rental regulation is one of the very few positive aspects of Britain’s housing market. If Britain had the intensely regulated rental market of the Netherlands or of Germany, there would be no point in even starting to look for a flat in London.

Posted by James Bartholomew Indexed in Housing
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Tuesday

The myth of the ‘great’ Attlee government

Peter Oborne is a journalist I admire. He has written some terrific articles and talked well on radio and TV. However I recently heard him debating whether Margaret Thatcher should get a state funeral when she finally, like everybody else, dies. He said that that there were other great prime ministers who had not been granted state funerals. Among one of two others he cited was Clement Attlee who had, as he put it, founded the NHS. Peter Oborne thus fell into the fairly widespread mistake of thinking that Attlee’s government was a great, reforming government. In fact I would suggest it was one of the most disastrous governments ever to take office.

The creation of the NHS was,  itself, a disaster. This has proved to be probably the least successful medical service in the advanced world. The unnecessary annual death toll from cancer – people who would have lived in other advanced countries – is horrific. The same very probably applies to heart disease but is more difficult to prove. The care in hospitals – particularly of the elderly – has been the subject of repeated scandals. If this was the only thing the Attlee government had inflicted on the country it would be bad enough.

But in addition to that was the campaign to prioritise council housing. The controls that were put in place and the inevitable inefficiencies of state planning meant that fewer homes were built in the five years after the second world war than in the years after the first. It was a disaster of under-supply.

Then there were the nationalisations. I have just bought an original copy of the 1945 Labour Party manifesto which devotes far more attention to nationalisation of industries than it does to the National Health Service  2 pages compared to less than half a page) and is much more specific. There it is laid out:

- Public ownership of the fuel and power industries – a disaster in that it lead to enormous numbers of heavily unionised people doing work at vast cost and low inefficiency which was paid for through unnecessarily high prices and taxes

- Public ownership of iron and steel – the same story. I remember that in the 1970s the cost of subsidising the loss-making steel industry was a major item in the public expenditure that had to be paid for by taxpayers.

- Price controls – there were government controls on all sorts of economic activity and a great deal of rationing. Indeed shortages are an inevitable result of price controls. It was bureaucratic and stunted economic growth.

Also on this list of extreme statist policies was public ownership of inland transport, so called ‘public supervision of monopolies and cartels’  (a pretty cheeky idea, given that the government was bent on creating its own monopolies), state guidance for export industries (as though these politicians would have a better idea of how to export than those actually working in the industries concerned) and – this is a good one – ‘better organisation of Government departments’ which would ‘not choke it with red tape’.

In fact, as the above items make clear, this was the most  ’red tape’ government that probably ever acquired power in Britain. This government was the foundation of a post-war rate of economic growth that was well below that of France, Germany or Japan. It does not deserve to be remembered as a great, reforming government. Yes, it certainly reformed things but in an extremely damaging way. It should be regarded as a bad government whose failures and mistakes – driven by left-wing dogma and the ultimate in that vanity which believes ‘the man in Whitehall knows best’ – should never be forgotten.

Certainly people at the time were glad to be shot of it. They voted it out at the first opportunity.

Posted by James Bartholomew Indexed in Healthcare and the NHS, Housing, Politics
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Thursday

The relationship between crime and unemployment

A third of those claiming unemployment benefit have criminal records. Article here.

It is a startling statistic. It seems pretty obvious that those who are convicted will, especially if they have been in prison, be more likely to go onto unemployment benefit and will also find it more difficult to get a job. But there may well be another – albeit less significant – factor at work here, namely that unemployed people are more likely to turn to crime.

The whole thing is an example of how one social problem leads to another: more crime leads to more unemployment which leads to higher taxes which leads to still more unemployment (due to the tax ‘wedge’) which leads to more crime… and so on.

Posted by James Bartholomew Indexed in Behaviour & Crime, Unemployment
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Thursday

The Spirit Level – “trash social science”

If you want a quick guide what may be misleading about the influential book, The Spirit Level, it worth listening to this interview with Peter Saunders, Professor Emeritus of Sociology at Sussex University.

This debate is highly important. If it were true that the crucial thing for measures of the well-being of a society was, as The Spirit Level suggests, the level of equality, then such equality might rationally become a target of policy. But, having heard Professor Wilkinson, author of The Spirit Level, and heard also his critics such as Peter Saunders, it seems that the book’s case is not soundly based.

Go to this link and then look for the radio item:

What’s wrong with The Spirit Level? 
ABC Radio National Counterpoint interview, 21 September 2011

Posted by James Bartholomew Indexed in General, Politics, Tax and growth
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Thursday

Interview in Sweden

 

 

 

Here is an interview I did earlier this year in Sweden.

http://www.axess.se/tv/program.aspx?id=2666

Posted by James Bartholomew Indexed in Education, European Union, General, Healthcare and the NHS, Parenting, Pensions, Politics, Unemployment, Welfare benefits
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