Monday, 1 September 2014

Healthcare and the great privatisation scam


To join day 3 of The People’s March for the NHS, I planned to catch the 7 am train from King’s Cross to Darlington. To cover the remaining 12 miles to Ferryhill in time for the 10am set-off, I would have to hitchhike – the country bus would take too long. 

The hitchhiking might have seemed the riskiest part of this plan, but I was more apprehensive about the train journey, having endured a chaotic rail trip to the Cotswolds the previous weekend. That train left Paddington 12 minutes late, so crammed there was hardly room to move, with passengers standing or perched on suitcases all down the aisle. As we crawled out of London, I had plenty of time to reflect that there was no financial incentive for First Great Western, a private company, to lay on an extra service – we’d all paid for our tickets already. 

Further delays and indignities followed, including being shouted at by a harassed conductor during an unscheduled change of trains at Reading station, before I found myself stranded in Oxford, still 40 miles short of where I wanted to be. Whatever the invisible hand of the market was up to, it certainly wasn’t getting me to the Cotswolds. As I learnt along the way, conversation being hard to avoid when you’re jammed up against other people enjoying the unexpected fellowship of disaster, this kind of thing is all too familiar to regular Great Western travellers.

As it turned out, my trip up the east coast to Darlington couldn’t have been more different. We left on time, the staff were cheerful and friendly and I had a seat all to myself. I discovered later that this line was taken back into public ownership in 2009 after its private operator had made a hopeless mess of it. According to the political economist Will Hutton, 'Directly Operated Trains is now the best run and most efficient operator, making a net surplus of £16m for the taxpayer.' So that's good then. Unless, of course, you're a free-market fundamentalist. The company's reward for this success, Hutton writes, is:

To be sold back to a private operator next February that will redirect the surplus through a tax haven as dividends, game the Department for Transport for higher support and walk away if the returns are not good enough. (Will Hutton, Stop picking passengers' pockets and bring trains back under public control, Guardian 14.08.14)


During the glory days of privatisation back in the 80s, selling a public company such as British Gas was trumpeted as the means to bring ordinary people into the shareholding class while extending economic freedom for all. Socialists might howl, old one-nation Tories long-retired to the House of Lords might grumble that we were flogging the family silver, but Margaret Thatcher was on a mission and enough people went along with it to keep her in office for 10 years. The privatising of the railways, always a dodgier proposition, wasn’t pushed through until three years after she’d gone. By the time the Royal Mail was sold last year, the great privatising project had been reduced to the level of farce, with shares snapped up for a bargain price and sold on for big profits and no pretence that any of this was for the public good. 

This was a small loss. We'll get by with email, mobile phones and FedEx. But some services are so essential, so complicated or so unsuited to competition that private ownership just doesn't work. All of these are true of healthcare (see my previous post) and most British voters know it. No major political party in Britain has ever campaigned on a promise to privatise the NHS. The Conservatives made no mention of such a policy at the last election. At the 2006 party conference, reassuring voters that it was safe in his hands, David Cameron said, ‘Tony Blair explained his priorities in three words: education, education, education. I can do it in three letters: NHS.’ 

It could never be formulated explicitly as a policy. It could only be done, as it is being done, piecemeal and by stealth. The Health and Social Care Act 2014 is a murky piece of legislation. One of the clearest accounts I’ve read of it appeared in the Daily Telegraph, a newspaper not known for championing socialist causes, under the headline, ‘Read this and prepare to fight for your NHS.’ The writer, Max Pemberton, a practising doctor and regular Telegraph columnist, emphasises his non-ideological position, but also his absolute commitment to fair and affordable provision:

Let me make clear: I am not ideologically wedded to a nationalised health service. My only concerns are that access to health care is affordable for all and that it is equitable. For me, it is a fundamental part of living in a fair, just society that all members are free from the fear of destitution should illness befall them. When a cohort of people live in the shadow of the fear of sickness, society is impoverished and weakened. The reason I support the NHS is because countless pieces of international research have shown it to be the fairest and cheapest way of providing health care. (Max Pemberton, Read this and prepare to fight for your NHS, Telegraph 31.08.14)

Concern that the NHS is suffering irreparable damage has motivated a group of women from Darlington – the Darlo Mums – to re-enact the 1936 Jarrow March from county Durham to Westminster, and a few dozen more to join them in walking the entire 300-mile route, averaging between 13 and 14 miles a day.

