Indeed Unity. I always think the crucial point was when in the Boer war the army found that laods of people it was recruiting were unfit for service! Quite a comment on the lives of the worst off in that period.

Is someone going to write a proper diary on comparative healthcare? I think there’s reason to treat Roger’s statements with caution, but it deserves a diary to put some parameters around the debate…

Before responding to anything, I just wish to point out/reject the framing exercise that is labelling me as referring to “a golden age”. Please strike that from your consciousnesses, for that is not what I am doing.

Metatone – take a squint at Danish healthcare a little closer, if you may. It might be your comments that need a little more caution!

Like all such Golden Ages throughout history, it didn’t really exist.

I think this is one reason why I’m so suspicious of a party that calls itself ‘conservative’, which says to me “let’s keep everything the same.” The same as what? And why do you suppose that would be a good thing?

You can just as easily be suspicious of progressive movements on the same grounds – to me that says “change everything” – change it into what and why ?

Mr Thornhill, it’s fun watching you make assertions, but it’s not deeply informative. That’s why it’d be nice to see a larger article from you about the Swiss system, then we’d see if your arguments actually stand up. So, far, they fail the WHO and OECD evidence test, repeatedly.

Roger:

The point I’m making is that, whether or not you specifically identify a particular period as a ‘golden age’ of philanthropy, generosity and self-reliance, the historical facts are clear as regards the social conditions that existed and operated throughout the first great experiment in free market capitalism – 35% of Londoners living in abject poverty and large segment of the population deemed unfit to serve in Boer War.

Charity and self-reliance, on their own, simply aren’t enough and the real lessons of the Victorian experiment in near unrestrained market capitalism aren’t to be found in the good works of an enlightened few but is just how close we came to a popular revolution, especially during the early part of the Chartist period.

“Play the ball not the man”

Mmm, didn’t quite work out with Neil Clark did it? (http://tinyurl.com/2jrr2c)
Was that OK because it was a ‘democratic’ decision to delete any reference to a ‘fascist’ in ‘Casting The Net’? Well, when I say democratic decision what I really mean is that Sunny decided to dump the reference even though it was in a piece written by Aaron – very liberal minded I must say! Frankly, if I were Aaron I’d have told you to poke your column after that.

And the commenters (including Sunny who also slurred Iain Dale in the same comments) found no difficulty in rererring to Clark as an odious, wretched idiot (as well as a fascist).

Oh yes, indeed, do play the ball chaps.

A wonderful start.

Re the mutuals of the nineteenth century, it might be more accurate to say workers were generous *within their means*.

Under a genuine (i.e. non-capitalist) free market, in which the state did not intervene on behalf of capitalists and landlords to enforce artificial scarcity of land, and consequently labor received its full product as a wage, polarities of wealth would likely be far less. In such an environment, the working class would have the resources to fully fund mutual aid arrangements, cooperative insurance, and the like.

To paraphrase some Georgist-leaning libertarian on this side of the pond, the policy should not be welfare or charity, but justice. When workers receive their full product as a wage, they won’t need charity. And you won’t see society pages clogged with Rotary club yahoos wearing color-coded ribbons, breaking ground, handing over giant checks, kissing pigs for diabetes, etc., who in any just world would have their heads in a guillotine.

My attitude toward upper class philanthropy was expressed by a 19th century mill-worker, quoted by E.P. Thompson, whose attention was drawn to a chapel built by the “generous” mill-owner for his workers. The worker pointed out that the chapel was paid for by his own sweat, and added “I wish it might drop into Hell, and Mr ____ with it.”

Kevin @9,

Well put, but maybe not the way you might think.

What many do not realise is that, through the agent of Welfarism, the State has become one giant “mill owner” who denies the worker the fruits of their labour via heavy taxation to fund its “charity”. Worse, there is no way out – you cannot escape the mill town now. You cannot flee the State unless you emigrate. Never before has a Mill Owner been so soundly backed by law, or had the power to control the law as we have now. Never has the arm of the Mill Owner been so long or their grip so tight and all-encompassing. And now our screens and newspapers are indeed full of smug parasites handing over cheques paid for by the sweat of others…this time it is Statist politicians. This time it is all of us, not just the benighted workers trapped in some satanic fiefdom paid in tokens for use at the company shop.

