What's given, what's not?

There is much talk of how Covid is putting pressure on the NHS. Such talk, however, often misses an important fact – that although NHS capacity is more or less fixed in the short-term, it is certainly not in the long-run. And past political choices have limited this capacity. For example, the UK has 2.8 doctors for every 1000 people compared to an average of three in OECD countries generally and more than four in Germany, Italy or Switzerland. We have only 2.46 hospital beds per 1000 people, compared to 8.0 in Germany or 5.9 in France. And we have fewer intensive care spaces than the average developed economy.

The NHS is under pressure because of past political decisions to limit its capacity. Failing to point this out exonerates what should not be exonerated – namely, a decade of fiscal austerity.

What’s happening here is, in fact, a widespread error – of regarding something as exogenous or given when it is in fact a creation of people, either deliberately via policy or inadvertently via emergent processes.

Another example of this mistake lies in the debate over how far Labour should accommodate itself to social conservatism. What some of this misses is that whilst there have always been social conservatives, they have not always been so salient or an insuperable obstacle to progress. Instead, the strength of social conservatism today is a product of economic conditions. As Ben Friedman has shown, stagnation breeds illiberalism. And Kenan Malik adds that, among working class voters, it is also “the product of decades of neglect.”

The strength of social conservatism is partly endogenous. One trivial fact tells us this. It’s that before 2016 hardly any of us were “leavers” or “remainers”; these are identities that were created by political debate.

There’s more to politics than merely giving punters what they say they want. As Kenan says, it is also “about standing on a set of principles and trying to win people over” – or, I would add, shifting the agenda from the culture wars to economics.

Social conservatism, though, isn’t the only example of public opinion being (partly) endogenous. Kris-Stella Trump has shown that the same is true of our attitudes to fairness. When inequality is high we regard that as fair, and when it is low we also see that as fair. Our perceptions of fairness are anchored by (what we perceive to be) the actual distribution of income.

Even the most intelligent social observers can sometimes fail to distinguish between the exogenous and endogenous. I’m thinking here of two otherwise excellent recent books, Case and Deaton’s Deaths of Despair and Thomas Phillipon’s The Great Reversal. Both show how capitalists have captured the state in order to extend their monopoly power. But their response to this is to advocate better policy, as if doing so were only a matter of intellect and goodwill.

Which it is not. Such proposals fail to see what they themselves have shown – that dysfunctional policy is endogenous, the product of capitalists’ political power. The remedy for this is not for policy-makers to simply try harder. It is for us to work for a stronger anti-(crony?) capitalist movement, so that policies to restrain rent-seeking become more feasible.

There is, of course, another example of confusing the exogenous and endogenous and one that’s been with us for decades. I’m thinking of the tendency to regard capitalism as natural, as the result of some innate human impulse to truck, barter and exchange. But this is not true. And believing that it is limits our ability to imagine a better world. As Ellen Meiksins Wood has written:

The naturalization of capitalism, which denies its specificity and the long and painful historical processes that brought it into being, limits our understanding of the past. At the same time, it restricts our hopes and expectations for the future, for if capitalism is the natural culmination of history then surmounting it is unimaginable. (The Origins of Capitalism, p8)

But capitalism is not natural. People have made it. And what we have made, we can change.

Comments

[Paddy Carter]

related to whether capitalism is natural or not, I got round to reading Everything Flows, Vasily Grossman's unfinished sequel to his masterpiece Life and Fate. Lots to interest economists in both books (and much else besides - if you haven't read them I really recommend them). In Everything Flows he talks a lot about the Soviet economy and its denials of freedom, of where to work, of what to produce, to do things on one's own initiative for one's own ends.

In your concluding paras, are you arguing that there is no natural impulse to truck barter and exchange, or that capitalism is not the only system that works with that impulse?

[Paddy Carter]

Actually, scratch that question. I think it's the latter. A more depressing comment: another concept in addition to exogeneity and endogeneity is path dependence, and the possibility that being in a situation of our own making does not imply it is easily unmade. Its amazing how little events such as the GFC have changed things.

[Nick Drew]

Capitalism, properly understood, most certainly is natural. It springs up spontaneously wherever it is not de facto suppressed - even in school playgrounds.

The fact that in many earlier societies, kings and/or high priests were mostly in charge and did indeed often suppress it (in favour of themselves calling all the shots as regards property and commerce), shouldn't obscure the basic facts.

