So, how would we increase the adoption of innovation in the NHS?
Lord Darzi wishes to increase the adoption of advanced medical technologies in the National Health Service. This looks like a decent enough aim. After all, it is true that the NHS falls behind on such things:
In the UK we are world leaders in healthcare innovation. British doctors and scientists discovered DNA, pioneered the first heart and lung transplants and led developments in modern genomics. We are now on the cusp of a revolution in which novel diagnostic tests, digital tools and biopharma products are becoming available and British doctors and scientists are again leading the way.
But there is little point in our top doctors and scientists developing new drugs, techniques and devices if they are not adopted and used by the NHS. It deprives patients of what can be life-saving therapies and creates frustration for clinicians and innovators.
We don’t enjoy that any of that is true but we’re fine with it as an account of the current reality. And we’d all like to change it too. The NHS is, among rich world health care systems, particularly bad at preventing “mortality amenable to health care”. That is, it’s not up there on the cutting edge of how to save lives.
To speed this process up, a joint government-industry group, the Accelerated Access Collaborative (AAC), which I chair, was launched yesterday in an improved form as an umbrella organisation to promote innovation across the NHS. The group, first announced in 2017, will direct innovators to sources of support, search out the best ideas, and identify cutting-edge treatments to ensure they are fast-tracked to reach more patients more quickly.
In our first year we have identified 12 products in seven areas, ranging from a computer programme to detect heart disease without invasive tests to a simplified procedure for treating enlarged prostate glands in men on a day-case basis. We estimate these products could improve the lives of about 500,000 patients and save the NHS up to £30 million. We will fast-track the use of these products by identifying clinical champions, removing financial and procurement barriers, and ensuring their uptake is supported by national clinical directors, policy teams and programmes.
That’s not the something we would do about it though. A committee to promote central planning isn’t the way to advance innovation. Innovation here being the adoption of new technologies to do interesting things like cure patients. For central planning is famously slow to innovate. From the work of William Baumol we gain the insight that it is markets which promote such, not bureaucracy.
The way to get to Lord Darzi’s admirable goal is for there to be more competition in the NHS. It can all still be taxpayer funded, free at the point of use, even non-profit if that’s what people desire. But competition is what increases innovation so if we desire more innovation we must have the competition.
As ever there are some things too important for us not to use markets. And saving Granny’s life would strike us as one of those very areas of importance whatever the strictures of the national religion.
Forty years since Margaret Thatcher became PM
Forty years ago, on May 4th, 1979, Margaret Thatcher became Prime Minister. She has been demonized by the Left precisely because she was so successful. She turned Britain away from state ownership and controls, toward free enterprise and market competition and proved their worth by the success they brought about. A remarkable string of achievements left her country more prosperous, more confident, and a major player on the world stage. She was rated amongst the most influential figures of her century.
1. She was a woman with a science degree, and rose to become Europe’s first female head of government. She inspired women to think they could aspire to succeed in what had been the male-dominated world of public service.
2. She had shown her steel in the 1980 Iran Embassy siege, when she had sent in the SAS to rescue hostages after the terrorists had killed one of them. That same resolution showed in the 1982 Falklands War, when Argentina invaded islands they had never owned, and which were uninhabited when British settlers arrived. She sent a task force and recovered the islands.
3. Her 1980 Right to Buy Scheme allowed those living in council (social) housing to buy their homes at greatly discounted prices and become home owners. Over a million people did so.
4. Inflation, which had peaked at 26 percent in the 1970s was brought under control as her Chancellors increased interest rates and indirect taxes to slow the growth of the money supply.
5. She reformed the too-powerful trade unions by making secondary industrial action illegal, instituting secret postal ballots for union leadership, requiring unions to ballot their members before strike action, and by abolishing the closed shop. She defeated the Miners’ strike of 1984-85.
6. She privatized most of the state industries, turning them into profitable and successful private firms, and popularized share ownership by ordinary people as well as professional investors. She introduced competition into them, helping to lower prices.
7. She reduced barriers to entrepreneurship, lowering regulations and creating enterprise zones and freeports. In a single day in 1986, the City of London was deregulated in a ‘Big Bang,’ ending centuries of the old boy network and turning the UK financial sector into a world beater.