Yes, let us have Justice in the form of the worker keeping the fruits of their labour. This does not prevent charity, indeed I say it can encourage it, and said it earlier, triggering a framing exercise that is the OP (which I will attend to later).

With Welfarism you have precious little Justice and precious little Charity. To the guillotine with it!

Sadly it is looking likely Roger (are you a member of the Adam Smith Institute?) will get his way and that we are hurtling back to an age before the Welfare State: that ‘Golden Age’ when people couldn’t afford a doctor, when child mortality was sky high, often spent many years in awful condition in the workhouse and then buried in paupers graves(apparently Frank Field is even calling for a return of the workhouse!)

It’s certainly unlikely there will be a welfare system as we know it in the u.k within five years. for example, the Tories are backing the Winconsin model of welfare, which basically means there is no welfare, plenty of ‘help’ job clubs, etc, but no money. Watching a package on it on Newsnight recently. It seemed to be a nightmarish and barbourous system using Orwellian language such that leaving people to rely on charity is described as ‘giving help’.
This is certainly the next phase of the neo-liberal offensive, the marketisation of welfare and the extension of the notion of the ‘deserving poor’. In the UK, the New Labour Gov’t are being aided by giant US multinationals (often corrupt, see below) who see rich pickings and UK training companies such as A4E who also want a piece of the pie. If the WM was ‘imported’ here as looks likely, (all main parties are rushing to attack the poor) it would cause misery for millions of claimants: particularly disabled claimants whose entry to the workplace is often difficult. It is clearly based on victorian values and blaming the victim, it was revealing that someone has to feed those who won’t get benefits and while there some progressive groups feeding the poor, of course it’s the Christian Right/Evangelicals with their disgusting notion of the deserving poor who were on hand to give a sermon about self help along with some groceries. Clearly the sanctimonious and the misanthropes will love it, cuts in welfare plus and you can feel good about it by giving some food to the needy.

It’s also interesting that while the neo-liberal economy is being challenged in so many areas, in welfare it seems to be in the ascendancy. We shouldn’t forget welfare systems worldwide were fought for by generations of trade unionists and activists such as the in the U.K, the National Unemployed Workers movement in the 1930’s etc,. Now, they are being dismantled in front of our very eyes and progressives, and todays’ unions etc seem to be doing nothing. Indeed, Brendan Barber, president of the T.U.C has broadly supported the UK welfare reforms.

Don’t the neo-victorians on here realize that life without benefits will lead to a dystopian future, some people of course will ‘triumph’ and make some sort of a life, but there is no doubt crime would rise and maybe over time social unrest. Though many will blame themselves and fall into despair, becoming invisible. Further, while benefits are still available in the UK, ‘reforms’ over the last few years have already made it one of the most draconian in Europe.

Btw, I do think this site has a real chance of creating a new momentum for the left, I do think, censorship question aside contributors like Roger should really be on Conservative or (new) Labour Home, I find his comments about poverty highly offensive. .

excellent summary on where welfare is going here:

New Labour, the market state, and the end of welfare

Jonathan Rutherford

Jonathan Rutherford looks at the connections between government and the insurance business in their joint project to reduce eligibility for sickness benefits.

http://www.lwbooks.co.uk/journals/soundings/debates/36rutherford.html

Since this all began with my suggestion to Roger with my criticsm of libertarianism suggesting that it was a “quasi utopian theory with not a jot of proof that it actually works”. I think that I’ll have to chip in my own couple of cents here.

I’m a left leaning Labour statist sort, who has little truck with libertarianism. My view of libertarianism is that they advocate a minimal state, providing only defense, law making and resolving legal disputes. Most libertarians I assume, would advocate such a model and suggest that it is better than any other alternative.

The problem I have with this set of ideas is that I really don’t see either a valid theoretical basis or a historical precedent for drawing this conclusion. The theoretical basis for this seems to stem from the idea that if you let people make their own decisions they will allocate resources in the best way possible. I consider this to be a leap of faith on the part of the libertarians.

As far as a historical precedent, the only examples of where libertarian ideas get an airing are 19th century and early 20th century liberal England. This doesn’t look good based on Unity’s analysis above. I assume libertarians would that technology rather than the welfare state has been the main driver for the rise in living standards, this may be true, but I think a few points need to be made here.

First is that the behavoir of most wealthy industrialists was not particularly philanthropic. Generosity was the exception rather than the rule, this indicates to me that expecting the deficit of welfare provision to be made up by individual generosity is wishful thinking.

