Rolling Stone described Goldman[Sachs]as “a great vampire squid wrapped around the face of humanity, relentlessly jamming its blood funnel into anything that smells like money”.
We should forgive a cliché when it becomes true.
In the mosaic floor of the opulent atrium of a house excavated at Pompeii is a slogan ironic for being buried under 16 feet of volcanic ash: Salve Lucrum, it reads, “Hail, Profit.” That mosaic would be a fitting decoration today in many of health care’s atria.
The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US health care is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.
Avarice is manifest in mergers leading to market concentration, which, despite pleas of “economies of scale,” almost always raise costs.
Yep. Don Berwick on fine form.
After Dani Rodrik, quoted by Walter Münchau in The New Statesman(26 January 2023).
Only two of the following are compatible with one another: the nation-state, democracy and globalisation.
If the personal is political, so is the political personal. Zeitenwende it is.
Feels about right. (From today’s FT)
For him[Michel Claise], financial crime has destroyed fundamental aspects of society. “White-collar crime is the cancer of democracy,” Claise wrote in one of his books, “Le Forain” (The Showman).
And prison works for white collar crime.
Belgian justice is doing what at first sight the European Parliament hasn’t done,” the country’s Prime Minister Alexander De Croo told reporters in his first comments on the scandal on Tuesday. “The European Parliament has a lot of means to regulate itself. It turns out that this is largely a system of self-regulation based on voluntary efforts, which has clearly not been sufficient.
But that peacocking would be ironic to Claise, who complained in October that Belgium’s police are under-resourced, fighting a war against modern, high-tech corruption using “catapults.” Earlier in the year, he said the Belgian government was “ on Xanax rather than Viagra.” Now it’s the European Parliament he has found dozing on the job.
The context for the following quotes from Adam Tooze is Ghana in particular and Africa in general.
For many African states this […steady growth, feeding an adequate tax base…] is a huge challenge.
One measure of the trust that a nation’s people have for the state is the amount of tax they are willing to pay. However grudgingly, under an unwritten social contract people agree to part with a share of their income in the belief that the state will spend it more or less wisely. The public goods provided range from schools, hospitals and roads to police, national defence and the running of the government itself. Everyone benefits from improved services, a better educated and healthier population, safer streets and protected borders. (David Pilling).
Which made me think of the UK.
Further on Tooze quotes Schumpeter:
What Joseph Schumpeter wrote in his essay “The crisis of the tax state” about the European state in the aftermath of the gigantic financial effort of World War I, is no less true for African states faced with the awesome development challenges of the 21st century.
“fiscal measures have created and destroyed industries, industrial forms, and industrial regions even where this was not their intent, and have in this manner contributed directly to the construction (and distortion) of the edifice of the modern economy and through it of the modern spirit …. The spirit of a people, … its social structure, the deeds its policy may prepare … all this and more is written in its fiscal history. He who knows how to listen to its message here discerns the thunder of world history more clearly than anywhere else.”
And again, I think of the UK.
One palpably relieved No. 10 staffer confirmed everything was “a lot more chilled” under the new PM, apart from the small matter of “the country falling apart.”
But when institutions are creations of the central state and (at least in significant part) paid for by it, their autonomy is limited; they risk becoming government brands, not self-created institutions as Burke might have imagined them.
“They who destroy everything certainly will remove some grievance”, Edmund Burke wrote of the French Revolution: and that has been true of the Year Zero element of the Conservative party. The country isn’t working, so smash things. When that fails, smash some more.
All the stuff of mainstream history — wars, revolutions, economies — is becoming a subset of the engulfing, elemental question: the fate of the earth; what humans have done to it and what they may yet do to repair and redeem the damage. We are running out of time. But what we have not yet exhausted is what, in the end, makes us human: the great storehouse of visionary imagination. If, at the eleventh hour, we have what it takes to pull off the greatest escape act in the human story, it will not be databanks or algorithms that will have got us there, but something like a poem, a novel, a painting or a song.
What Václav Havel, in his most original and penetrating text, called “the power of the powerless” is capable of putting despotisms on the back foot, simply by being in sync with the simplest and most natural human instincts. Authoritarians can mobilise their heavy artillery of terror, torture, imprisonment and persecution; but in the end, Havel argued, they are not that well equipped to fight the asymmetric battle between lies and truth. Havel believed that the vast majority of people are not content to be forever walled within a prison of falsehood, where the price of material security and domestic safety is the unconditional surrender of personal freedom.