[Jim]

Seems fairly easy to imagine (rightly or wrongly) that capitalism arises naturally. This if one imagines human networks and money - family - relatives - friends - town/city. This imaginary capitalism seems an extension of the family business and thereby 'a good thing'. Real capitalism has developed way beyond that notion - but is able to keep some of the image. Our political structures seem to have evolved in a similar way. Tribal leaders - war lords - kings - emperors - parliaments and religions. All ways of bossing people about and focussing their economic effort.

How might capitalism be altered or could new ways of turning human thought and hands into a flow of effort be discovered?

E M Wood hints that people were compelled into capitalism by changes in land ownership and use. We might look to the development in Europe from serfdom to an industrial society. Underlying that change was a constant factor - land ownership, if landowners were to continue residing in comfort they needed to extract rent from the new industries. So the evils of capitalism are all the fault of the wicked old landowners?

Well, we might take a look at Vietnam and China where the old landowners were swept away. Any visit will encourage the thought 'capitalist communism'. The two ideas seem to coexist quite well in those places. Plainly they have come up with a different way of allocating land resources. But the way human thought and hands are turned into a flow of money seems pretty much the same as in the West. From the outside it looks pretty capitalist.

We might temper the worst excesses of capitalism but that soon leads to a race to the bottom as the competitive advantage of nations takes effect. Or we might try some sort of cooperative. This immediately leads to who sets up the cooperative and who runs it and who folds it up when no longer worthwhile. Or we might try some sort of state run industry. The snag with this is that it tends to satisfy political convenience rather than economic logic. Then runs out of money and promises and we go back to wicked but reliable (for taxes) old capitalism.

E M Wood suggests capitalism was forced on us by change in land use. But we can see several societies around the world where different kinds of land use change have still led to something that looks a lot like capitalism.

[WaitingForAVaccination]

Never mind capitalism this post makes a very good point about the tragic under resourcing of the NHS over the past 10 years.

The Covid-19 crisis is being wasted. No matter what happens this winter, next winter (21/22) the NHS will be close to being overwhelmed as is usual in any year. There is no pressure for a step change in resources for the NHS as a result of COVID-19. There should be.

Sir Ramsay MacStarmer should be harrying the Government for a long term increase of NHS resources. Also immediate improvments in bringing back former NHS staff onto the temporary register. Increase the cap on the number of students who can train as doctors. Spads, think tank wallahs, stop thinking about the philosphy of capitalism and get something done.

[Dipper]

I'm shocked that an organisation run on lines of an enterprise of the former Soviet Union should turn out to be a massive inefficient bureaucratic nightmare and permanently short of money.

The reason we are short of Doctors because the Doctors restricted entry, for years turning away enthusiastic and qualified people. And years ago, nursing was a vocation of choice of girls leaving school. Then they made it degree only, then they restricted places, and now there's a shortage. Quelle Suprise.

[Paulc156]

@Dipper.
Nursing back in the day was more about injections, bed pans, changing beds and taking temperature. Due to almost constant medical advances it's a lot more demanding so no bad thing a degree is required. Shortages just as easily explained by onerous work conditions rather than difficult entry requirements. Understaffed and overworked. Retention is the problem not motivation to qualify. It ain't rocket science.

As for doctors restricting entry I think you'll find that more of an issue in fully privatised USofA (than here) where even well qualified foreign doctors struggle to gain entry.

We put far less into our health provision than other states but you seem to expect better services regardless. Quelle surprise!

[rsm]

"As Ben Friedman has shown, stagnation breeds illiberalism."

Friedman shallow analysis ignores the 1930s and 1970s. Are we stagnating now? Yet Biden liberalism thrives. 1950s America was expanding yet McCarthyism arose and civil rights were suppressed. Friedman is wrong.

[WaitingForAVaccination]

Dipper

What sort of private health cover have you got?
Does it help you jump the queue for a vaccination?

