There are two key pieces of evidence to consider with regard to Jeremy Hunt’s recent handling of NHS management:

1) The original paper, which can be found here.

2) Jeremy Hunt believes in homeopathy. The man ultimately in charge of the NHS believes in homeopathy. (!)*

Combine the two and ask yourself if Jeremy Hunt has read the paper let alone understood it. There is a reason why people spend lives studying statistics. It isn’t straightforward. Let us consider the primary conclusion as stated in that paper:

“Patients admitted at the weekend are more likely to be in the highest category of risk of death.”

That is the first sentence of the conclusion. Consider this alongside the fact that the two days with the lowest number of deaths are… Saturday and Sunday. It is simple to understand why total number of deaths is not the most important measure. Do you think Jeremy Hunt would understand why?

A GCSE maths student might have heard the well worn truism ‘correlation doesn’t imply causation’. It seems self evident to me that mortality rates (the likelihood of dying within thirty days of admission but not within three days (as a toy problem ask yourself why the authors of the paper chose that seemingly bizarre measure)) will be dependent on patient behavior surrounding the causes of admission. To what end do we move elective surgeries from weekdays to weekends? If the aim is not to improve mortality rates for a given type of hospital admission (i.e. for a given patient, their likelihood of a positive outcome) then we have entered in to a world of truly Carrollian logic.

My central criticism of the paper is that removing those deaths within three days does not as they claim ‘confirm the robustness of the model.’ Rather it is arbitrary and statistically simplistic.

The second conclusion of the paper is:

“Patients admitted on Saturday or Sunday face an increased likelihood of death even when severity of illness is accounted for.”

That is of course more pointed, but ask yourself how the authors determined severity of illness. How would you do that without measuring outcome? Do you not accept as the ultimate measure of severity of illness that of likelihood of death? Alternatively, it is not a measure of severity of illness, it is severity of illness.

Crucially the author’s go on to state quite plainly:

“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading. From an epidemiological perspective, however, this statistic is ‘not otherwise ignorable’ as a source of information on risk of death and it raises challenging questions about reduced service provision at weekends. Similar to our previous analysis, we have found that patients already in hospital over the weekend do not have an increased risk of death.”

My summary of this statement would be ‘its complicated, further study needed.’ Have you ever read an academic paper that didn’t have that conclusion? One final point about academic papers is that people churn them out. They are professionally obliged to publish as much as they can. Consider the volume of literature generated by the medical profession and wonder why one paper with vague conclusions surrounding widely available data has received so much attention. The attempt to fix a problem which is not understood by changing doctors contracts is therefore wilfully simplistic to the extent that one must question what other aims are being followed. Is there any meaning at all in the phrase ‘a truly 7 day NHS?’ It clearly doesn’t mean a 7 day NHS because that already exists. This whole debacle represents a new low in government debate.

Finally, and most contentiously, let us truthfully ask ourselves what the motives of government are. If you wished to dismantle the NHS would you perhaps intentionally instigate a strike as a means to devalue a profession and turn public opinion against it. The British people hate strikers and the government knows that. The doctors have made the crucial error of trying to argue rationally with politicians. They are bound to fail. This might explain their desperate lashing out, but only allows us to criticise their tactics not their argument. This final paragraph betray’s my personal prejudice but don’t lose your intellectual rigour and let it prejudice you against the principle arguments above.

Best,

*An exclamation point doesn’t seem enough.

Addendum
As a further note regarding the paper, I wonder if the authors are broadly Bayesians or frequentists. At the risk of being offensive to doctors and biologists everywhere (one can only hope), perhaps you should have asked a mathematician to do this research.

I want out. I’m going to make a couple of points but essentially it comes down to a sense of disgust at seeing a great nation, the largest military power in Europe and one of its biggest economies reduced to haggling over benefits for new migrants. Pittance my friends! It is a perfect example of a handing of sovereignty to an undemocratic technocracy that limits the capacity of national governments to enact full control over policy, regardless of which side of the house it comes from.