But what if Havel was wrong?
An interview with Georgina Sturge, a statistician in the House of Commons Library. The first quote deals with an issue I have heard about before, although I do not know further details. If it is not true it will be.
Sturge also cites the cautionary tale of Carmen Reinhart and Kenneth Rogoff, two Harvard economists whose 2010 model purported to show that, if a country’s debt-to-GDP ratio exceeded 90 per cent, the risk of a negative impact on long-term growth became significant. This research was used by George Osborne to justify austerity, on the grounds that if the UK didn’t get its debt under control, the economy would shrink. The only problem? Reinhart and Rogoff had made an error, missing off five rows of data on their spreadsheet, negating their conclusion about the risk of negative growth. By the time this was spotted, austerity was well under way and its effects are still being felt now. And while it’s a stretch to say that David Cameron and Osborne would have pursued a different course had the mistake been caught earlier, bad data gave them cover for their economic programme.
If we want our politicians to use data more responsibly, Georgina Sturge argues, we need to invest in better ways of collecting it. It’s perverse that we know more about the performance of Premier League footballers than how many children are out of school.
Not really. It’s just money.
John Naughton writes:
As you may remember, I’ve been impressed by Brad DeLong’s book, Slouching Towards Utopia and have been tracking the reviews via his blog. When I enthuse about the book to people they often ask for a thumbnail description (something like an elevator pitch, I suppose) and I struggle to come up with something compact and succinct. So I was pleased to discover yesterday that Brad now has one, courtesy of Robert Reich (who, if memory serves me right, was Secretary for Labor in Bill Clinton’s administration. Anyway, here it is:
My thumbnail description—which Bob Reich suggested to me—is that, while we have made extraordinary progress at figuring out how to bake a sufficiently large economic pie so that, potentially, everyone can have enough, the problems of slicing and tasting that economic pie have completely flummoxed us. Thus while we are rich and powerful beyond the wildest dreams of avarice of previous centuries, that is all. We can neither equitably distribute our wealth nor properly utilize it to live wisely and well, so that people feel safe and secure, and live lives in which they are healthy and happy. To say “have not been distributed particularly evenly” and “our desires have grown” catches only half of it. Distribution has not been inept, but has been positively poisonous. And utilization has fallen vastly short not just because of our rising expectations: people 200 years ago would also have hoped along with us for a world in which they were not stalked by flying killer robots, and in which sinister people in steel and glass towers did not attempt to hypnotize them via dopamine loops to glue their eyes to screens in terror so they could be sold fake diabetes cures and crypto grifts.
That’ll do nicely. (JN)
When it comes to Ukrainian refugees, the Home Office can be forgiven for not predicting the latest twitch. Cruelty is a feature of Britain’s asylum system, not a bug. Welcoming refugees is a reversal of previous policy. Indeed, the department has spent the past year coming up with schemes of near comic-book villainy to deter migrants from crossing the Channel. These plans have ranged from wave machines to processing arrivals on St Helena, an island in the South Atlantic. (A deal to process asylum-seekers in Rwanda is now being mooted.) An engine built to reject people has suddenly been told to accept people, akin to slamming a car into reverse while speeding along a motorway.
Our laws are unfortunately not widely known, they are the closely guarded secret of the small group of nobles who govern us. We like to believe that these old laws are scrupulously adhered to, but it remains a vexing thing to be governed by laws one does not know. I am not thinking here of various questions of interpretation and the disadvantages that stem from only a few individuals and not the population as a whole being involved in their interpretation. These disadvantages may in any case be overstated. The laws a(er all are so old, centuries have worked on their interpretation, even their interpretation has in a sense become codi)ed, and while there is surely room still for interpretation, it will be quite limited. Moreover, the nobility has no reason to bend the law against us, if only because the laws were in their favour from the very beginning, the nobility being outside the law, and that is why the laws seem to have been given exclusively into their hands. There is wisdom in this disposition – who could question the wisdom of the old laws? – but it remains vexing for the rest of us. Presumably that is not to be avoided…
Franz Kafka. The Problem of Our Laws’ – ‘Zur Frage der Gesetze’ – translated by Michael Hofmann. Link
Russia’s war will remake the world | Financial Times Martin Wolff.
