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How Milton Friedman inspired coalition NHS reforms

by Dave Osler     January 18, 2013 at 12:30 pm

When you trust someone to wield a scalpel on the most sensitive parts of your anatomy – and such, dear reader, was my painful lot some 18 months ago  – you cross your fingers and hope they are a properly trained surgeon.

But according to the libertarian right, regressive attitudes like that hold back the development of a free market in health services.

The requirement for licensure both prevents all and sundry who wish to practice medicine from doing so, and deprives the rest of us of the opportunity to purchase their services, and so should be scrapped.

In case you suspect that I am making this stuff up, it is all there in black and white in the work of Milton Friedman, a thinker whose impact on the policies of governments of all parties since the 1970s has been incalculable.

On a range of issues from monetarism and exchange controls to the clear ideological animus against public housing, the emasculation of trade unionism and explicit tolerance of tax avoidance, Friedman’s ‘Capitalism and Freedom’ has been the de facto blueprint for successive administrations.

His stipulations often have had to be watered down, simply because they are too extreme for public taste. But Friedman’s work is nonetheless crucial to understand neoliberal thinking, largely because it provides the intellectual underpinnings for what Thatcherism, the Third Way and now the coalition have tried to do.

That brings me to the present government’s decision to hand over the National Health Service to the private sector, which will effectively result in the transformation of hospitals into what Friedman called ‘department stores of health’, acting as intermediaries between patients and service providers.

Such a change is necessary, the late economist maintained, because bodies like the British Medical Association, which licences doctors to practice, are monopolists who purposely restrict entry to the profession in order to boost members’ wages.

Instead, Friedman suggested an alternative based on untrained practice, including practice by ‘people who have no professional qualifications at all’. And of course, when it comes to routine matters such as scans, it would be foolish to argue that doctors should undertake tasks that technicians can carry out perfectly well. But Friedman wouldn’t stop there.

‘I conclude that licensure should be eliminated as a requirement for the practice of medicine,’ he writes, and anyone should be ‘free to practice medicine without restriction except for legal and financial responsibility for any harm done to others through fraud and negligence’.

Individual GPs and hospitals should be replaced by the medical equivalents of John Lewis and Selfridges, with consumers able to judge between them on the basis of reputation. That having surgery is an act in no way akin to purchasing a pop-up toaster is in no way considered an obstacle to such a vision.

Here we have the inspiration for the Clinical Commissioning Groups and the ‘any willing provider’ clauses contained in the Health and Social Care Act, which is the strongest medicine the Tory and Lib Dem right feels it can get away with forcing down the electorate’s throat right now.

Naturally, it would be hyperbolic to maintain that the legislation is the full Friedmanite Monty. But it takes us more than half way there, and its impact on the standards of practitioners is all too predictable.

Never mind doctors without borders; the next stop is doctors without qualifications.

Scotland: at least Labour could oppose independence independently

by Dave Osler     October 19, 2012 at 2:40 pm

In a part of Britain in which the population still gets overly excited about the ideological alignments of its football clubs, the British flag is not just a neutral patriotic symbol.

Thirteen-year-old Lee Heron was earlier this year sent home from his high school in Newton Stewart, Wigtownshire, for wearing a Union Jack T-shirt his mum had bought him Primark. This attire, his teacher deemed, was likely to inflame sectarian tension among the pupils.

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Labour should prioritise unions over business

by Dave Osler     September 30, 2012 at 5:54 pm

There are 400 ‘business representatives’ at the Labour Party conference this week, to highlight an interesting choice of words found in a recent Financial Times report. I am kind of hoping that the phrase is an unnecessarily imprecise synonym for ‘exhibitors’.

But if the rules have been changed while I wasn’t looking and the Confederation of British Industry and the Institute of Directors do get official delegations nowadays, that would only mark the logical culmination of the trajectory Labour has been on since the days of the Prawn Cocktail Offensive of some 20 years ago.

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Lib Dems: will the real Nick Clegg please stand up?

by Dave Osler     September 23, 2012 at 7:25 pm

Review of ‘Nick Clegg: the biography’ by Chris Bowers (Biteback Publishing, 2011)

Under Charles Kennedy, the Liberal Democrats stood against the Iraq war, did not want a replacement for Trident, opposed tuition fees, and favoured a 50p tax band for Britain’s highest earners.

I was not a Labour Party member in 2005, and while socialist principle precluded me from even considering support for a party with no connection to the organised working class, it was readily understandable why that particular set of policies appealed to many leftists rather more than what was on offer from Blair at the time.

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Neither men nor mice need a bigger Heathrow

by Dave Osler     August 28, 2012 at 11:48 am

Let’s not be hypocritical here; like most Londoners who go on holiday, take weekend breaks, and travel for work, I use Heathrow several times a year. But not when I can possibly avoid it, though.

I vastly prefer Eurostar for meetings in Brussels and Paris, and as I live only a bus ride from Euston, it works out quicker to catch the train to Edinburgh or Glasgow.

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From BCCI to StanChart: a brief alternative history of investment banking

by Dave Osler     August 8, 2012 at 7:28 am

The Bank of Credit and Commerce International, which collapsed in 1991, was not widely known as the Bank of Crooks and Cocaine International for nothing.

True, the Bank of England was a bit sniffy about it, largely on account of its connections to the Middle East, and refused to grant BCCI full banking status. Neverthless, the regulatory authority of the day remained perfectly happy for it to act as a second-tier licensed deposit taker in the UK.

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Immigration: Miliband shouldn’t pander to the right’s fantasies

by Dave Osler     June 22, 2012 at 2:21 pm

I remember home secretary David Blunkett chanelling Thatcher with his denunciation of asylum seekers ‘swamping’ British schools, and I remember self-professed veteran anti-racist Phil Woolas demanding tougher immigration controls. Boy, did those guys pull the wool over my eyes!

While ministers posed publicly as decently white racist riders on the Clapham omnibus, they were all the while dissing the plebs in Rochdale when they thought the microphone was switched off.
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Adrian Beecroft highlights mindset of Tory right

by Dave Osler     May 23, 2012 at 2:03 pm

Some of the £537,000 Adrian Beecroft has given to the Conservative Party in recent years came into his possession by lending out small sums of a few hundred pounds a time, at rates of interest as high as 4,000% a year.

It’s probably fair to assume that among those who see little choice but to subject themselves to usury will be people that have lost their jobs and do not have recourse to more reasonable sources of credit than wonga.com.

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All you can eat Buffett

by Dave Osler     April 12, 2012 at 1:24 pm

Not many political fads to emanate from the US deserve to make an Atlantic crossing. But the principle of a so-called Buffett rule is something that the left this side of the pond should at least be talking about.

First enunciated in an op-ed piece in the New York Times last year, written by or perhaps ghosted for legendary investor Warren Buffett, the simple idea here is that millionaires should pay a minimum tax rate of 30%.

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News International upholds probity? So be it

by Dave Osler     March 26, 2012 at 2:18 pm

The righteous, so the rabbinical maxim has it, have their work done for them. After yesterday’s Sunday Times so perfectly skewered the venality of the Conservative Party, all the average lefty need do is sit back with a big wide smirk on his or her face.

Some commentators are suggesting that this operation was carefully planned, by way of a reprisal from the Rupert Murdoch camp for the Leveson Inquiry. The theory is entirely plausible, and if that is indeed the case, the irony that probity is here being upheld by News International should be apparent to all.

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