By the way, if the nation were to vote to leave what would happen? I have a depressing hunch that we may simply be offered another referendum. Except this time we can both deny new migrants benefits for three months but also get a lollipop. In the interest of shit stirring and improving our negotiating hand we should therefore vote to leave at the very least to make the governments sweat a bit.

“In a referendum the population always votes for the status quo”. AKA voters are pussies.

I’ve seen scientific investment used as an argument. Like all the arguments based on investment, this is just giving us our own money back, the only difference being we can’t control where the money goes. Can you deny that the European Research Council (ERC) grants have a political undertone? What science gets funded has political causes and consequences.

Immigration
The core left vote is disproportionately anti Europe and anti immigration. Also, we could actually increase immigration if we wanted and let anyone from the whole world in if we were out of Europe but not if we are in it. All being out of Europe would do would allow us to control immigration as and when we want. So immgration can’t be part of the argument against leaving. If you want more immigration you are freer to have that out. If you want less you are also freer to have that out.

The creation of the Eurozone has already made us a sidelined country. The future of Europe depends of securing the future of the Euro which inevitably depends on some sort of fiscal union and democratic government. Back to Keynes’ idea of charging interest on any current account surplus? Lets let them sort all that out and then join the currency in 50 years? In the mean time we can figure out what we want our own country to look like.

A partisan argument
An out vote will totally destabilise the party of government. It will be David Cameron’s primary legacy. It could be a key part of the election strategy of both parties. If the conservative leadership thinks they can depend on Labour MPs supporting the status quo its job will be a lot easier. Again my argument comes back to stirring the maximum amount of shit.

Maybe in a hundred years Europe will be a great democracy and we can beg them to let us back in and use their money. So be it. We’ll look desperate. So what?

Here is an ideal timeline:
1) UK votes out of Europe.
2) Government says they will offer a second referendum if more concessions made.
3) second referendum passes and we get a few more measly scraps.

Ha ha fuck it. I don’t know what the fuck I’m on about mate.

Love,

The great lesson of China’s assent has been that things which appeared to us inherently connected are now revealed as two separate entities that exist independently. Their creation of capitalism without democracy creates space for a whole set of apparently contradictory systems of government. Here, I will be discussing the possibility of free market socialism. Where China can have productive capitalist enterprise without individual liberty or free markets, might we be able to create free market libertarianism with social ownership (social and/or state) of for profit enterprise.

Are not the British railways a classic example of capitalism without a market? The fact that the trains are privately run (they actually aren’t privately owned) does not stop the fact that there is no competition with another provider. This is surely what leads to high prices and poor service. When Kings Cross and St Pancras both ran trains to Edinburgh there was clear competition. Two train company’s were fighting for your custom. So might we stop arguing for nationalisation of the railways (which would remain a monopoly, just a state monopoly) and instead argue for a free market. The way I suggest this might be possible is if more than one company can run trains on a given line. If when I arrived at the station I was offered a Virgin train for £10 in ten minutes or a Tesco train in an hour for £5 we might see some actual free market competition. Obviously one effect will be that trains will crowd around the busy times, but is that not what a central control system aims to do? The worry might be that no one would run trains late when there are fewer passengers, a service which is useful to a large number of people. However, given that the companies would be free to run those services at any price they wished might they choose to operate a number of very small trains at high price throughout the night?

The final leap of the imagination would then be that groups of customers would be free to set up a cooperative to run trains. The commuters alliance might buy one train and start with one morning service and one evening service. Members would be guaranteed a seat and any vacancies could be sold off. Instead of having capitalism without markets, we would have markets with a mixture of ownership types. All manner of niche ticket types might emerge, and prices would be kept in check by free market competition.

I have used the trains as an example. Clearly there is something about a train line which is inherently monopolistic, so I claim my arguments might be more applicable in other realms.

