Right to Buy… but Flexible

1) The UK’s Housing Crisis is making us all collectively poorer.

2) Right to Buy was successful but somewhat flawed.

3) A slightly modified ‘Flexible’ Right to Buy circumvents these flaws and provides a meaningful weapon against the Housing Crisis.

So what is Right to Buy?

The UK’s Right to Buy (RTB) policy allows a social tenant to buy the property in which they dwell. Buyers are provided with a 35-70% discount off the market price of their new home. In London, the maximum discount amount is £116,200. Outside of the capital (who knew such a place existed?) it’s £87,200. And herein lies the problem…

Because the tenant is only offered a discount on the house they’re living in, the inflexibility of RTB has (as a first-order effect) stopped many from being able to buy their own homes. Why? Despite the huge discount - many tenants still cannot afford to buy their own social home. Especially in London where over 200,000 social houses are in areas where median house prices exceed £500,000. Even if you get 70% off a £500,000 home, this still prices out most of those in social housing. Surely we need something more… flexible?

What is ‘Flexible’ Right to Buy?

Where ‘Flexible’ Right to Buy (FRTB) differs from RTB is that it allows those in social housing to choose to buy a house outside the one in which they were living and still redeem their RTB discount. Making their purchase potentially cheaper and in any area (with social housing) they might prefer. Consumer surplus is sure to increase.

FRTB also allows for a more efficient distribution of housing. When you give people more money and more choice when buying their home, they’re more likely to buy where they are happier, where they can earn more, and even where their families are based.

The tenant’s old home would then be sold, funding the FRTB discount and raising additional revenue for the local councils:

‘A conservative estimate of the impact would see 21,000 tenants take advantage of the scheme with £2 billion of discounts on £9 billion of stock and net receipts of £7 billion.’

RTB has been around for 40+ years, which means modest reforms to the existing infrastructure to allow for FRTB should be relatively simple. FRTB should also be politically palatable than other radical housing solutions because you can increase the available homes in areas of high demand without having to fight with a single council or planner. Hopefully.

FRTB does have a few drawbacks, though. Albeit solvable ones.

FRTB is primarily a demand-side measure. Without implementing complementary supply-side measures to increase the housing supply, increasing demand for houses by making them relatively cheaper can end up worsening the Housing Crisis. More people will demand housing when it is cheaper. And if supply stays the same, this means more people are clamouring for the same amount of houses. Not good.

It seems obvious that a policy such as this needs to be used in tandem with sensible and significant supply-side policies. And where do we find these? Look no further than the Adam Smith Institute’s housing policies: 

• Let residents in each street vote to allow existing houses to be extended upwards or outwards.

• Allow development on small areas of the green belt within walking distance of train stations, whilst preserving areas of exceptional beauty.

• Liberalise a range of design regulations, including rules on space requirements, height restrictions, window size, corridor width, stair steepness, and minimum lift numbers; Simplify the developer contribution process by replacing section 106 agreements with a single infrastructure levy.

• Legalise subletting for social tenants to make better use of existing social housing stock.

Taking stock…

As our Senior Fellow, Sam Bowman, notes in his Housing Theory of Everything - the Housing Crisis might just be the single most damaging and far-reaching ailment the UK is suffering with. FRTB is but one right step on a long road to housing recovery.

Increasing taxes on profits from investment will reduce investing

It’s a simple enough construction - you get less of whatever you tax. So, if you increase the taxes on profits from investment there will be less investing done:

Britain’s largest North Sea producer has blamed the new windfall tax as it prepares to cut hundreds of jobs and shift attention to outside of the UK.

Harbour Energy says it is reviewing its UK organisation “to align with lower future activity levels” after the tax rate on North Sea drillers was increased from 40pc to 75pc following months of soaring gas and oil prices.

The FTSE 250 company told staff of the planned job cuts on Wednesday. It has not revealed how many jobs will be lost. Industry sources believe it is in the hundreds. It employs around 1,500 in the UK.