Second, with regard to economic growth, many libertarians argue that by reducing the tax burden leads to greater economic growth. This does not seem to be borne out by comparisons over these historical periods, I don’t have any figures to hand but I believe that there is little difference between economic growth in the late 19th century (Classical Liberal England) and the post war 20th Century (the peak of the welfare state), in fact, I believe that post war growth was slightly better.

The system has it’s problems, but I really don’t see on how libertarianism can be considered the solution.

Andreas Paterson,

I’d agree with your analysis of the problems with the libertarian position.

However.

What was quite interesting in Zhoras’ thread was that a more nuanced arguement developed. Put at it’s simplest, Roger then went on to argue that a competitive sector would, in fact, be able to provide universal health care and suggested that the Swiss model had merit. Whatever you think of it, the Swiss system is no libertarians fantasy.

Insurance is compulsory. The state picks up the tab for the destitute, etc, etc.

If we are going to see progress, then Roger cannot, I would hazard, expect this forum to give free reign to rampant libertarianism. In the sense that it will be debated to death. However, neither should this forum have truck with those that spout the mantra that the NHS is the “Best Little Health System in the World”, when it clearly is not.

Anyone left to fall out with?

My modest proposal was that we should be looking at best outcomes and practice. As far as I recall, no one asked to ‘see me’ on that idea.

The French seem to be quite good at this sort of stuff. Health Care, I mean.

Zohra,

Sorry about getting your h out of place.

In the other thread I was somewhat torn between writing a reply about libertarianism of a reply about healthcare I ended up with a confused mess that I ended up throwing out.

Beyond that though, I think the need to continue the debate on healthcare in it’s own thread (hopefully not this one). In short though, I think it would be wrong to misrepresent my position as blindly believing in the greatness of the NHS. I’m open to ideas but don’t want to fall for the middle ground fallacy.

I feel that our perception of the NHS is too often distorted by negative press coverage that is unrepresentative of it’s day to day performance. I think that it can be said NHS does at least do a reasonable job and I am skeptical of the “the NHS is broke, we ought to do something” attitude.

I’m not sure that some catchy or radical policy change is really any better than just keeping the NHS stable with gradual changes where needed.

In the league tables from various studies that people including myself referenced, NHS performance relative to other countries was variable with the NHS better than another country in one study but worse in a different study. This to me suggests that we should take these studies and their results with a pinch of salt. Oh, and Switzerland spends 60% more per patient on healthcare than we do. (source)

Andreas Paterson,

In short though, I think it would be wrong to misrepresent my position as blindly believing in the greatness of the NHS. I’m open to ideas but don’t want to fall for the middle ground fallacy.

Oops! I certainly didn’t intend to imply that.

The evidence suggests that the French have the best Health Care system on the planet. We float about at around the mid teens. What I am suggesting is that we look at better ways of provision, with the blinkers off.

And, perhaps to assuage you, we should look at what they do, think about it, and then decide. That is not the philosophy of a radical. It is, I would suggest, a sensible approach.

I am no more thurled to a Swiss system than an American one. What I do think is that looking at the best, for everyone, should be what a Liberal Conspiracy is about. And, btw, the American one is rubbish.

This is not, for me at least, about politics. It is about getting the best possible Health Care for the citizens of the UK, and if it is better, then we should look at adopting it.

I agree, this needs a thread of it’s own.

John Rogers @11.

John, “highly offensive”? You really need to justify why you see fit to use that kind of language. Just because you are offended by something, does not mean I am or what I say is offensive…and yes, your suggestion IS censorship, no question.

Andreas @12.

I think Douglas has responded and my own posts will bear out that I am no idealistic, dogmatic Libertarian.

As for “leap of faith” it is just as much a leap of faith to think that the State can spend money in the best way, or at least better than the saps (i.e. us) who actually EARNED the money in the first place. Evidence is strong to say it is not. I cannot provide the link right now but studies have shown for every £1 in tax revenue, the State manages to procure purchases of a value 30p. That is appalling.

To suggest that there is no theory behind Libertarianism, or, as you are describing here, Minarchism, is an odd one, to put it politely. I am not aware of the ratio of Libertarians who promote such an extent of Minarchism you suggest, but I think it is unwise to generalize in the way you do.