Let me finish with an arrogant generalisation:

Capitalism and free markets are enemies. The capitalist will always prefer the monopoly and control of the market. How can we encourage the free market with a willful disregard for ownership type? Capitalism and free markets are independent entities. Free markets (free exchange of commodities) are the aim, with or without capitalism (private ownership of the means of production).

The right often uses arguments in favour of markets to justify capitalism but anyone can see they are two separate modes and are not dependent on each other.

The great question then becomes how might a system of taxation and regulation be designed which encourages mixed ownership (anti-capitalist and anti-state) whilst retaining free markets? Some people might claim my insistence on taxation and regulation as the only means to foster this new order is a fatal flaw, but do we not already see a great deal of taxation and regulation in the service of capital? Can we design a system which reduces both but creates a different type of taxation and regulation?

The factory worker didn’t own the factory under Stalinism any more than he did under capitalism. Is it naive to argue for the best of both worlds? Or is it naive to argue for the perfection of the status quo?

Can someone tell me why this wouldn’t work?

Love and kisses,

Perhaps the most serious critique of Marxist and Hegelian dialectical materialism is put forth in Karl Popper’s little gem The Poverty of Historicism. If I may be so bold as to offer my own summary of the main argument I give the following:

Any objective approach to economic or social theory is fundamentally unscientific and bound to fail because the theory will impact the phenomena under observation rendering the theory instantly defunct.

I broadly accept this and would never give sociologists the compliment of calling them social scientists. However it recently occurred to me that it might be possible to categorise political and economic thought in a logically consistent manner which encapsulates Popper’s concerns. I claim this may be possible by considering self reference in economic theory. I propose to offer a number of possibilities:

1) Weakly self consistent theory: a theory which describes social phenomena in a society where belief in that theory is held by the majority and where it is not.
2) Strongly self consistent theory: a theory which describes social phenomena in a society if and only if belief in that theory is held by the majority.
3) Self inconsistent theory: a theory which can describe social phenomena in a society if and only if belief in that theory is not held by the majority.
4) Wrong theory: A theory which describes no phenomena regardless of whether it is accepted by the population. This one covers most of the ideas I have ever had including probably the entirety of this post.

The ideal would be to find an example of 1. The theory would work before being accepted and would therefore be easiest to popularise. However, example 2 creates a fascinating possibility. It is with example 2 that an interesting possibility for policy arises. Perhaps consumer confidence is an example. Not a good example because the individual can believe that increased investment depends on consumer confidence but also believe that there is no consumer confidence and therefore one would be unwise to invest. Nevertheless policy makers only have to invent some imaginary cause of optimism and the cause is rendered legitimate.

The analogy of the placebo or self fulfilling prophesy might be helpful. The aim of economists might then be to construct a theory which if adopted by the mainstream will produce effects which are described by the theory. The leap of logic here is that such a theory may not describe any effects that exist before its creation. The real question which then remains is will such a theory lead necessarily to a prisoner’s dilemma scenario. That is, while the individual knows it will work if everyone accepts it, she also knows that it will not work if some subsection does not.

To make a more tendentious assertion, Popper was perhaps arguing that Marxist thought is an example of 3. It may describe phenomena as they currently exist but if it becomes adopted as an active political movement it ceases to describe real phenomena… leading to a runaway nightmare. A Marxist capitalist is a hypocrite and a Marxist communist is a contradiction.

An example
The challenge I would like to set my self is to create an example. The major difficulty is that it is possible to find examples that reference some other theory and therefore become a prisoner’s dilemma or otherwise resort to classic cooperation problems. Anyway, here is my best attempt:

1) Any society that believes in both the following statements and the current one will produce phenomena that are consistent with the statements.
2) The economy is fundamentally unstable and strict adherence to these rules is the only way to mitigate risks associated with the fundamental instability.
3) This theory is always true regardless of whether it is known to the population. (a false statement)
4) Some final statement regarding public policy such as loose fiscal policy will mitigate risks associated with the business cycle (this could be non-Keynesian or essentially anything the population might believe).