The move is likely to ring alarm bells in Whitehall, which has been trying to boost North Sea oil and gas production even as it raids producers’ profits to try and help households facing record energy bills.

One possible reaction here is a shrug and a “Well, that’s how it works”. It’s also possible to mutter that perhaps, as we all insist that Britain invests too little, we should lower the tax rates on the profits from investing.

A much more interesting idea - interesting because it’s obviously wrong - is to insist that people don’t, in fact, consider the taxation of future profits when making investment decisions. Folk are just happy to make any return so those profits can be lifted without affecting the volume of the original investing.

We can even prove that this idea is wrong. A simple consideration of two of the largest financial markets in the world show that it is. US Treasuries pay Federal income tax upon the interest received. US municipal bonds do not pay that Federal income tax. Risk-adjusted - for all observations in this field must be so adjusted - munis pay a lower interest rate than Treasuries. The only possible explanation for this being that people look at the post-tax yield, not the pre-tax one, when making their decision over which to invest in.

It’s possible to go into more detail. Holdings of munis are heavily concentrated among higher rate income tax payers for that’s who the tax-relief is worth most to. Coroporations, who are taxed on interest in an entirely different way, hold near no munis. The only useful, or indeed possible, explanation for these behaviours being that people look at the post-tax income, or profit, from their investments not the pre-tax ones when making their investment decisions.

Anyone saying different has to overcome that evidence from the Treasury and municipal bonds markets in the US. Good luck with that one.

Taxing something reduces the amount of that thing done. So, if we desire more investment, something that large parts of the Establishment are insisting we must have, we should reduce the taxation of profits from having invested.

Jeremy in Nuclear Wonderland

MPs on the Commons’ science and technology select committee heard yesterday that the establishment of Great British Nuclear has been delayed due to friction between the business department and the Treasury over the budget for new projects. Given we know that all of the UK’s eight nuclear power plants are due to shut by 2028, apart from Sizewell B, which is closing in 2035, the need for new nuclear power is imperative. Especially when five of these are still providing about 13% of the UK’s electricity.

A new one (Hinkley Point C) is under construction but “reports surfaced this week suggesting that the nuclear power station in Somerset will not be operational until 2036, 11 years after its original 2025 completion date.” The other new one (Sizewell C) is a replica of Hinkley Point C and has been under consideration for 12 years and the government hopes to make a final decision by 2025. Being a replica should make Sizewell C easier and cheaper to build but, unfortunately Hinkley Point C has technical problems and duplicating Sizewell B would have been a better bet.

Britain’s chaotic approach to nuclear energy can all be laid at the door of HM Treasury. Prime Minister Johnson recognised the need to action and, in March 2022, grabbed a target of 24GW for nuclear out of the air which, he claimed, would be 25% of electricity demand – a not unreasonable baseload given the volatility of renewables. Unfortunately, then-Chancellor Sunak forgot to mention that electricity met only 20% of our energy demands and would have to supply nearly 100% by 2050.  So 25% of demand needs more like 56GW than 24GW and, furthermore, someone seems now to have cunningly inserted “up to” before the 24GW.

Johnson also announced that a new organisation would take charge of delivering this nuclear programme pronto, Great British Nuclear (GBN). Apparently GBN has a shopping list of what it needs to get going but the public are not allowed to see it. HM Treasury is concerned that GBN wants to spend money.

So the current plans are to decide (maybe) to add two more Sizewell Bs or Cs in the next Parliament, i.e. by 2030, and hope they are up and running by 2050.  So we’ll have four operational 2.3GW plants by 2050, i.e. 13.2 GW – well they only said “up to”. Note that the plans only encompass when decisions might be made – not when the plants might be generating electricity.

Of course, we could have a fleet of small or advanced modular reactors which are far better value for money but HM Treasury regards them as unfamiliar and therefore unacceptable. Never mind their being introduced today into Canada, the USA and China or that they are more welcomed by the French.