In 1936 the decision to march on London was an act of desperation for men whose town was suffering over 70% unemployment, widespread malnutrition and rising infant mortality. Enjoying support and encouragement along the way they also suffered guilt at eating so well. Ham sandwiches were a luxury their families back home in Jarrow couldn't possibly afford.  


Better fed and no doubt better shod than those working men, I joined this new Jarrow March for days 3 and 4, crossing the county border from Durham to Yorkshire. I was back a week later for day 12 with my wife, Leni, and brother and sister, Tom and Liz. I was happy to be reunited with the 300-milers for one more day, and to meet other day-trippers like me. I spoke to nurses, paramedics, administrators, schoolteachers, veterans from the 1980s anti-nuclear camp on Greenham Common, a retired psychiatrist, a local mayor, a parliamentary candidate, an MEP, an opera singer and a lay clerk from Ripon Cathedral. By day 12 the numbers marching had swollen to hundreds, with large crowds turning out at various stopping points. People stood in front gardens and shop doorways to clap and express thanks. Passing drivers sounded their horns and waved. It was a moving and exhilarating experience. 




It’s obvious that, as it makes its way down through England, the march is meeting broad and enthusiastic approval. Perhaps by the time it reaches London on Saturday 6 September, it will be big enough to attract some serious media attention as well. I hope so. A bad train service causes waste, inefficiency and frustration. A failing healthcare system is a more frightening prospect altogether.


Sunday, 31 August 2014

Five arguments for public healthcare


In response to the creeping privatisation of the National Health Service, a group of women from Darlington have organised a 22-day 300-mile march from county Durham to Westminster following the route of the 1936 Jarrow March. You can read about it here: http://999callfornhs.org.uk/. More on this later. Meanwhile some general thoughts on healthcare provision.
















Access to healthcare is a fairly basic human need. So is having food to eat and clothes to wear. In fact you might consider these even more basic. But nationalising the allocation of food or clothing would be soviet-style lunacy – much better for people to sort this stuff out for themselves. This is what private enterprise is good at. So why entrust healthcare to the government?

First because sickness is so unpredictable and potentially expensive that only the exceptionally wealthy could budget for it. To solve this problem capitalism provides insurance companies, which are motivated by profit to do three things: sell policies, deny claims and steer clear of sick people.

Secondly because although choice is a good thing, and simple enough when it comes to shoes or sausages, options for treatment can be so complicated, so finely balanced and of such uncertain outcome that they can be baffling not only to the individual patient but to the individual practitioner. We don’t need competing stallholders crying their wares and hiding their ingredients and processes from each other, but a marketplace of ideas and information.

Thirdly because new drugs and procedures are commonly developed and sold by multinational companies with huge budgets for sales and advertising. We need whoever’s passing them on to us to have some bargaining clout and the means and motivation to conduct their own research on what works and what doesn’t.  

Fourthly because ill-health is sometimes catching, and its causes, consequences and cures often have a social dimension. The profit motive doesn’t offer much encouragement for competing providers to look beyond their own potential markets and consider the larger picture.

And because, in the end, healthcare isn’t about selling stuff. Pile it high and sell it cheap might be a recipe for success in the grocery business, but it shouldn’t apply to antibiotics. It’s not about selling services either. In his preface to The Doctor’s Dilemma, George Bernard Shaw expresses despair at the thought that ‘any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg.’

Sunday, 17 August 2014

Book-banning and British values

Adapted from an article published in The Bangladesh Daily Star

The government has been making book-related news this year – and not in a good way. In May we learned that an intervention by Michael Gove, who was then still Secretary of State for Education, had prompted exam boards to drop non-British classics from their GCSE English syllabuses. Apparently Gove was particularly disappointed at the popularity of Steinbeck’s Of Mice and Men. Gove insisted that he wasn’t banning anything. He just wanted British school children to read more home-grown books. 
   
Under the new regulations, pupils must study a Shakespeare play, a 19th-century novel, a selection of poetry since 1789, and a work of fiction or drama from the British Isles from 1914 onwards. I assume that start date for poetry is to make room for William Blake, an anarchic visionary loved by conservatives who misread 'Jerusalem' as a jingoistic poem, though I can’t explain the gap between the end of the nineteenth century and 1914, a black hole big enough to swallow most of the works of Joseph Conrad, one of our greatest immigrant writers.