This represents a further abstraction on top of Keynes’ discussion of optimism/pessimism being self-fulfilling. The key point is that statements 1 to 3 could create statement 4 so long as the population can be made to believe false ideas (surely not?!).

Believe it or not, I meant this post to be a joke. A Very Unfunny Joke (VUJ).

Let me finish with a joke. Marx famously defined Communism as the authentic movement replacing capitalism. Could the necessary extinction of humanity fulfill that definition?

Best,

In which I aim to convince you, dear reader, that the title contains not the slightest hint of irony.

Let us cast our minds back to the series of limp Conservative party leaders that followed Tony Blair’s 1997 landslide; a massive electoral victory only equaled by David Cameron’s recent gargantuan landperturbation that was voted for by an overwhelming majority of people of all ages of pensioner and all shades of white from off pink to slightly yellowy pink to ever so mildly tanned. There was William Hague, Ian Duncan Smith, Michael Howard and David Cameron, a list which cannot be said aloud without a descending cadence into melancholy. The volume of political ideas from those four is too big to mention but I will try. There was the Big Society. There is no such thing as Big Society. The sole political idea has been a reduction in the size of the state from 42 to 36 percent of GDP. British fiscal conservatives may regret their confidence in the miraculous effects of such an economic strategy.

In this scheme Jeremy Corbyn occupies the same position as Ian Duncan Smith. Any fair minded observer would have to admit it is difficult to say Ian Duncan Smith was significantly less ridiculous or hopeless. In this post I will offer a summary of the single biggest issue, economics, and why Osborne is weaker than he may appear and Corbyn stronger. Fundamentally I think it comes down to the inaccessibility of the counterfactual and the current strange state of affairs where any growth is considered a miracle of perfect fiscal and monetary policy (in nominal GDP let alone real GDP or god forbid real per-capita GDP). The real economic question should be ‘how much lost output?’ I admit I will leave aside foreign policy and other key parts of political thought. Jeremy Corbyn is clearly a million miles from the mainstream belief that there is no possibility the killing of perhaps a million people for no clear reason may have been a mistake. It is worth remembering that taking the most modest estimate of 150,000 deaths leads to a ratio of the worth of American to Iraqi lives at 150,000:3000 ~ 50:1. Nevertheless, let us constrain the debate to ‘economic competence’.

The madness response to the financial crash
“The definition of insanity is doing the same thing over and over and expecting it to come out different” – various attributions including Jefferson and Einstein.

The Labour party response to 2008 I would sum up as ‘we were wrong about free markets stabilizing themselves and that government intervention is always wrong’. The Conservative party response has been ‘what problem? lets get back to business as usual’. Therein lies the bizarre logic of the last two elections. The incredible feat of positioning by George Osborne was to persuade the minds of ‘sensible’ people that the global financial meltdown that started in the American sub-prime mortgage industry was caused by the UK budget deficit. This economic illiteracy (or mendacity, which may or may not be worse) will be tested as soon as a budget surplus coexists with a recession or more likely fails to materialise, both of which are very real possibilities. The only real difference between the two tribes is that we fools on the moderate left actually believed the efficient market hypothesis for a few heady days at the start of the millennium. The right always knew the credit cycle could never be controlled, they just saw the opportunity to blame inherent economic structure on the ridiculous hubris of Gordon Brown’s The End of Boom and Bust. As a straight forward piece of arithmetic you must accept that reducing the size of the state is not identical to eliminating the deficit and controlling debt.