8. In the Kenneth Baker education reforms she transformed schooling by giving parents a choice of school, and by allowing state funding to follow the child to successful schools. This changed top down direction into bottom up control directed by parents.
9. She brought foreign investment flooding into Britain by repealing exchange controls and by lowering taxes on businesses and incomes.
10. By taking a firm stand against Soviet aggression and expansionism, and supporting President Reagan by deploying US missiles to counter Soviet missile deployment, she was instrumental in bringing the Cold War to its end in victory for the West and freedom for those who had suffered under Communist dictatorships.
It is difficult to convey to those not there the mood of Britain in the 1970s. There was a sense of hopelessness and helplessness. Things seemed shoddy and second rate compared with what we saw abroad. Public services were deplorable, and transport pathetic. Goods and services were renowned for their low quality and late delivery. The helplessness derived from a general belief that things could only get worse, and that nothing could be done about it.
Margaret Thatcher applied vision and determination, and Britain’s recovery was as fast as it was dramatic. It took only a few years to restore confidence and optimism. What had seemed impossible actually happened. Fortune magazine and Newsweek both ran cover stories on the theme “Britain is Back!” And it all started 40 years ago. May the 4th be with her, always.
Who was it that really benefited from the cotton mills?
Larry Elliott tells us that it was only the mill owners who benefited from King Cotton:
There is nothing surprising about the hollowing-out characteristics of markets because, left to their own devices, they work in uncompromising ways. Nor is there anything new at work because just as the rewards from the cotton mills in the early 19th century went to the factory owners, so the fruits from the platform technologies go to those running the mega-businesses of Silicon Valley.
Larry Elliott is wrong on this. As Brad Delong points out:
Moreover, there is another very important group who benefited mightily from North American slavery: consumers of machine-made cotton textiles, from peasants in Belgium able for the first time to buy a rug to London carters to Midwestern pioneers who found basic clothing the only cheap part of equipping a covered wagon. Slave-grown cotton could be produced cheaply, yes, but the cotton-growers did not collude and so sold their cotton at prices that incorporated only a normal rate of profit. Cotton could be spun and woven by machines at amazingly low prices, yes, but British factories did not collude and sold their garments at prices that incorporated only a normal rate of profit.
As has been pointed out, capitalism didn’t gain QE I her pair of stockings but those Satanic mills did gain the factory girl her choice of pairs.
So too the analysis of who gains from Big Tech these days.
As in previous industrial revolutions, the automation process substitutes capital for labour and that means greater efficiency and faster growth. But the gains from higher productivity will go to the owners of capital unless workers are strong enough to resist. In recent years that has not been the case, which is why average earnings have decoupled from per capita growth rates.
It’s entirely nothing to do with the workers resisting. It’s about competition and the consumer surplus, as William Nordhaus has pointed out. Near all of the benefit, well above 90%, flows to consumers. The only reason that we say average earnings have decoupled is because we’re not measuring that benefit.
As we’ve pointed out before, for several years - between the dropping of the $1 a year charge and before it carried advertising - WhatsApp was recorded in our economic statistics as being a fall in productivity and a net loss in GDP. This from something which gained some 1 billion people some or all of their telecoms needs for free.
Getting this basic analysis right is important. Even if the essential point - the capitalists taking all the gains - is true understanding the above also tells us the solution - more competition, more free trade to provide it. So that, as last time around, it is consumers who benefit.
And set the murderous Machiavel to school
Few people have their names turned into words. No doubt Thomas Bowdler had no such intent when he published his expurgated “Family Shakespeare.” Captain Charles Boycott, ostracized by the Irish tenants of the lord he acted for, never anticipated his enduring fame, any more than did Vidkun Quisling when he served as Nazi puppet Prime Minister of occupied Norway. The top title of them all, however, surely goes to Niccolo Machiavelli, born 550 years ago on May 3rd, 1469.
He was active in the politics of the Italian city states of his day, in the world of de Medicis and Borgias. He served as Secretary to the Chancery of his native Florence and undertook diplomatic missions. While he wrote poems, songs and comedies, he is best remembered for “The Prince,” a work of political analysis set in the form of a letter to Lorenzo de Medici. What made the work infamous was its brutal realism. Machiavelli broke with the tradition of describing how wise and just leaders should behave, and wrote instead about what princes actually do.