[ltr]

January 5, 2021

Coronavirus

US

Cases   ( 21,578,606)
Deaths   ( 365,620)

India

Cases   ( 10,375,478)
Deaths   ( 150,151)

UK

Cases   ( 2,774,479)
Deaths   ( 76,305)

France

Cases   ( 2,680,239)
Deaths   ( 66,282)

Germany

Cases   ( 1,814,565)
Deaths   ( 36,510)

Mexico

Cases   ( 1,455,219)
Deaths   ( 127,757)

Canada

Cases   ( 618,646)
Deaths   ( 16,233)

China

Cases   ( 87,183)
Deaths   ( 4,634)

[ltr]

January 5, 2021

Coronavirus   (Deaths per million)

UK   ( 1,121)
US   ( 1,101)
France   ( 1,014)
Mexico   ( 986)

Germany   ( 435)
Canada   ( 428)
India   ( 108)
China   ( 3)

Notice the ratios of deaths to coronavirus cases are 8.8%, 2.8% and 2.5% for Mexico, the United Kingdom and France respectively.

[aragon]

Well PFI and finacialisation of hospital building didn't help the NHS.

https://www.nhsforsale.info/privatisation/other-issues/pfi-new/

"We have seen how PFI contracts wrap NHS trusts up in a schedule of rising payments. For some the debt has become toxic, but most contend with PFI pressure that will not recede without intervention."

https://www.quora.com/Why-are-there-so-many-Indian-Doctors-in-UK

As for doctors their are Indian medical schools designed to supply the NHS.

And of course pay and conditions in the care sector are only attractive to foreign workers.

"Toto, we're not in Kansas anymore..."
Wizard of Oz.

Our current/developing situation is not capitalism. But has been branded Neo-feudalism.

But you will not own anything (even if you may for it!). It will all be rented/licenced or leased.

http://www.theendofownership.com/

https://www.gnu.org/philosophy/right-to-read.en.html

(Warning refrences Chinise Government)

https://locusmag.com/2021/01/cory-doctorow-neofeudalism-and-the-digital-manor/

http://sneak.berlin/20201112/your-computer-isnt-yours/

Yes that nice new Mac M1 hardware you paid so much for is controlled by Apple and by extension the US Government and what you do is visible to your ISP etc.

And the licensing/surveillance model is extending to anything with a microchip, like a tractor or fridge as is the control facilitated by intellectual property.

I have covered before the impact of AI or Machine learning on employment.

https://www.iotforall.com/impact-of-artificial-intelligence-job-losses

"McKinsey reckons that, depending upon various adoption scenarios, automation will displace between 400 and 800 million jobs by 2030, requiring as many as 375 million people to switch job categories entirely. How could such a shift not cause fear and concern, especially for the world’s vulnerable countries and populations?

The Brookings Institution suggests that even if automation only reaches the 38 percent means of most forecasts, some Western democracies are likely to resort to authoritarian policies to stave off civil chaos, much like they did during the Great Depression."

Of course we have already outsourced our economy to China, India, USA, Germany, South Korea, Tiwan and Japan etc..

https://www.nytimes.com/2021/01/04/opinion/manufacturing-united-states-masks.html

"n the past two decades, the U.S. economy has been lulled into following a path of offshoring, driven by an ideology celebrating short-term financial gains above everything else. The country, once a manufacturing powerhouse, is populated by corporations that have moved manufacturing overseas and lost their ability to produce domestically, leaving little behind except shell companies that employ relatively few people. The United States no longer produces even the essentials, from personal protective equipment to our smartphones and laptops."

What is true for the USA is even more true for the UK.

So unless you in the top 10% and shrinking or the top 0.1% things look grim.

It's always been grim up North!

[aragon]

More on PFI:

https://www.independent.co.uk/voices/nhs-funding-pfi-contracts-hospitals-debts-what-it-rbs-a7134881.html

"The NHS has more than 100 PFI hospitals. The original cost of these 100 institutions was around £11.5bn. In the end, they will cost the public purse nearly £80bn. The total UK PFI debt is over £300bn for projects worth only £55bn. This means that nearly £250bn will be spent swelling the coffers of PFI groups.

[...]

To put it more simply: it would cover the entire NHS budget for approximately two and a half years.

[...]

the UK PFI debt is four times the size of the budget deficit used to justify austerity. In other words, austerity is a political choice rather than a necessity."

https://www.researchgate.net/publication/12899954_The_private_finance_initiative_PFI_in_the_NHS_-_Is_there_an_economic_case

[Dipper]

@ Paulc156. Turning people over in bed does not require 3 years of education. I know nurses do a lot more than that, but a healthy organisation keeps reviewing how it uses people, what roles there are. The Royal College of Nursing's is strongly incentivised to have a thing called nursing that it protects and restrict access to.