A new world is being born. The hope for peaceful relations is fading. Instead, we have Russia’s war on Ukraine, threats of nuclear Armageddon, a mobilised west, an alliance of autocracies, unprecedented economic sanctions and a huge energy and food shock. No one knows what will happen. But we do know this looks to be a disaster.
Rana Foroohar In the FT
I have a dermatologist friend who recently sold his practice to a private equity firm, but couldn’t bear to stay on after because management forced him to cut the amount of time spent with patients in half, and focus more on scale and less on people…
Why does the idea of Leon Black or Stephen Schwarzman focusing on post-Covid health issues make me feel more depressed? Is healthcare going to become the new subprime, with surprise billing, crushing debt, and sub-par treatment? Our system is complicated and patchy as it is. But Peter, the larger issue is what I’d like your take on. Do you agree with folks who say that we’ve never left the great financial crisis? With debt at record levels, and the Federal Reserve about to raise rates significantly, where will you be looking for financial risk?
There are several reasons to worry about the future. One is the past.
Janan Ganesh in the FT.
Martin Wolff writing in the FT today.
Yet does this really matter? One used to think that economic performance was crucial to political success. Now we know there are alternative political tactics. If economic outcomes and fiscal largesse disappoint, Johnson can return to what has worked so well since 2016: the battle of undaunted Britain against the despotism of Brussels. Indeed, we are already seeing just this in his attempt to rewrite the agreement he reached over Northern Ireland just over two years ago.
In the last resort, blame what is wrong on foreigners. This has worked so far. But the patriotism card surely cannot work its magic forever.
What Trump understood, as did populists elsewhere, is that the voters’ respect for established politics is rooted in a bargain. Public faith in democracy — in the rule of law and the institutions of the state — rests on a perception that the system at least nods towards fairness. There have been reforms to that end since the crash, but little to suggest they are enough.
There was nothing wrong with the ambition of the post cold war optimists. It remains hard to see how the world can work without liberal democracy and a rules-based international system. What the optimists missed then, and the China watchers overlook now, is the hollowing out of trust in democracy at home. Of course, China is a potential threat. A second presidential term for Trump would be a much more dangerous one.
It may be that history will conclude that the excessive optimism of the 1990s is being mirrored today by too much pessimism. That’s a judgment I intend to leave to others. For a political commentator, 25 years in the same slot is long enough. So this is my last column. I will continue to write from time to time as an FT contributing editor, but otherwise intend to go in search of a better understanding of, well, history.
Fintan O’Toole in fine form.
The great question of America’s twenty-year war in Afghanistan was not whether the Afghans were fit for democracy. It was whether democratic values were strong enough in the US to be projected onto a traumatized society seven thousand miles away. Those values include the accountability of the people in power, the consistent and universal application of human rights, a clear understanding of what policies are trying to achieve, the prevention of corrupt financial influence over political decisions, and the fundamental truthfulness of public utterances. In the first two decades of the twenty-first century, the American republic was fighting, and often losing, a domestic battle to uphold those values for its own citizens.
Critics of the war argued that the US could not create a polity in its own image on the far side of the world. The tragic truth is that in many ways it did exactly that.
The easiest way to cope with the reality that the longest war in US history (longer than World War I, World War II, and Vietnam put together) has ended in defeat and an ignominious and deadly evacuation is to fall back on the belief that the Afghans were never capable of creating or sustaining a modern nation-state. The US, after all, spent $143 billion on “nation building” in Afghanistan. Adjusted for inflation, that is more than it spent on the Marshall Plan to rebuild Western Europe after World War II. Why did it not achieve similar results? The problem, it is comforting to conclude, must lie with the Afghans themselves: too backward, too poor, too inextricably entangled in medieval tribalism and obscurantist religion. [emphasis added]
Worth reading in full.
The following is from Pulse, a magazine that is aimed at GPs. My point is not so much about the specifics but a more general point.
Professor Spector said cases were rising exponentially and people who have only had one vaccine dose should not be complacent.