Leaving those peculiarities aside, a teacher eager to engage the interests of students might well feel boxed in by a list with such a historical emphasis. But it’s the ‘British Isles’ requirement that is proving controversial, excluding as it does writers as varied as Chinua Achebe, Anita Desai and Harper Lee.

Countering the charge of parochialism, a spokesman for the department of education pointed out that, though the twentieth century work has to have originated in the British Isles, the 19th-century novel does not. This was probably not meant as a joke, though it spectacularly misses the point that it was in the 20th-century that English literature went global.  

In June it was the Prime Minister who was turning the clock back. In an article in the Mail on Sunday about British values, David Cameron said that ‘we are bringing proper narrative history back to the curriculum’, naming as his favourite book Our Island Story. Written for children at the height of the British Empire, this book could now only be read as a curiosity. It’s hard to imagine it featuring on any syllabus except as an illustration of Edwardian attitudes and it’s a dismal thought that it might actually be our Prime Minister’s favourite, or that he might really consider more analytical approaches to history ‘improper’. More likely this was a craven appeal to voters abandoning the Tories for UKIP.   
 
Meanwhile Justice Minister Chris Grayling was dealing with the continuing ripples of protest at his ban on parcels for prisoners. As Grayling was desperate to point out, he wasn’t actually banning books, just parcels, whatever they happened to contain – underwear, toiletries, presents from prisoners’ children. Cutting the supply of books was just a side effect. 

This argument didn’t seem to help. Grayling faced objections and protests from large numbers of British writers, including Carol Ann Duffy, Alan Bennett, Hari Kunzru and Irvine Welsh, before the story became international, with former political prisoners from around the world expressing concern. Nadezhda Tolokonnikova of Pussy Riot, freed after 16 months in a Siberian jail, said that, for a prisoner, ‘Books make up your entire world.’ Dissident Belarusian journalist Iryna Khalip put it this way: ‘In prison books become the air… No books – you cannot breathe.’

When the victim's of Putin and Lukashenko start calling you oppressive, you know you're in trouble. Democratic governments have no business directing what we may and may not read. But as long as books matter, they’ll go on meddling. 

Wednesday, 2 July 2014

Is this the end for serious fiction?


This is reprinted from The Bangladesh Daily Star

On a visit to New York, I meet an old novelist friend in a café in Greenwich Village. He’s enthusing about Breaking Bad, the acclaimed American drama series about a chemistry teacher with lung cancer who, faced with prohibitive medical bills and an insecure future for his family, starts cooking illegal methamphetamine. My friend tells me TV drama has finally achieved the status of high art to rival the Victorian novel.

He suggests that Charles Dickens was the TV dramatist of his age. Being serialised in magazines such as Household Words brought Dickens’ work to a mass readership. It also enabled readers to respond while the story was still taking shape, just as modern dramas are subject to constantly updated viewer ratings, reviews, blogs and fanzines.

But why is Breaking Bad the break-through drama, I ask him, the one that has elevated the form to Dickensian heights? He tells me it’s because it achieves genuine artistic coherence. The Sopranos, though beautifully crafted episode by episode, under the pressure to generate fresh story lines while maintaining the essential dynamic on which its success depended, descended to the level of soap opera. Most original dramas are like this. Expensive to make, they have to be commercial products first and works of art second. And nobody knows if they’re going to last one season or ten. Uniquely, Breaking Bad followed the logic of its opening premise, taking its characters through life-changing experiences, resolving dramatic instabilities by smashing through into even greater instabilities, and finally resolving into a single coherent narrative structure.

Suddenly my friends looks gloomy. ‘So where does this leave us?’ he asks me. ‘What are novelists for, now?’ I understand his concern. But television is the least of our worries. On the plane from London I was reading a piece by Will Self, arguing that the literary novel isn’t dying, but only because it’s already dead. In fact it’s been walking around in a zombie state for three quarters of a century, ever since James Joyce took it as far as it could go, and beyond, in Finnegan’s Wake. What does the future hold for serious fiction? In Self’s view, within twenty years it will have been squeezed out of cultural significance by the distractions of social media and our addiction to instant information.


It’s a bleak outlook. Leaving the café, I console myself with the thought that among anxieties about possible futures for the planet, the decline of the novel rates fairly low. I find myself outside the Strand bookstore, the biggest, longest surviving independent bookshop in Manhattan. Inside I find fiction prominently displayed, heaped on tables labelled Modern Classics, Just Arrived, and Best of the Best. I seem to be looking at all the novels I’ve ever read, all the novels I’ve ever thought of reading, and vast numbers of novels I’ve never heard of.  It’s a big scruffy space estimated to hold 2.5 million or 18 shelf-miles of books. It’s crowded with young people. And they’re all buying.  