Machiavelli wrote that governance is about seizing and holding power, and doing whatever it takes to do so successfully. It is important, he said, to be ruthless. When a prince needs to act cruelly in order to inspire fear, he should do so quickly and decisively. Benefits, on the other hand, should be eked out slowly so their goodwill lasts longer.
Duplicity is important because people see only the appearances, and are fooled by them. Rulers have to be brutal, even evil, he advises, because force is successful, whereas virtue is not; but the ruler should feign virtue to avoid incurring hatred. Sometimes, he advises, a prince has to murder opponents, especially if they are of a family that previously ruled.
His stark insights into power have made his name endure as a catchword for devious duplicity and double dealing. This overlooks his originality. He saw past the honeyed words and understood that government is about power, the power to make people live as you tell them to live rather than as they might want to live.
Many leaders since Machiavelli have realized that a monopoly of armed force can be used for the brutal suppression of dissent. Lenin, Stalin and Mao knew that, as did Castro and Chavez, and more recently Maduro. It helps if, like Machiavelli’s prince, you pretend to be virtuous, and proclaim it is all done in the name of the people. “Brotherhood of mankind” and “rule by the workers” have proved effective cloaks to hoodwink people into supposing virtue when the cold reality has always been about maintaining the naked power of the ruler and his clique.
The only antidote has been the separation of powers so that some elements of it can restrain its use by others. Even this, though, knows no final victory, only a constant ongoing tension between them. Machiavelli saw what rulers were like, and had the nerve to speak the truth about them.
The role of the state in AI
Artificial Intelligence (AI) has already changed our way of life, from predictive and transactional algorithms to improved healthcare treatments. Since AI will continue to change our lives, it’s worth our time to consider historical precedent. What role should the government play in times of rapid social change?
In 1933 Congress (USA) passed the ‘American Agricultural Act’, encouraging the destruction of crops and livestock: 6.4 million piglets were slaughtered [1]. This was done to combat “overproduction” [2]! The East India Company was granted a monopoly in 1600 [3]. We are all aware of the mercantile nature of the British Empire, a tax exemption would have been sufficient to encourage British trade in India. Admittedly two different examples aren’t conclusive but brevity insists I cherry pick. I can’t help but notice a trend in the effects of government intervention.
The Chinese and American governments are pouring resources into AI research, and no wonder when AI will likely define the world’s next superpower. However, we are being presented with an implied choice, a false choice, between government research and no research. The government cannot research AI, it can only take resources and talent out of the private sector. This isn’t the first time governments have heavily invested in AI research. The Japanese government funded the ‘Fifth Generation Computer Systems 1982’, losing out to competition, despite gargantuan funding [4].
Imagine if governments kept drills from us, in order to save construction jobs. It’s dangerous to let the government pick winners in markets, the consumer should be sufficient. If we wish to avoid problems with AI, we’re going to need to outsource problem-solving to as many people as possible, not to civil servants.
AI will allow the workforce to shift away from repetitive work toward creative work. Nail salons and genetic counselling didn’t exist decades ago, in the 19th century dead horse removal was a massive industry in cities [5]. Perhaps essay writing will become a common livelihood!
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[1] Livestock Under the AAA, The Brookings Institution, 1935
[2] Hurt, R. Douglas, Problems of Plenty: The American Farmer in the Twentieth Century, (Chicago: Ivan R. Dee, 2002), 68
[3] Niall Ferguson, Empire: How Britain Made The Modern World, page 18
[4] Andrew Pollack, “Fifth Generation” Became Japan’s Lost Generation, June 5, 1992, New York Times
[5] Jennifer Lee, “When Horses Posed a Public Health Hazard”, June 9 2008, New York Times
Alex Jones-Probert is the runner-up of the 18-21 category in the ASI's 'Young Writer on Liberty' competition.