The Treasury nuclear wonderland has two stand-out features: delaying the commissioning of nuclear generators, ostensibly to save taxes, as discussed above, and ensuring users pay twice as much as the French or Americans to restrain our enthusiasm for buying electricity at all.  It does that in three ways. The first is fixing the way wholesale electricity prices are set so that everyone pays the most expensive tender price to the National Grid rather than (as other auctions work) the lowest.

Then it adds the “Green Levy” alongside other taxes so that today’s consumers pay for the electricity used by the next generation of consumers. Never mind renewables being cheaper, today’s consumers have to pay a premium for it.

The third way today’s consumers are hit with future costs is the “Regulated Asset Base” (RAB) model HM Treasury will use to finance Sizewell C and all future nuclear power plants. This is the successor to the Private Finance Initiative which financed £12 billion of English hospital building at a cost to the taxpayer, by the time the idea was dropped in 2018, of £79 billion in repayments. Only it is worse. The idea, like the Green Levy, is that today’s electricity user pays for tomorrow’s consumption inflated by City profits. Someone seems to have conceived the idea that if we all pay a lot more for our electricity today, it won’t hurt when the zero carbon costs hit us in 2050.

The bottom line of all this is that the Treasury’s ducking and diving is hugely damaging for today’s and future electricity users and preventing any sane nuclear policy being implemented.

Abolishing clinical leadership is no way to improve GP services

Ever since the NHS was created in 1948, GP services have remained privately run. They are typically partnerships of General Practitioners who employ a Practice Manager to look after the smooth running of the admin. The virtue of the model is that doctors themselves are in charge and, despite (in England) the deluge of diktats from their local Integrated Care Board and from NHS England, they feel empowered by the fact that they decide how their practice is run.

Now Keir Starmer has floated the idea of taking away their clinical leadership and turning them into paid employees of the NHS. Instead of the administration reporting to them, they’ll report to the administration. Supposedly, this move will allow “GPs to focus on caring for patients rather than the admin that comes with effectively running a small business” and work “much more closely with other parts of the system”.

Mr Starmer points out that many GPs already are salaried rather than acting as partners. Of course different GPs have different preferences. Some like to act as locums receiving a day rate. Some are keener on a salary than a partnership. But the beauty of the existing system is that it allows GPs to choose what sort of career they want. Nationalising GP practices would narrow those options and, ultimately, make GP careers a less attractive option.

There are two problems with NHS GP services right now. The first is that there is a shortage of doctors. There is a perception that, in the golden age, GPs were highly responsive and worked hard, and that now they’re all part-time and won’t lift a finger. In fact, the average GP is working 38.4 hours – a full-time job – even though in the way the NHS counts it they are only officially working part-time. Regardless, it's hard to see that making GPs employees would encourage more hours to be worked.

So why are there too few doctors? Well, it’s because, in our state-controlled system, the government artificially caps the number of medical students. Farcically, a new medical school at the University of Worcester isn’t allowed to take any English students because of the limit. Simon Trickett, who leads the local NHS commissioners in Herefordshire and Worcestershire, expects to spend over £70 million in locum and agency staff because of the shortage of doctors. He told The Observer: “It is really frustrating. The local system is 100% behind this medical school. The GP surgeries, the hospitals, the community services and the local councils all really want it. But it is being blocked from entering the market.”

The second problem with NHS GP services is that the incentives are set wrongly. GP practices are paid principally on the number of patients they have in their database, and not for actually seeing a patient. Is it any surprise, then, when patients of some practices find it difficult to get an appointment?

The solution is to cut public sector pensions

There is always a well-known solution to every human problem—neat, plausible, and politically impossible. This should not stop us, as with the laddie and the new clothes, pointing it out.

No doubt nurses and teachers will be even more determined to strike later this week when they see how the pay gap between the public and private sectors persists in the latest official figures.