Saturday, 21 June 2014

Are creative writing courses a waste of time?


This is reprinted from The Bangladesh Daily Star, whose literary pages can be seen here http://bd.thedailystar.net/literature

Hanif Kureishi caused a stir at the Bath Literature Festival by describing creative writing courses as ‘a waste of time’. He said that most of his students at Kingston University have no talent, and talent can’t be taught. He gets no marks for tact, but does he have a point?

In recent years in Britain there’s been a huge expansion in university courses in creative writing. It’s no coincidence that this has coincided with a shift from public to private financing of higher education, and the growing pressure to respond to consumer demand. Creative writing is what the customers want. But can the universities deliver on their promise?

Novelist Lucy Ellman thinks not. She used to teach creative writing at the University of Kent, but now describes such courses as ‘the biggest con-job in academia’, suggesting that universities charge fees on false pretences. If people take these courses in the expectation of getting published, many will be disappointed. If they have fame or wealth in mind, they’re almost certainly deluded. But students I talk to often have more modest ambitions. They speak of wanting to improve their writing, or of needing the structure to help them write a story they’ve been thinking about for years.

Asked if he would consider studying creative writing himself if he were starting out now, Kureishi said, ‘No… that would be madness. I would find one teacher who I thought would be really good for me.’ That’s easier said than done. Most aspiring writers work in isolation, sometimes with no one to consult but family members or friends who mean well but don’t really get what they’re trying to do. You can’t pluck a good teacher out of the air. The university course provides a community of students and teachers who understand the urge to write and respect the struggle to produce good work. 
   
The defenders of creative writing courses often talk about the elements of craft that can be effectively taught. Novelist Matt Haig says that courses can be ‘very useful, just like music lessons can be useful’.  I understand the temptation to liken this new subject to more established kinds of training, like studying an instrument. But there’s a huge difference. Playing music is a precise discipline. Predictability is an asset. It’s best to start young, and you can’t expect to think about self-expression before you’ve achieved some level of technical mastery. In contrast, people typically take up novel writing in adult life, sometimes in midlife. It’s an activity that springs from individual experience and celebrates personal vision. It’s not a skill that can be acquired in predictable stages. Publishers may value craft, but they continually seek fresh voices. 

To this extent, Kureishi is right to emphasise the importance of individual talent. But, for the very same reason, startlingly good work can sometimes emerge from apparently unpromising students. University courses may not be able to teach people to become writers, but they do provide an environment in which writers can find themselves. 

Friday, 13 June 2014

We still don't do God


A humble college lecturer by the name of Dave Brat has just made big political news in America by defeating House Majority Leader, Eric Cantor, in a Republican primary. Brat took an extreme line on immigration and rode a wave of tea-party anger against the Washington establishment.
  
We know Dave Brat is humble because he said so. Asked what he attributed his success to, he replied, 'What do I attribute it to? I attribute it to God. I am utterly humbled and thankful. I’m a believer. So I’m humbled that God gave us this win… God acts through people, and God acted through the people on my behalf.'

This kind of religious talk apparently goes down well in conservative circles in Virginia. But even in more northern, more coastal, and more cosmopolitan regions of America, some level of religious faith seems to be a basic requirement for political life, whereas here in Britain the leaders of two of our three major parties currently call themselves atheists, and members of parliament can survive whole careers without having to commit themselves one way or another.

It was Tony Blair’s press secretary Alastair Campbell who famously said, ‘We don’t do God.’ Far from being a statement of unbelief, this was an attempt to establish a kind of religious ‘don’t ask, don’t tell’ policy. If people felt Blair might be dodgy on religion, the fear was that he had too much of it rather than too little. When he was interviewed at length by Jeremy Paxman during the build-up to the Iraq war, one of Blair's most uncomfortable moments was when Paxman asked him whether he and Bush prayed together.

BLAIR: No, we don't pray together Jeremy, no.
PAXMAN: Why do you smile?
BLAIR: Because – why do you ask me the question?

Imagine an American president acting so coy and being made to look so shifty in response to a simple question about religious practice! What Paxman had done, of course, was to evoke an image of inappropriate intimacy between our Prime Minister and the American President, while implying that Blair’s determination to invade Iraq might be based on something other than a rational calculation of costs and benefits. These were the subtexts that made Blair squirm. We really don’t do God.   