Aditya Chakrabortty says we're all being terribly mean to Greta Thunberg
Apparently us on the right are just being most mean, playing the girl not the ball. We’ll even admit to have made the occasional pointed comment elsewhere. But the actual argument against Greta Thunberg’s demands is that they are wrong:
Which left the eco-denialists back here with a stonking great headache: how to bash this 16-year-old celeb? Not by dismantling her arguments, not when the scientists and Sir David of Blue Planet back her up. Nor by sniffing around her record, since by definition a teenager hasn’t much of a past to rake over. The standard methods of political warfare off-limits to them, they are trying something new and unusual. They are sinking their teeth into her.
She was “chilling”, declared Brendan O’Neill, editor of the hard-right website Spiked, after picking on her “monotone voice” and “look of apocalyptic dread in her eyes”. Given Thunberg’s openness about her Asperger’s, this was a dog whistle if he knew about it, but it was at best crass if he didn’t: the kid’s on the spectrum! Bringing up the rear were the bloggers at Guido Fawkes, trying to eke a three-course meal out of the morsel that Thunberg’s mum performed in the Eurovision song contest 10 years ago – cast-iron proof of “an incredibly privileged background”. This finding has been gurningly spread on social media by none other than that vomiting dustbin of opinions Toby Young. You don’t need to be much sharper than him to observe that he is the son of a baron who rang Oxford University to get his boy a place.
Aren’t the comrades just being horrible?
And to the actual arguments. Start with assuming the IPCC is entirely correct, climate change is happening, we’re causing it, we should stop doing so. What is it then that we should do? The Stern Review tells us that we should not have emissions targets and favourite technologies and selective subsidies and the central planning of the economy. Some things are just too important for us to not use the powers of markets. We should change price incentives the once and allow those markets to chew through them - a carbon tax.
Which is something that the UK has, largely and not perfectly, done. So too the EU with the ETS.
William Nordhaus gained his Nobel last year largely for exploring another aspect of the same question. We should not try to root out everything we’ve already built and replace. Apart from anything else there’s a lot of embedded CO2 in whatever it is that we build. Instead we should work with the capital replacement cycle. Use up the built environment then make sure that when we replace, in the normal course of things, we do so with non- or less- emittive constructions.
The Special Report on Emissions Scenarios, the foundational document of the entire IPCC process, points out that a globalised capitalism with such a gradual change in energy generation technology - the A1T scenario - nicely solves the problem for us. And also leaves future humanity as rich as it is possible to do so while still solving that very problem of climate change.
Other than those price incentives the only other action necessary is investment in driving down the costs of those non-emittive technologies. As per Stern, Nordhaus and all sorts of other people perhaps some judicious government investment in solar panel technologies, batteries, grids able to deal with variable supplies and so on. As even Bill McKibben can be found agreeing we’ve done that. The necessary technologies exist. As per Stern, Nordhaus etc, they will naturally be the first choice in that replacement cycle. To insist that they won’t be is to insist that they’re not ready for prime time yet.
Greta Thunberg argues that we’ve got to tear up the entirety of society and start again. All the adults in the room argue that we’re on the right path, we just need a few more tweaks here and there and then wait for markets to do their thing.
Thus the argument against Greta Thunberg and the adulation she’s receiving isn’t that she’s a teenager, nor anything else more personal about her or her character. It’s simply that she is entirely misinformed, ignorant even, on the subject under discussion.
As the IPCC assumes as it starts its work, the solution to climate change is a non-fossil fuel using globalised and free market capitalism. People proposing other solutions just aren’t in tune with, are ignorant of, the relevant science. As Greta isn’t proposing that then she’s incorrect. Which is the argument as to why we should ignore her.
When Hungary began dismantling the Iron Curtain
Many Hungarians are rightly proud of their country’s role in ending the Cold War. On May 2nd, 1989, the Hungarian government began dismantling their part of the iron curtain that stretched across Europe “from Stettin in the Baltic to Trieste in the Adriatic.” Hungary’s part of it was a 240km line of rusty barbed wire fencing just inside its border with Austria. An Austrian friend once took me through a forest to see it and one of its watch towers from a safe distance.
First they turned off the electricity that ran through it, then they began cutting sections of the wire. When Hungary's Foreign Minister, Gyula Horn, and his Austrian counterpart, Alois Mock, held a symbolic fence-cutting ceremony at the crossing, both armed with heavy bolt cutters, and filmed by Western TV crews, much of the barbed wire had already gone, sold for scrap by the Hungarian army. The most visible sign in the first few weeks was the number of cars in nearby Austrian towns such as Graz with washing machines strapped on top.
