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 are constantly being 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.