The Office for National Statistics said private sector pay increased by 7.2%, before adjusting for inflation, while the equivalent figure for the public sector was a meagre rise of 3.3% in the three months to the end of November.

With inflation running at 10.7% in the penultimate month of the year, it is not difficult to see why so many nurses and teachers have found themselves struggling to pay food and energy bills, while an increasing number queue at a food bank.

It’s possible to go back and have a look at the numbers for public versus private sector pay. ASHE at the ONS is the source, open to anyone who can wrestle a spreadsheet. In 1997 public sector pay was some 101% of private. In 2010 115.8%, Last year, 2022, 115%. So forgive us if we don’t weep too much for the downtrodden public servants.

Of course, these numbers do not take account of the different skills, seniority and responsibility mixes in the jobs done - but all those figures suffer from that same problem so they are still comparable. The other thing they don’t account for - because they are the raw wages figures - are the details of further compensation. Job security, differences in sick and maternity pay perhaps and the biggie, pensions.

Meanwhile, other public sector staff are taking industrial action – ambulance drivers, nurses and rail workers – with others also threatening to walk out.

The NEU argues strikes are about maintaining teachers’ real pay against the background of double-digit inflation. It calculates teachers have suffered a 23pc pay cut in real terms since 2010. The union says: “This is not about a pay rise but correcting historic real-terms pay cuts”.

But the NEU’s headline figures do not tell the whole story, because they ignore the value of the “deferred salary” teachers earn through their generous defined benefit pensions, a guaranteed inflation-linked pension for life, based on salary and years worked – a major part of total public sector pay.

The annual cost to taxpayers of new public sector pensions – calculated just like private sector pensions – are published in individual pension scheme accounts.

The Teachers Pension Scheme accounts show that from 2010 to 2022 the annual cost to taxpayers of pensions, after teachers’ own contributions, shot up from 15.5pc to 67pc of salary – two thirds of salary – largely because of lower real interest rates.

Adding pensions to salary to get total pay paints a very different picture – rather than a 23pc fall in real terms, teachers' total pay and pensions has gone up by 10pc.

At which point a little theory. The aim of a pension is to accord with the lifetime income hypothesis, which assumes that we’d like to smooth our incomes. We work for 30 to 40 years, we live for perhaps 80. Rather than feast in our working years then starve we save some of that working life income to pay for the Golden Years. The theory can be extended to our borrowing before working wages arrive then paying off the loans when they do. We smooth that total working compensation over all of our living years that is.

This is true whether we call it paying taxes to gain access to welfare, making pension contributions to gain an annuity or taking out student loans. We smooth a working life’s income over all of life. It’s possible to argue with the details of this, but the base idea is obviously true.

One of those details is that an assumption is made - we’d like to have largely the same consumption possibilities over that lifetime which the working years must pay for. That might not be wholly true - consumption desires among the over-90s might be rather lower than among the sprightly 70 year olds. Fewer cruises and skydiving adventures desired perhaps - possibly offset by care costs, possibly not. But details - the base idea of smoothing is clearly true.

So, what actually is the complaint being made here? Among those teachers, public servants in general, too much of their working compensation is in delayed wages - those pensions - and not enough in current wages. The solution is therefore obvious. Cut the pensions to pay more in current wages.

Neat, plausible, and politically impossible.

In a well accounted for world those future pensions would be part of the national debt. For they are promises of future bounty from the nation’s government. For near all of them there is no fund, no pot of capital - they are simply a claim upon future tax revenues, where there is a notional fund the fallback is still tax revenues. We are not in a well accounted for world. Those pension liabilities are off the books in a manner that a corporation would be closed down and bankrupted for trying.

Therefore, while raising wages now and lowering wages then should have no effect upon the government accounts - if they were properly kept - they would in fact have an effect - because those government accounts are not properly kept.