The main impact was not on Hungary, however, but on East Germany. While citizens behind the iron curtain could not travel to the West, they could travel to other countries in the Soviet bloc. East Germans could travel to Hungary, and with a hole now cut in the iron curtain, they could escape from there into Austria and on to West Germany. They began to do so in large numbers as the summer developed. Most famously at a “friendship picnic” between Austrians and Hungarians, 900 East Germans used the occasion to make a mass escape across the border. They were even given maps to help them do so. Hungarian border guards were told by their government to “face Austria and check the passports of anyone coming in.” They were told not to look behind them at people going out.
Soon East Germans were taking this escape route in tens of thousands, packing trains and buses, or abandoning their Trabant cars in Hungary as they took their one-way trip to freedom. The East German government was in impotent fury as its population drained Westwards, escaping the Berlin Wall by circumventing it through Hungary. Its leader, Erich Honecker, asked the Soviet government to intervene, but Gorbachev declined.
By their actions, the Hungarian government had lit a fuse that burned its way to the heart of the Soviet system of repression. The Berlin Wall was taken down by East and West German citizens early in November, as the Communist governments of Eastern Europe were toppled one by one, ending the Cold War in a victory for the West.
The people who today enthuse about socialism probably have no knowledge of what life was like in the socialist puppet states of central and Eastern Europe, or of the massive apparatus that had to be erected to keep their citizens from escaping. They probably have no knowledge either of the thousands who died trying.
The Hungarians who began its end knew they were taking a big risk. Their 1956 Revolution had been brutally and bloodily suppressed, and they could not be sure it would not happen again. They tell that when, in the summer of 1989, they reburied the five martyrs of that 1956 rising murdered by the Kremlin, they added a sixth coffin for the remains of communism.
Rage Against The Machine 2.0
The Industrial Revolution saw incredible advancements in technology that increased productivity, reduced prices and dramatically improved standards of living, while also liberating those crippled by abject poverty. But this was not the view that was shared by many at the time. Some saw automation, especially in stocking and textile, as a conspiracy by greedy industrialists to enlarge profits. They believed that new machines will create unemployment en masse, with a permanent underclass of workers who no longer have economic value. An extreme branch of this school of thought, the Luddites, thought that the only way to stop this was to destroy these evil machines. Laissez faire capitalism seemed antithetical to the workers’ progress, and intervention seemed the only remedy.
It goes without saying that the Luddites were wrong. Free markets and innovation led to more employment, not less, and even in the industries that they attempted to de-industrialise. This prediction is widely known as the Luddite fallacy.
However, the fallacy is alive and well. ‘Neo-luddism’ is growing in popularity, from tech tycoons such as Richard Branson, to television political pundits such as Tucker Carlson. Just like their ideological ancestors, they believe that some sort of protectionist measures should be placed on the market mechanism. Their current topic of obsession is the issue of self-driving vehicles, which is set to take over transport and delivery industries. Mr Carlson likely spoke for many techno-phobes when he said he would ban self-driving trucks “in a second” in order to protect the estimated 3.9 million U.S. truck drivers [3]. Actions against self-driving vehicles are already being taken, such as a bill passed in San Francisco in late 2017 that limited the number of autonomous robots on the streets. Ordinary people are also raging against the machine, with reports of “human on robot assaults”.
Such concerns and actions are understandable, but overall are economically and historically illiterate. With regards to the historical indifference, it could be argued that just because automation has never killed jobs (on aggregate), it doesn’t mean that can’t happen. This argument is sound. However, the economic myopia employed by such influential ‘thought leaders’ is that they fail to understand basic economic theory. Automation leads to a short period of displacement and unemployment for workers but in the long run yields lower costs of production, meaning lower prices, higher incomes, and increased demand for labour.
In the case of self-driving cars, the benefits include safer and faster journeys, faster delivery times speeding up supply chains, more trade and higher growth [4]. All of this requires more labour, as this is what will facilitate these growing incomes and lower costs of living.