The UK really does now have a problem and we’ll probably be seeing, in a week, 20,000 cases and by 21st June well in excess of that number,’ he said. ‘Most of these infections are occurring in unvaccinated people. We’re only seeing slight increases in the vaccinated group and most of those in the single vaccinated group,’ he said.
He goes on to say:
Covid is also acting differently now. Its more like a bad cold in this younger population and people don’t realise that and it hasn’t come across in any of the government information.This means that people might think they’ve got some sort of seasonal cold and they still go out to parties and might spread around to six other people and we think this is fuelling a lot of the problem.
The number one symptom is headache, followed by runny nose, sore throat and fever. Not the old classic symptoms. We don’t see loss of smell in the top ten any more, this variant seems to be working slightly differently.
He advised people:
who were feeling unwell to stay at home for a few days, use lateral flow tests with a confirmation PCR test if they get a positive result.
Now comes the boilerplate Orwellian response from the Department of Health and Social Care
[A] spokesperson said: ‘Everyone in England, regardless of whether they are showing symptoms, can now access rapid testing twice a week for free, in line with clinical guidance.
Experts keep the symptoms of Covid-19 under constant review and anyone experiencing the key symptoms – a high temperature, a new continuous cough, or a loss or change to sense of smell or taste – should get a PCR test as soon as possible and immediately self-isolate along with their household.’ [emphasis added]
From the Guardian.
Among the victims of the contaminated blood scandal, which is the subject of a public inquiry, were 1,240 British haemophilia patients, most of whom have since died. They were infected with HIV in the 1980s through an untreated blood product known as Factor VIII.
In 1983, Ken Clarke, then a health minister, denied any threat was posed by Factor VIII. In one instance, on 14 November 1983, he told parliament: “There is no conclusive evidence that Aids is transmitted by blood products.”
However, documents discovered at the national archives by Jason Evans, whose father died after receiving contaminated blood and who founded the Factor 8 campaign, paint a contrasting picture.
In a letter dated 4 May 1983, Hugh Rossi, then a minister in the Department of Health and Social Security (DHSS), told a constituent: “It is an extremely worrying situation, particularly as I read in the weekend press that the disease is now being transmitted by blood plasma which has been imported from the United States.”
(HIV screening for all blood donated in the UK only began on 14 October 1985.)
Rossi’s letter was considered damaging enough for the government to seek to prevent its release in 1990 during legal action over the scandal, by which time Clarke was health secretary.
In another letter uncovered by Evans, dated 22 March 1990, a Department of Health official wrote to government lawyers saying it wanted to withhold Rossi’s letter, despite admitting the legal basis for doing so was “questionable”.
Clarke has a legal background. There is a large logical gap between between denying ‘any threat’ and the statement that there is ‘no conclusive evidence’. The Department of Health would be better named the Department without Integrity. Recent events suggest things are no better now. It didn’t all start with Johnson.
Some words from Edward Said, quoted in Adam Shatz’s review of Places of Mind: A Life of Edward Said by Timothy Brennan. Ever more timely.
Victimhood, alas, does not guarantee or necessarily enable an enhanced sense of humanity,’ he said. ‘To testify to a history of oppression is necessary, but it is not sufficient unless that history is redirected into intellectual process and universalised to include all sufferers.’ He went on:
It does not finally matter who wrote what, but rather how a work is written and how it is read. The idea that because Plato and Aristotle are male and the products of a slave society they should be disqualified from receiving contemporary attention is as limited an idea as suggesting that only their work, because it was addressed to and about elites, should be read today. Marginality and homelessness are not, in my opinion, to be gloried in; they are to be brought to an end, so that more, and not fewer, people can enjoy the benefits of what has for centuries been denied the victims of race, class or gender.
The idea that education is ‘best advanced by focusing principally on our own separateness, our own ethnic identity, culture and traditions’ struck him as a kind of apartheid pedagogy, implying that ‘subaltern, inferior or lesser races’ were ‘unable to share in the general riches of human culture’. Identity was ‘as boring a subject as one can imagine’; what excited him was the interaction of different identities and the promise – the ‘risk’ – of universality.
Terrific article from Andrew Curry. The graph shows medians, and 20 and 80 centiles His explanation is worth reading.
Looking from askance, the Irish writer Fintan O’Toole, said what was more remarkable was how uncomfortable, in all the “orgy of coverage”, commentators had been to address the very European nature of Prince Philip’s story.