It is still the correct solution though. Cut public sector pensions to raise public sector pay. Unless, of course, once we’ve included the value of those pensions into those public sector pay packets we just decide to cut them anyway.

Why Existential Risks are really really bad

Imagine what a catastrophe looks like to you. Running out of toilet paper mid-bathroom visit? Stubbing your toe? Making a bad investment? Losing a key election? Or even being forced to watch Love Island by your housemates?

Now think bigger. When we talk about Global Catastrophic Risks (GCRs), we mean world wars, huge forest fires, single (or double as in the case of the attack on Japan in 1945) nuclear bomb attacks, cyber hacks that take out continental energy systems, and more. 

Now think even bigger. An event that kills or impedes so many people (perhaps 99 per cent or more) that humanity as it once was may never, ever recover. Types of X-risk include:

• Climate Disaster – an event so destabilising it obliterates agricultural supply chains, forces mass migration, and induces extreme floods, droughts, and other weather events. This may be caused by man-made climate change, or by an asteroid hitting Earth, or even a nuclear winter.

• Nuclear War – as we saw in 1945, the firing of 1 or 2 nuclear weapons is indiscriminate and a huge loss of life. But it wasn't quite a GCR nor anywhere near an X-risk. However, a nuclear war between, say, the US and Russia - with a combined 11,405 warheads between them - may bring about a nuclear winter from which there is no coming back.

• Biological Risks – both naturally occurring and man-made pathogens could prove much deadlier than the COVID-19 pandemic we just suffered. Some in the field of Biotechnology are more fearful of artificial pathogens which could be created as a weapon. The Government Office for Science report expresses similar worries. With genetic advancements, it is becoming easier and thus more likely that a rogue terrorist group (or state) might seek such a destructive power.

• Artificial Intelligence – what’s AI going to do? Is ChatGPT going to take over the world? Not quite. But some fear that this increasingly more powerful technology could one day be as smart if not smarter than people. And at such a point, how do we ensure they are acting in our interests? How do we ensure they don’t turn us into paperclips…
  
  

These are all examples of X-risks. I know, they sound like they’re straight out of a science-fiction book… but they’re not. And they’re more likely to happen than we think.

Professor Toby Ord, a Senior Research Fellow in Philosophy at Oxford University — whose work focuses on the big picture questions facing humanity — puts the likelihood of an X-risk event at a 1-in-6 chance of happening this century. Other academics in the fields are less conservative.

Scary, right? If there was a 1-in-6 chance of you dying today in your car journey, would you drive? An X-risk event would be so bad for the UK and for the rest of the world because it is virtually irrecoverable. So one would hope we are doing a lot to prevent it? Not enough, I’d argue.

A charitable explanation as to why the UK does not seem as prepared against X-risk as it could be has something to do with both 1) the inherent ‘short-termism’ we see in our Governments, and 2) the relative unlikelihood of an X-risk occurring. It seems (politically) more rational to use extra funding to bring about services that will win votes at the next election. But, as the pioneering AI Professor Stuart Russell said:

“You can’t fetch the coffee if you’re dead.”

In other words, we cannot even think about making the world a better place through policy if we’re all… dead. An X-risk will destroy not just our economy, but might also mean the end of the human race as we know it. This sounds bad to me!

What kind of policies might be helpful here? The Centre for Long Term Resilience (CLTR) has an idea which includes the implementation of a government Chief Risk Officer (CRO). A ‘three lines of defence’ model will introduce less siloed risk management with clearer accountabilities across government. And on AI, our work at the Adam Smith Institute has rightly focussed on how AI might or might not steal our jobs.

But we should probably start thinking a little harder and a little longer about how we might avoid X-risks.

Driverless cars will change us

The Department of Transport is very worried about self-driving cars. Their new report finds that the new technology could make traffic 85 per cent worse and exacerbate the current congestion situation — where motorists spent an average of 80 hours last year.