'Retention is the problem not motivation to qualify. It ain't rocket science.' Other professions do not operate like this. There is not a shortage of accountants or solicitors. And if they don't like what their employer is offering, they go somewhere else. Retaining the principle of free at the point of provision but moving to outsourced provision would massively improve healthcare for all concerned. Doctors and nurses would get paid more for a start.

@ Waitingforavaccination 'What sort of private health cover have you got? Does it help you jump the queue for a vaccination?'

I have no private health cover. It think private health schemes largely a waste of time. Most seem to take money to source private healthcare more expensively than if you simply rocked up with your credit card. If you have a serious need, the NHS is there. I do use private health on occasion, typically for minor things for my children when the NHS can't be bothered.

If I could jump the queue by paying a fee, then that would be more money going into health care. It would make providing healthcare more profitable, encouraging investment in it and making it more available. It might mean non-paying people get vaccinated more quickly.

[ltr]

So that we know, there are currently fewer nurses per 1,000 population in the UK than the OECD or US or of course Germany:

7.8 UK
8.8 OECD
11.9 US
13.2 Germany

Jeremy Corbyn wanted to build up the NHS, but of course Tories wanted to be austere and the press did not care a fig.

[Dipper]

ltr - Under Labour the professions were allowed to restrict admission and keep numbers down. Johnson and the Tories are increasing numbers.

Of course Corbyn wanted to increase the number of nurses. And Doctors. And free broadband. And everyone can have a house. And everyone can have free food. Because under Labour, everyone should have everything they could want, in as much quantity as they want, for free right now. Because having something is just a matter of wanting it. And anyone who says otherwise is an evil crony-capitalist exploiting the workers.

[ltr]

"Under Labour the professions were allowed to restrict admission and keep numbers down. Johnson and the Tories are increasing numbers."

Important assertion, but please reference this when possible.

As for Jeremy Corbyn, at least recognize how special a political leader he wanted to be and could have been. Mocking Corbyn is saddening, and do remember how Corbyn's leadership was falsely ruined. Know what decency is in a political leader such as Corbyn, as we once knew.

[Paulc156]

@Dipper.
Logic check: Shortages of nurses are not due to onerous academic requirements. If the nurses qualify then leave...right?

As for Corbyn and his supposedly unaffordable promises,(which might be called investments in the public good to those less hostile to social democracy) that pet theory is being put to the test right now by almost every advanced economy in the world. Over half the amount of money Corbyn proposed spending in 5 years over and above taxation has already been spent in less than 12 months by this Tory gov, (without any of the positive benefits afforded by public investment) as it has been elsewhere. And boy did the sky fall in...eh...you mean it didn't?! Inconvenient that ;)

[Nick Drew]

@ ltr, "do remember how Corbyn's leadership was falsely ruined. Know what decency is in a political leader such as Corbyn, as we once knew"

Don't confuse personal courtesy, an even temper and grandfatherly mien, with decency

this is the man whose first instinct on learning of the Salisbury poisoning, was "let's hand over all the evidence to the Russians for them to analyse and tell us what happened"

(I spare you his long record of persistent, purposeful bias in favour of vile causes across the world; and perennial disloyalty to his own Party)

[ltr]

Of course, Jeremy Corbyn has been and is a political leader of decency and humaneness, and care for all the public and grand vision for the country. Corbyn shows us what is the fairest, finest temperament of or for British leadership.

[Nick Drew]

ah, sorry, I hadn't twigged you were being sarcastic

[Zoltan Jorovic]

Stumble & Mumble -I'd be interested to read the evidence for whether capitalism is, or is not "natural" (whatever that means). Unfortunately although you normally reference these sort of assertions, you appear not to have here.

As regards the NHS, of course there are many issues with how it is run, as with any very large, highly complex , multi-specialty organisation, and with the control exercised by professions (just as there are in legal, accountancy, engineering professions etc). However, in terms of the amount spent versus the outcomes derived, the NHS scores very well internationally - especially compared to the US system. Above and beyond that, it provides a level of security to all which eliminates one major stress factor, and binds us together in a way which can't be measured, but is clearly hugely valued by a large majority of the British public. We love our NHS, and all the bullshit fantasy "let's-play-capitalist" playground theorising that passes for intelligent discussion among a set of contrarian "Free" thinkers who in their comfortable, well-padded armchairs like to pretend they are some sort of self-made driven "natural" winner of original mind (when parroting the same old shit that all the other similar idiots repeat) hasn't changed that and I suspect never will.