“He was a ‘rootless cosmopolitan’, one of Theresa May’s citizens of nowhere: Greek, Danish, German . . . British. He changed his name, his religion, his citizenship, his identity,” said O’Toole.
“In that there’s this deep contradiction of Englishness. The monarchy, guarantor of the ‘island nation’, is a multinational firm. No one embodied this more than Philip.”
And I guess he didn’t shop at John Lewis, either.
Whereas the Economist throws in some historical asides:
A royal marriage could reshape international alliances. Hilary Mantel describes the politics of Henry VIII’s reign as “graphically gynaecological” because it was dominated by the king’s desire to produce a son. Modernity is built on the negation of all of this.
The theatre of monarchy is not primarily a theatre of works performed and duties fulfilled. It is a theatre of majesty. The only way to fully modernise the monarchy is to abolish it: the point of the institution is to act as a counterbalance to the everyday world of value for money and performance targets. Monarchy is romance or it is nothing.
Critics said she frittered away unprecedented levels of goodwill and made strategic errors over Brexit. “Her intransigence, petulance, arrogance, lack of generosity, and political myopia have been catastrophic for unionism,” tweeted Deirdre Heenan, a social policy professor at Ulster University.
Northern Ireland’s founders viewed the link between religion and constitutional preference as essentially fixed at birth. Ninety years later, 21st-century unionists saw those two issues detach to an extent which would have astonished their forefathers. By 2016 there was significant Catholic support for the union; not enthusiastic, certainly not flag-waving, and rooted in self-interest. They didn’t want to give up the free health care of the National Health Service or to risk well-paid public-sector jobs. Since the Good Friday Agreement (gfa) of 1998, which brought peace and set up a devolved government in Belfast, residents could be legally Irish, enjoying taxpayer support for Irish sports, culture and language while territorially within the uk.
And then unionism’s leaders blew it. In five years Arlene Foster, leader of the Democratic Unionist Party (DUP), has arguably done more to advance Irish unity than the 72-year-old Gerry Adams, former head of Sinn Fein, the political wing of the Irish Republican Army (ira).
And then there is Boris.
It’s not when Boris Johnson is lying that you have to have to worry. If he’s lying, that just means he’s still breathing. No, the real danger sign is the gibbering. It’s what he does when he can’t be bothered to think up a lie. [emphasis added]
Third, Johnson’s character. The prime minister approaches truth the way a toddler handles broccoli. He understands the idea that it contains some goodness, but it will touch his lips only if a higher authority compels it there.
Dani Garavelli is the LRB.
MSPs are fixated on these meetings because a breach of the ministerial code would trigger an automatic resignation, or did in the days before Priti Patel. But the public doesn’t seem to care about exactly when Sturgeon knew, and you can understand why. Pan out and what do you see? A woman who refused to bow to pressure to help a friend when other women made sexual harassment complaints against him: ‘As first minister I refused to follow the age old pattern of allowing a powerful man to use his status and connections to get what he wants.’
The SNP’s problems are not all linked to the Salmond allegations. After nearly fourteen years in power, the party is exhausted. But, with or without Sturgeon at the helm, there is no effective opposition (the Tories’ Scottish leader isn’t even in the Scottish Parliament, and Scottish Labour’s leader, Anas Sarwar, its sixth in the last decade, has only just been elected). The polls were predicting that on 6 May the SNP would regain the majority it won in 2011 (despite a PR system that was supposed to prevent absolute majorities) and lost in 2016, but now a hung parliament is being forecast (and a drop to 49 per cent support for independence). I find it hard to imagine that the spirit of 2014 will ever be rekindled. Defeat back then was strangely energising. Were the SNP to secure another referendum, could a truce be called in the party’s civil war? What shared idea of Scotland would Yes supporters unite behind now? It’s been a long six years.
It is hard not to be moved nor not be angry on reading the editorial in this week’s Lancet, written by three members of the Covid-19 Bereaved Families for Justice group.
The UK Prime Minister Boris Johnson has previously suggested that an immediate public inquiry into the government’s handling of COVID-19 would be a distraction7 or diversion of resources in the fight against COVID-19. We have long proposed that quite the opposite is true: an effective rapid review phase would be an essential element in combating COVID-19.