Looking at the small print, however, the Department reckons this spirit-crushing rise in driverless car congestion isn’t going to happen until 2047. Assuming a ‘fast uptake’ of the technology by which autonomous vehicles make up half the car fleet by then. 

And maybe the Department is simply softening us up for a whopping ‘congestion charge’ (a.k.a. a tax on vehicle use). After all, with the switch to electric-only vehicles promised by 2030, they’re not exactly going to raise much from petrol duty!

But I’m still not convinced. Because this report, like so many others that emanate from Whitehall, ignores the fact that the public adapts to changing circumstances.

For example, I regularly drive from Southern England to Scotland. It takes most of a day, it’s very tiring, and traffic hold-ups on the motorways are a big frustration. So when I get my driverless car, am I going to do the same journey but take nine hours’ worth of reading matter with me?

No, I’m going to get into my jim-jams, set off long after the pubs have closed, and wake up in Scotland after an overnight journey that takes two-thirds of the time. Driverless vehicles will allow people to spread their journeys into less busy times.

And another point. Just about every time I drive 400 miles to from and to Scotland, I see at least one accident or near miss, many of the former holding up traffic, and sometimes adding half an hour to my journey. Driverless cars will be safer. They don’t nod off and veer into the next lane. They don’t overtake dangerously. They know how to keep control of the vehicle if they hit some broken glass and a tyre goes.

And they can be more efficient too. They know what the most fuel-efficient speed is in any set of conditions. And unless you are in a rush, you can benefit from all that saved electricity cost. These are positive improvements, congestion or no congestion.

In town, driverless cars will really free up urban road space. Right now, it’s hard to navigate through many of our towns and cities, particularly the older ones with narrower streets, because of all the cars parked outside people’s houses restricting the flow. Sometimes people are parked on both sides such that two vehicles can’t pass each other and you have to slalom from one side to the other.

The thing with a driverless car is that you don’t have to leave it outside your house. You can tell it to park somewhere else. Or go make money for you on some new driverless car ride-hailing app. So the car drops you off, you turn in, the car goes off to the car park on the edge of town, then when you get up in the morning it comes along to pick you up again. And it gets to you very easily because there aren’t streets full of parked cars to impede it.

The mandarins at the Department of Transport should remember, too, that any car brainy enough to navigate its way round Hyde Park Corner and up Piccadilly without running into anything or anyone else is probably brainy enough to figure out the quickest route to wherever you are going.

We will end up with, arguably, fewer cars on the road — but ones that are used more intensively. One car can serve the needs of scores of people at different times of the day (and night). Autonomous vehicles can even pick up your groceries, and your neighbours’, and drop them off one after the other, without you needing to get in the car to go to Sainsbury’s.

My prediction, then, is that autonomous vehicles will lead to less congestion, not more. By spreading journey times, ungumming streets, navigating the quickest routes and by being shared by multiple users. I’m just hoping that medical science, too, will advance enough that I will still be around to tell the Department of Transport that they were wrong.

The NHS doesn’t cover what it used to

One of the ways the NHS in England has rationed services is by labelling some treatments as “Procedures of Limited Clinical Value”. Introduced from 2009 onwards, the label is a way of focusing NHS expenditure on surgery with the greatest clinical benefits. Sounds a reasonable way to get value for money, doesn’t it?

Yet, according to the Royal College of Surgeons, Procedures of Limited Clinical Value have “been extended” because of financial restrictions and “many proven operations known to enhance health and improve quality of life have been included in this category, and hence are being denied to patients who need them.” What’s more, the Royal College says that: “Many of the procedures deemed of low value prevent complications and more serious conditions developing later. Denying them ultimately endangers the lives of patients and the standard of treatment available in the NHS.”