In order for these benefits to materialise, we must abandon this hostility to technology. Rational discussions and debates should be had. However, we must remain staunch in our defence of free markets, as only this will permit progress. The future will be exciting and beautiful as a result.
Nim Etzioni is the runner-up of the under 18s category in the ASI's 'Young Writer on Liberty' competition.
Things will never make sense unless you consider migration
There are indeed inequities in this world but few to none of them will make sense unless one considers migration. By which we mean here the internal sorting of the country’s population, not the effects of any influx - or its absence - from outside. That Eastbourne has a higher average lifespan that the Gorbals is true, but that people move to the coastal city to retire explains some to much of that. People who have reached the age of 65 they can retire at having a longer expected lifespan than the population as a whole - and very much longer than places people leave if they can.
Equally, Michael Marmot’s insistences about health inequality become much clearer when we - as he so often fails to do - consider that health inequality itself will cause economic inequality. It is not just and only that economic inequality causes health inequality.
To today’s muttering:
Mind the green gap: access to nature shouldn't be a luxury
An interesting concept in itself, the historical human problem has been how to gain shelter from the ravages of nature. Good to know that capitalism and free markets have inverted that concern. But still, migration isn’t being properly considered:
Access to green space is important for both mental and physical health. There is plenty of research that backs that up, but it is also just common sense, something most of us viscerally feel. Increasingly, however, access to nature is becoming a luxury: growing inequality has resulted in a “green gap”. A recent study by researchers at the University of British Columbia, for example, found that access to parks and green space in American metropolitan areas correlates with class, education and race. The whiter and richer you are, the more likely you are to have access to a few trees.
It is a similar story in the UK. According to a 2013 report by the National Children’s Bureau, for example, the least deprived children in Britain are “nine times more likely than those living in the most deprived areas to have access to green space, places to play and to live in environments with better air quality”.
Let us just take that as being true. What might be causing it?
Let us again take as being true that access to green spaces, parks and the delights of controlled nature, is indeed desirable. So, what is going to happen over the decades? Humans desire these things therefore the richer among us will preferentially purchase where these things exist. The poorer will find their housing needs better met by living in the cheaper areas which do not have them.
That is, it is the very insistence that the greenery is something we value which explains the sorting into rich and poor inhabitants of the relevant areas. As shown by the difference in property prices.
There’s simply so much that cannot be understood without considering the effects of migration.
Mayday, Mayday, Mayday
May 1st could be remembered for many things. It was on this day in 1707 that the Act of Union joining England and Wales with Scotland took effect, creating the United Kingdom. It was also on May 1st that the first adhesive postage stamp, the Penny Black, was issued, creating the UK popular mail service that was used so skillfully to disseminate leaflets by the Anti Corn-Law League.
It was also the date in 1851 that Queen Victoria opened the Great Exhibition, to demonstrate the UK’s achievements to the world, and to sell them. Another great opening on the day was in 1931, when the Empire State Building was dedicated in New York. So iconic was it that it featured two years later in the classic movie, King Kong.
But mostly May 1st is hailed as International Labour Day, celebrating the achievements of working people throughout the world, and by implication, their revolutionary class struggle. It was introduced in the UK as a public (bank) holiday by the Labour government of 1978 as a sop to the unions, in a gesture it was hoped would curb their militancy. It did not.
It exacerbated an unfortunate imbalance of public holidays, already too loaded to the first half of the year. We have them on New Year’s Day, Good Friday, Easter Monday, and Whit Monday - now called the late May holiday. After the late August bank holiday there is nothing until Christmas on December 25th. We could usefully scrap the early May holiday (Mayday holiday) and add something in the Autumn, maybe the Monday following Trafalgar Day on October 21st.
It is not without significance that the socialist Labour Day is celebrated in the Spring, at the time of planting and promise. It is full of hope of what might be achieved. By contrast, the capitalist Labor Day celebrated in America takes place on the first Monday of September, when the harvest is in and its actual achievements can be hailed. The socialist one is of aspiration; the capitalist one is of achievement. It is a useful analogue of the results of the contrasting systems. The one is full of youthful hopes and promises; the other delivers the goods.
It is also of note that “Mayday,” (from the French “m’aidez”) is a call of distress recognized worldwide…