An independent and judge-led statutory public inquiry with a swift interim review would yield lessons that can be applied immediately and help prevent deaths in this tough winter period in the UK. Such a rapid review would help to minimise further loss of life now and in the event of future pandemics. In the wake of the Hillsborough football stadium disaster on April 15, 1989, for example, the Inquiry of Lord Justice Taylor delivered interim findings within 11 weeks, allowing life-saving measures to be introduced in stadiums ahead of the next football season.
I will quote Max Hastings, a former editor of the Daily Telegraph and Evening Standard, and a distinguished military historian, writing in the Guardian many years ago. He was describing how he had overruled some of his own journalists who had suspected Peter Mandelson of telling lies.
I say this with regret. I am more instinctively supportive of institutions, less iconoclastic, than most of the people who write for the Guardian, never mind read it. I am a small “c” conservative, who started out as a newspaper editor 18 years ago much influenced by a remark Robin Day once made to me: “Even when I am giving politicians a hard time on camera,” he said, “I try to remember that they are trying to do something very difficult – govern the country.” Yet over the years that followed, I came to believe that for working journalists the late Nicholas Tomalin’s words, offered before I took off for Vietnam for the first time back in 1970, are more relevant: “they lie”, he said. “Never forget that they lie, they lie, they lie.” Max Hastings
Two of Hasting’s journalists at the Evening Standard were investigating the funds Peter Mandelson had used to purchase a house.
One morning, Peter Mandelson rang me at the Evening Standard. “Some of your journalists are investigating my house purchase,” he said. “It really is nonsense. There’s no story about where I got the funds. I’m buying the house with family money.”
I knew nothing about any of this, but went out on the newsroom floor and asked some questions. Two of our writers were indeed probing Mandelson’s house purchase. Forget it, I said. Mandelson assures me there is no story. Our journalists remonstrated: I was mad to believe a word Mandelson said. I responded: “Any politician who makes a private call to an editor has a right to be believed until he is proved a liar.” We dropped the story.
Several months later
…when the Mandelson story hit the headlines, I faced a reproachful morning editorial conference. A few minutes later, the secretary of state for industry called. “What do I have to do to convince you I’m not a crook ?” he said.
I answered: “Your problem, Peter, is not to convince me that you are not a crook, but that you are not a liar.”
The default, and most sensible course of action, is to assume that the government and many of those who answer directly to the government have lied and will continue to lie.
An article discussing Canadian health care with echoes of the UK’s own parochial attitude to health care (and don’t mention Holland, Germany, France, Switzerland…).
How do such gaps and problems persist? Part of the problem, ironically, is the system’s high approval ratings: with such enthusiasm for the existing system, and with responsibility for it shared between federal and provincial or territorial governments, it’s easy for officials to avoid making necessary changes. Picard sees our narrowness of perspective as a big obstacle to reform: “Canadians are also incredibly tolerant of mediocrity because they fear that the alternative to what we have is the evil US system.” Philpott agrees that Canadians’ tendency to judge our system solely against that of the United States can be counterproductive. “If you always compare yourself to the people who pay the most per capita and get some of the worst outcomes,” she told me in a recent Zoom call, “then you’re not looking at the fact that there are a dozen other countries that pay less per capita and have far better outcomes than we do.”
The Holy See is thus viewed as the central government of the Catholic Church. The Catholic Church, in turn, is the largest non-government provider of education and health care in the world. The diplomatic status of the Holy See facilitates the access of its vast international network of charities.[emphasis added]
There is a famous quote ( I don’t have a primary source) by the great Rudolf Virchow
“Medicine is a social science, and politics is nothing more than medicine on a large scale.”
I know what Virchow was getting at, but if only.
“I work for a government I despise for ends I think criminal.”
John Maynard Keynes, 1917, in a letter to Duncan Grant.
The above quote via John Naughton who commented
I wonder how many officials in the US and UK governments currently feel the same way.
Following on from the previous post, here is a bit more economics, surely germane to Deaton and Case’s work, and which provides yet another example of where the ‘observation’ (‘facts’) may, if not shout for themselves, at least whisper that something important is going on. The graphs are from Saez and Zucman’s The Triumph of Injustice. Note the timeline for each graph.