In reality, the supposed Procedures of Limited Clinical Value include surgery that a specialist in an NHS hospital thinks their patient would materially benefit from. What counts as a Procedure of Limited Clinical Value is determined locally by NHS commissioners, so the list varies around the country, but banned treatments can include early cases of cataracts, hip replacements for osteoarthritis, surgery for shoulder pain and hernia repairs, where patients are deemed not to have met a “clinical threshold”.

The patient might well be told that they could apply to the local NHS commissioners in an attempt to get special funding for their treatment – a process designed only for exceptional circumstances. Patients in NHS hospitals may also be given the option of paying for the treatment themselves, either in the private patient unit of the NHS trust or in a nearby private hospital.

So why is this rationing happening? The easy answer is to suggest that it’s due to cuts in NHS funding. The only problem with this argument is that NHS funding has significantly increased in real terms during the entire time that Procedures of Limited Clinical Value have existed. The real issue is that resources the NHS already has are not being used productively because the incentives in the system are set wrong.

I used to work for a private provider to the NHS, which ran the Nottingham NHS Treatment Centre for 11 years, under an initiative created by the Labour government. The operating theatres there ran at 1.5 times to twice the throughput of an NHS-run hospital. The building used thinking that came from Lean manufacturing, where the aim was to eliminate waste in processes, so surgeons never had to wait for the next patient. Systems were organised like a Japanese production line so that everything was in the right place at the right time. The centre was great for cutting down the waiting lists in Nottinghamshire, and it had an excellent safety record. Indeed, the Care Quality Commission rated the facility as “outstanding” for surgery.

It is difficult to replicate high productivity in NHS-run facilities because there are bureaucrats and incentives trying to stop it. NHS surgeons are paid fixed salaries, whereas in the private sector they are typically paid a fee for each patient they treat, or paid for a “session” (what others would call a shift). As a result, the private sector gives them a big incentive to make themselves available for extra weekend or evening surgery, and to have a well-organised operating theatre so they can treat as many patients as possible. Conversely, if doctors try to increase the throughput of an NHS operating theatre to get through the waiting list for elective treatments, they may be discouraged from doing so to save costs and to help the budget of their local NHS commissioners. So the NHS has huge overhead costs for buildings, equipment and staff, but tries to save money by slowing down the treatment of patients.

Childcare isn't worth it

Agreed, this is going off the reservation polite society inhabits but it is true that childcare is not, in fact, worth it. Or, to narrow the claim a little, much of the childcare that it is being proposed we all pay for is not worth it:

Bridget Phillipson, the shadow education secretary, believes the “scale and ambition” of Labour’s childcare reforms will compare with Aneurin Bevan’s creation of the National Health Service.

In a bid to resolve one of the biggest problems facing families, and therefore the economy, the rising Labour star has a plan, as yet not fully costed: to guarantee childcare for all parents of children aged nine months to 11 years.

That children are taken care of is, of course, entirely worth it. So much about homo sapiens sapiens only makes sense when seen in the context of the young of the species being helpless for just so many dang years.

But that other people are paid to take care of other peoples’ children isn’t, for the vast majority, worth it. In that overall and national economic sense.

Britons pay the third-highest childcare costs in the developed world. The average cost of sending a child under two to nursery full-time is £263 a week, according to the National Childbirth Trust.

Let’s just use that number as the full cost. It isn’t, that already contains some subsidy but we’ll use it all the same.

So, we have a cost to society of that £263. The average wage in the country is £32,000 a year or so, call that £600 a week. The benefit of bearing the £263 cost is that a further parent can go out to work instead of being stuck at home. We gain the benefit of the £600 in production at the cost of the £263.

But that’s only for someone on median wages. Someone on minimum wage might make £370 or so working full time for a week. And once we tick off taxes then the value of the output is pretty close to that £263 cost. So, it’s not obvious at all that paid childare for someone on lower than median wages is in fact a worthwhile economic endeavour.

Or, of course, if there are two children - which is, among families which have any children at all, the modal number. £263 times two is £526 and it looks like it’s not worth it even for someone on median wages - and it’s definitely not for someone on minimum.