“The dream of the welfare state is over”
The New Labour approach to let the UK have one industry, financial services and services for those required to maintain financial services, with a little bit of tax to ease the worst off in society has been proved unsustainable and it will take a large amount of intellectual heavy lifting to come to a new model of economic management. The benefit of a weak leadership is it allows all this debate and formulation to go on. This is a much better state of affairs than simply trying to brush policy inconsistencies under the carpet and waiting for the government to fail. That approach invariably succeeds at some point under some leader who wants success but has no ideas. There has been no leader since Thatcher who has based their politics on ideas and not mere personal competency. I saw a great moment of truth in Cameron’s famous slip that ‘this is a career defining… country defining election’. Do we want a politics of ideas or a politics of competent professional managerialism. The left has this opportunity under a leadership schism to produce new ideas. Imagine we had some magic 3D printer that we could use to build the perfect leader in any image we chose, would this help in any way to produce a desirable Labour party? Of course the answer is no, there is work to be done in building the next Labour government.

The twin deficits
The trade deficit and the budget deficit are intimately related. George Osborne’s attempt to eliminate the trade deficit by artificially removing the budget deficit is arithmetically bound to fail and this presents an enormous opportunity for the left. The only real question is whether the left can be ready to capitalise on George Osborne’s inevitable failure to remove the budget deficit by 2020. The truth is that it probably can’t be ready for a decade but this is a necessarily long project and the violent outburst that is the current leadership is a better way to reform and regroup. A political party has to be much bigger than its leader, it has to be a whole body of thought put together by academics, journalists and technocrats in addition to supporters in general. It takes time to formulate a full set of policies before it is eventually handed to a leader who can tie it all together into a simple narrative and sell it to the country. The democratic leadership of open splits and disagreements speeds this process along. There is a real sense of the need for ideas in developing a new economic model. The UK cannot continue to be a nation which buys more than it sells and has no real economic productivity, only the global financial bureaucracy of the City of London. The myths and nonsense spouted before the last election will fall to pieces and there will be a space for new ideas. Perhaps we might be so optimistic as to believe the average British brain can handle a more complicated analysis than ‘they forgot to fix the roof while the sun was shining’. Eventually the central logical flaw in the idea of a long term economic plan to centrally plan an economy in such a way as to insure it is not centrally planned will be revealed. Has there ever been a more perfect example of Orwellian double-speak than a ‘long term economic plan’ for free markets? We have the space now to reveal this fallacy.

Entrepreneurship and “Business”
Show me an entrepreneur and I’ll show you someone whose primary concern is access to capital and not the top rate of income tax, which they could only dream of hating. The financial services industry are not really capitalists in that they aren’t speculatively investing in new firms at a risk. What we need is more capitalists and the City of London simply will not provide them. My fundamental argument here is that the umbrella term of “Business” could not be more misleading. The difference between small and medium size enterprise (SME ~ 1 to 250 employees) and big business could not be more drastic. Feel free to lump them together but the fact is policy that is good for one is not necessarily good for the other. I claim the Conservative party is the party of big business, and that the Labour party should aim to be the party of SMEs. This would in a sense be a sort of new Thatcherism in which it is not free markets but government that drives a massive increase in small firms. Entrepreneurship could be encouraged with regional investment banks and increased funding for commercially driven research. Meanwhile taxation could be targeted more at big firms, and especially in those sectors with low employee to profit ratios. The rise in self employment is a major socio-economic shift that should be the natural home for leftist thinking. Managing risks to individuals in setting up new businesses is surely a way to boost variety in the commercial ecosystem and have a more healthy spread of company sizes. The added benefit of small firms is that they are far less likely to be foreign owned and are less free to move overseas. While middle income homes will obviously be the predominant battle ground the whole new social class of the self employed, the freelance, the small business person and the ‘precariat’ can be one important battle ground if we chose it to be.