As for the deficit in welfare provision, the fact that it will not be made up is precisely the point. People are not willing to finance such spending voluntarily in the areas the State and their lobbyists decide. Large numbers object to some areas of spending. To suggest that charitable giving would not rise if taxation fell significantly (as Unity does – I have not forgotten!) is a “leap of damnation”, to use the terminology here.

If you do not believe in low taxation, then it sounds like you are in favour of the National Mill Owner, who denies the worker the full fruits of his labour so they may spend on “charity” at the Mill Owner’s discretion, and to the benefit of said Mill Owner in terms of patronage and ego.

p.s. Switzerland spends more per person, but around 40% is top-up for private add-ons. Considering the Swiss system delivers what is described as equivalent to an excellent private plan in Germany or the US as the BASIC minimum package required by law is something worth thinking about. Anyhow, I am not hung up on precisely the Swiss model, but one that resolves the dysfunctions of the NHS in terms of it being a State run, direct taxation funded monopoly.

p.p.s. I also think the American public healthcare system is seriously in trouble and no example to follow.

Unity @7,

I have to disagree. Your entire article hinges on at least two presumptions. 1, that I am referring to a “golden age” – you use that concept repeatedly and the entire article hangs from that scaffold. 2, you suggest with zero evidence that I have been “failing to appreciate that the historical origins of welfare state”, which is just not so. Quite the reverse – welfare provision began as voluntary cooperatives but these were killed off by the State going back on its promises not to do so and introducing by stages Welfarism.

If you trawled the population today you are just as likely to find an even larger proportion of young people unfit for active duty. In 1914, Australians were fit and strong yet most Londoners were not. Is that a fact of Liberal Capitalism/Welfarism? No.

If you want an example of how a town can exist very well thankyou without the State, then see from this posting by the now lapsed blog Raw Carrott:

++++++
The other day I purchased several second hand books on the history of my local town. I was surprised to see quite how bad a job the Left (and other Statists) have made of improving the town over the years. In fact, an objective observer might be forgiven for thinking the council and central government were determined to ruin, rather than improve, the town.

The works display, quite clearly, that long before the “welfare state”, at least as we know it today, came into existence, there was a fairly substantial amount of “welfare” available to residents of my local town.

I also purchased a map of the area dated 1899. With the books and data from the map, I was amazed to discover that the town has boasted the following facilities:

* Several swimming pools
o There is now only one

* Two police stations
o There is now only one

* A delightful town hall
o They replaced it with an ugly expensive one

* A cricket ground in the centre of the town
o It’s not in the centre any more

* A cycle track
o There isn’t one any more

* A rugby and football pitch in the centre of town
o The rugby isn’t in the centre any more

* Two well-equipped and clean local hospitals
o The nearest hospital is now 12 miles away and deadly

* Four train stations served the town
o There are now only two

* Trains to London took 16 minutes
o They now take at the very least 23 minutes, usually more like 45.

* There was once a wide selection of good schools
o There are now just failing state schools, mediocre state schools and private schools.

* The High Street used to have real shops
o We don’t even have a Dixons any more

* The area used to have many real pubs
o We now just have BOGOF-pub-bars

While the loss of Dixons from the High Street may be considered a good thing, it seems pretty self-evident that the town has been ruined. The best bit though, is that the two local hospitals were not paid for through taxation – but through patronage, charity and paid contributions from the local community.

In fact, the larger of the two hospitals was founded in 1879. In 1882, a mortuary, ambulance house and other “conveniences” were added. In 1900 a donation of £10,000 was made by a local benefactor. Additional land was acquired, a new operating room erected and fitted with “every modern requirement” and several other improvements were made to the establishment.

A further £10,000 was left to the hospital by another gentleman and was used to found an extension to the hospital, including the installation of “a complete X ray apparatus”.

To give an idea of how wonderful this healthcare provision was, consider that the hospital was built in 1879 when the population of the town was just short of 8,000 (see graph below). Note how, as the population increased so too did the facilities and size of the hospital. One might say the town had a health care system responsive to the needs of the local community.

Population growth

Today, with a population in excess of 65,000 people we have one “real” in-patient hospital and it’s located about 12 miles away (a 23 minute car journey). It also happens to be a rather shit hospital (complete with utterly meaningless “Three Star” rating)…

++++++++

So many people seem to think the world was workhouses and Dickens before 1948.