For those in the top 10% of the income distribution this all makes perfect economic sense of course. But for those lower down, well, it really isn’t obvious that the economic output gained is worth the economic costs that have to be carried to gain it.

Therefore, you know, we shouldn't do it.

We do, these days, call it childcare instead of having servants but it’s the same activity all the same. And has always been true it’s only logically sensible for those who can afford servants to have them. Waving around claims of subsidy from taxpayers - that’s all the rest of us - doesn’t change this calculus at all.

For very large portions of the British population paid childcare doesn’t make sense. So, why is everyone shouting that this is what we must do?

We can put this more simply perhaps. The lady who does the childcare has children. So, the children of the lady who does childcare have to go to childcare to free up the lady to do childcare. And what on Earth do we gain from that arrangement?

How rationing in the English NHS stops patients seeing specialists

Over the past decade and a half, the NHS in England has offered some modicum of patient choice. The instigator was Tony Blair, who was determined that patients should receive treatment within 18 weeks of being seen by their GP. And so, he introduced a range of reforms to cut waiting lists, including the introduction of Choose and Book.

Choose and Book was a system whereby for a range of conditions, such as joint pain and eye problems, patients were offered a choice of hospital. Instead of automatically being sent to their local NHS trust, they could also choose from availability in private hospitals, with the NHS picking up the bill. Patients loved the opportunity to select a faster appointment, and this helped cut NHS waiting lists.

Of course, the NHS establishment hated the reform, believing that the money from operations should stay in the public sector. Over time, the NHS has undermined it. First, the software was rebranded from “Choose and Book”, a nice, patient-friendly term which encouraged selection, to the bland-sounding “e-Referral System”. Then a new form of rationing was introduced which stopped it working as well. For many health problems needing a referral to a specialist, GPs are now banned from making that referral directly. The e-Referral System now only allows them to refer a patient to an NHS referral management service.

Referral management services exist to cut the number of patients seeing specialists. GPs apparently can’t be trusted to decide whether a patient needs to see a specialist, so NHS bureaucracies all over England have been created to decide if they should block the patient’s visit. A typical experience once referred to a referral management service is that a patient receives a letter saying that their case is waiting to be examined and that they should not call to enquire on progress for at least two months.

By the time the referral management service gets round to examining the patient’s record, some patients will have simply given up or gone private, saving the NHS money. Then the game is to try to get the patient to accept some form of care that doesn’t involve seeing a hospital specialist. For example, if the patient has joint pain, she might be encouraged to do some exercises at home, download an app or read some online literature. Alternatives to surgery are encouraged, such as physiotherapy – which is often the best treatment anyway – or the patient might be encouraged to put their knee in a brace rather than have knee surgery. All this saves money and cuts down on referrals to specialists.

We can think of this approach in two ways. On the one hand, many patients who see a specialist will be offered something other than surgery anyway. After all, it’s better for a patient to avoid an operating theatre and have some less invasive treatment if they can. By discouraging or preventing a patient from seeing a specialist, it saves the NHS money. On the other hand, this approach could be perceived as a bit cynical. Indeed, it could actually be seen as discriminating between different types of patients. Pushy middle-class professionals will insist on seeing a specialist, whereas less well off patients might be fobbed off more easily. Far from the NHS in England offering equality, it is possible that access to NHS specialists is now affected by wealth and confidence.

The upshot is that the experience for NHS patients in trying to see a specialist is often pretty bad. The gap between this and the private sector is huge and increasing. If a private patient is paying out of pocket for her own treatment, she may not even need to see a GP: she can book straight in with a specialist within days, and get an assessment and advice from a specialist.

I suspect that most people, given the choice, would rather have their case examined by a specialist rather than an official in a call centre or a less qualified clinician. And they certainly would rather not have the hassle of NHS bureaucrats slowing down and trying to block their treatment.