Osborne’s weakness on business: A case in point.
If you desire evidence for my claim that Osborne is bad for SMEs consider the following policy. The government plans to replace the once yearly HMRC self assessment with four quarterly returns. You may or may not know that cash flow is one of the single biggest problems facing small firms. That is, while the balance of payments in the long term may be profitable they often struggle with short term problems of cash flow. For instance perhaps the VAT bill is due in a week and they are waiting on a customer to pay for a large invoice which they have just sent in full knowledge that small company is often late due to cash flow problems. Now ask yourself the following question: What is more harmful to cash flow 1) having to pay 100 pounds in a year, or 2) having to pay 25 pounds in three months and again in six months etc. Think about that for five seconds and then also consider the extra accounting and bureaucracy costs associated with filing your accounts four times as opposed to once. The only business that can help is accountancy. Perhaps accountancy firms have good lobbyists? Finally, if this move is so helpful to ‘business’ why are large firms exempt? Perhaps large firms have good lobbyists?

One final example: the citizen’s wage
I want to make one further case for why the left and a mixed economy is a natural bed-fellow with SMEs: The effect of personal risk on entrepreneurship. Consider the following analogy. If the safety of cars increases, what effect does it have on the average speed of road users. To put it another way, are you more likely to risk starting a new business if failure means misery for you and your family or if it means merely a year of lost earnings and a return to employment. Surely, you can see then how socialising personal risk is good for entrepreneurship. Consider the effect radical leftist policy such as a citizens wage might have on entrepreneurship. Perhaps people who would otherwise take a precarious job at Sports Direct might instead try to engage in some form of self employment. Perhaps a majority would chose instead to stay in their bedroom at their mum’s and play Fallout 4 but there would absolutely be an increase in entrepreneurship. Another source for mediating risk than inherited wealth could have a truly transformative effect on business innovation as well a reduction in miserable low paid work. We have already socialised the risks of high finance so why not do the same for low finance?

Conclusion
Clearly the assumption has to be that Jeremy Corbyn will fail to win in 2020 as Ian Duncan Smith did in 2005 (remember my comparison of the stages of opposition). However, the scene will then be set for a coherent left to build a new economic consensus and regain power. George Osborne will likely pay no electoral price for not running a surplus by 2020 (or by fudging one with asset sales; is there some new gold reserve? Hospital contracts?) but the lack of ideas and intellectual foundations of the modern right will be revealed. The Labour party will then be the only party that can offer an alternative to the Thatcher-Blair consensus that ultimately led to the crash of 2008. Put simply, the UK must be built on actual economic output and not depend so heavily on incompetent financial services which must be periodically socialised. The absence of an actual long term economic plan from the Conservatives is the main source of this fantastic opportunity for the left. A left based on the consensus of academic economists not the ‘serious economists’ who work in journalism. After the second world war did that great socialist state the USA take a hands off free market approach to Germany and Japan? And was the result so disastrous? A left which accepts the delicate interplay between state and private enterprise in sectors such as pharmaceuticals and other high tech industries. A left which recognises the core economic investment of a good education for the whole population. A left which champions the great economic energy generated by programs that socialise personal risk such as the NHS as well as other more tendentious examples such as guarantees for high street banks and regulating to protect them from the risks of investment banking.

A crisis of leadership and ideas is appropriate and beneficial. This is a decade long project to create a new economic settlement, which fosters real productive economic growth and a more balanced economy. Neither major party currently has a serious package of reform to deal with this and the democratic, unsteady and presumably already failed leadership of Labour will allow us to exorcise our demons (economic and otherwise) far quicker than the ‘perhaps we can get a better looking leader who is good at presentations, sales and PR and not produce any new ideas’ approach of the Conservatives 1997-2010.

The only other alternative, no matter how improbable, is that Jeremy Corbyn succeeds. No-one could claim this to be impossible. A large recession for instance would drastically change the political debate and surely after ten years claims of ‘the mess we inherited’ would start to ring false. Perhaps this is what is really believed to be the true danger for the Labour party? Perhaps the Overton window will prove a fickle mirage and a more serious criticism than unelectable will have to be found.

Let me finish with an important reminder of the unsteady intellectual vulnerability at the heart of our current government, which may provide some context for evaluating the state of the UK Labour party:

“Vote Blue, Go Green” – David Cameron, 2009.