Sawbones

I doubt if there’s much of Winston Churchill’s politics that I’d agree with, but he did say that “Democracy is the worst form of government, except all those other forms that have been tried.”

That sums up my attitude to democracy. You can’t love it, but you have to accept it, because everything else is worse. Though the UK’s form of democracy is deficient, in that a party can have a large majority in the House of Commons on the basis of a minority of the votes cast; and because it gives parties an incentive to address the concerns of “marginal” constituencies while ignoring “safe” ones.

I’ll be voting “yes” in the referendum on voting reform. The proposed system, Alternative Vote, has its flaws, but I think it would be an improvement.

In the mean time, we’re stuck with a government that nobody wanted. Only 36% of the voters voted for Conservative candidates, but that gave the party 47% of the parliamentary seats. Conversely, 23% of the votes were for Lib Dem candidates, but they only got 8% of the seats. It’s a pretty fair bet that most Lib Dem voters’ “second preference” would not have been for a Conservative candidate, but a Conservative – Lib Dem coalition is what we’ve got.

I went through all that to cheer myself up a little about the good sense of the electorate. After all, only 36% actually voted Conservative, meaning that only about a third of the voters either believed the lies or didn’t care. Clearly, if you were rich, there was no down side to voting Conservative, but I suppose that this third of the non-rich who did so actually believed the fundamental Conservative assertion that a dramatic and immediate reduction in the government deficit was essential.

It has now become clear, if it was ever in doubt, that deficit reduction was a pretext, a justification for the more fundamental Conservative policy of “small government”. Or to put it another way, cutting state expenditure in order, ultimately, to cut taxation.

Conservative Election Poster

I think I remember several occasions when the Prime Minister claimed that the National Health Service would be “safe” under his government. To quote Douglas Adams, this is obviously some strange usage of the word “safe” that I wasn’t previously aware of. A major part of the current plan (initially affecting England and Wales) is to devolve many of the spending decisions to local GPs. Sounds good, doesn’t it? Power to the people.

Actually, that’s another bit of Conservative misdirection. The real key element in that idea is to allow doctors to choose between health facilities which may be state-owned or privately owned. Since each doctor will have a finite budget (of our money, incidentally), they will be driven to seek value for money, or, inevitably, to choose the lowest tender. According to Conservative ways of thinking, “the market”, or competition, is the only way to ensure that costs are minimized.

As a corollary, they also believe that private organisations always will have lower costs than public ones. The Conservative plan is clear then: break decision-making down to the small scale to confound strategic vision; limit funds to encourage choice on cost, not quality; and thus move more healthcare into the private sector.

I’d like to challenge the last link in the chain of logic there, even though there are better arguments against it (such as “why would you choose cheap rather than good if it was your own medical care?”). The idea than private enterprise must be better value than state-run is contradicted by a powerful force: simple arithmetic.

To put it bluntly, the cost of medical care plus profit is always going to be greater than the cost of care alone. If that seems not to be the case, then you’re not comparing like-for-like. Or if the NHS is less efficient than it could be, then fix it. Don’t throw it to the sharks.

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