Blair’s predecessor, John Major, once went so far as to speak nostalgically of an England of warm beer and village cricket and ‘old maids bicycling to holy communion through the morning mist,’ but he was only quoting Orwell. In one of her more grotesquely unctuous moments, Margaret Thatcher recited a 1912 prayer, which she inaccurately attributed to St Francis of Assisi, about replacing doubt with faith and despair with hope, but she was more in her element berating Anglican bishops for being soft on the poor and praying for the souls of dead Argentinian soldiers. No one really thought she’d got religion.

And no one really thinks David Cameron has got it either, even though he announced over Easter that 'we should be more confident about our status as a Christian country, more ambitious about expanding the role of faith-based organisations, and, frankly, more evangelical about a faith that compels us to get out there and make a difference to people's lives.’

Is it just me, or does that ‘frankly’ sound like an awkward clearing of the throat before the scary reference to evangelism? And isn’t there just a hint of embarrassment in the way the indefinite article holds ‘faith’ at arm’s length? And what’s the sentence really about anyway, but getting Tory-like stuff done in the world and having a presence on the international stage, with some vague nod to religion in the middle? But in this country, where we don’t do God, it’s as close to a ringing declaration of belief as a Prime Minister can get.  

And who can doubt that Cameron’s religious revival has been inspired by the surge of support for the UK Independence Party? For the benefit of American readers, I should explain that UKIP is a bit like the tea party, though there are fewer cattle-ranchers armed with assault weapons among its members and more old maids bicycling through the morning mist.

Their leader Nigel Farage has called for a ‘more muscular defence of our Judaeo-Christian heritage’. I’m not sure bluff, beer-soaked Nige would spot a Judaeo-Christian if it bit him in the leg, but I think he might recognise Dave Brat as the kind of bloke he could have a pint with – as long as Dave stuck to the immigration issue and didn’t go on about God. 

Tuesday, 3 June 2014

Still armed, still dangerous


Expressing shock at the killing of six UCSB students in Isla Vista last week, a journalist on MSNBC said, ‘What a combination of anger, firepower and delusion.’

If firepower is only part of the problem it’s clearly the most urgent part, and the part most responsive to public policy. What can you do about an angry deluded man-child with a gun? Take his gun away for a start. Then you might think about diagnosing his psychological condition or exploring how his misogyny and sense of entitlement  may have been fuelled by cultural forces.

But what seems like common sense to most people is heresy to some. 

I’ve posted about the gun lobby before (Armed and dangerous, January 2013). There’s a new device, worn on the wrist like a watch, that allows a weapon to be fired only by its owner, so that a loaded gun found in the house by a child or snatched by an intruder becomes harmless. The people at the National Rifle Association are working hard to keep it off the market. They also object to new technology that could print every bullet, at the moment of firing, with a code unique to the gun that fired it, which would help police to solve violent crimes. 

On the other hand, they have a history of defending plastic assault rifles that could be smuggled past metal detectors, and bullets designed to pierce body armour, and they have no problem with child-friendly weapons made for small hands.  

The NRA is an industry lobby masquerading as a grassroots organisation and too many politicians are scared of it. But big money is only part of its power. You don’t have to dig very deep into online conversations about the Isla Vista shooting to find people who think guns are not the problem but the solution, and who blame California’s gun laws, which are marginally more restrictive than most, for the failure of anyone to gun down the killer. In internet forums the opposing sides face each across a chasm, shouting, ‘Look what your policies have brought us to!’

According to opinion polls, most Americans are persuaded that some minimal measures, such as requiring background checks for all weapon sales, would be a good thing. The gun advocates are not impressed by the evidence for this, or for anything else, because they are not focused on a pragmatic reduction of harm. 

There are two kinds of fundamentalism behind this attitude, each with its sacred text. There’s an apocalyptic kind of Christianity that encourages hostility to social progress, while emphasising personal salvation and self-reliance. And there’s a form of libertarianism that treats the Constitution as Holy Writ, especially the Second Amendment, which the true believers misread to suit their prejudices, being resolutely opposed to anything that would weaken the ability of the private citizen to defend himself against his neighbour or the federal government. 

If unregulated gun ownership is an inalienable right, any inquiry into what happened at Isla Vista must begin and end in Elliot Rodger’s soul, about which nothing can ever be done.