Thursday, January 03, 2008

Jeremy Leggett strikes again

Some people accuse the Guardian of being mindlessly opposed to marketing. Well, those people are proved wrong every time Jeremy Leggett is given, for free, space in the Guardian to sell his industry. Last time, he was drawing ludicrous analogies to Spitfires. This time, he's mounting an incoherent attack on the Government's nuclear plans. It isn't worth fisking most of his article as he isn't writing very well and gets lost in inane chatter about consultations. He takes what should have been the central argument in his article, the superiority of renewable power to nuclear, as a given and I can't imagine anyone who isn't a renewable energy executive being convinced.

The article is only worth noting for this, incredible, section - which is a masterpiece of the Comment is Free genre:

"In March the EU agreed a target of 20% renewables in the energy mix; 27 leaders signed up, Blair among them. The EC costed the switch to renewables at €24bn to €31bn a year, assuming an oil price of $48 a barrel. At $78 there would be no additional cost. Before the year was out, oil almost hit $100."

Does he realise what that is saying? Those are estimates of the subsidy that will be required to make renewable energy work. If we are above the oil price at which renewable energy has 'costs' (i.e. costs more than running on oil) then there shouldn't be any need for a subsidy at all.

Leggett clearly thinks the EC estimate is credible or he wouldn't be citing it. Fantastic! Let's scrap the various subsidies to renewable power and let those fine people in the renewable power industry outcompete expensive, peaked oil.

Gracchi responds on the NHS and lifestyle choice

Gracchi has some criticisms of my post on the NHS and lifestyle freedom. I don't think any of his criticisms stand up to scrutiny. I'll take the risk of pulling some sections of his post out for brevity's sake. I'm sure he'll correct me if I've taken anything out of context or missed important arguments.

"Those who support the NHS and support drug legalisation today often overlap. Whereas those who want to privatise the NHS and support drugs being illegal often overlap as well."

This is certainly true. A prime example, that I mentioned in my post, is the Liberal Democrat party that both aspires to be liberal, in the libertine sense, and also to support the NHS. People are quite able to hold positions that make their other positions untenable in practice. They'll be frustrated if they ever try to put their policy platform into effect over the medium term but that's not a concern for a Liberal Democrat. Equally, there are plenty of reasons other than lifestyle liberalism to support NHS reform - better results for example. Gracchi misses the point I was making: not that supporting the NHS makes any given thinker less liberal with respect to lifestyles but that the existence of the NHS makes it harder to sustain lifestyle liberalism in practical politics.

His explanation for illiberalism is the 'yuck' factor. This could be important at the margin but I don't think it can really be the driving factor behind bans. If it were why would there be a new crusade against the relatively attractive behaviour of middle class drinking?

People need to rationalise their beliefs and the 'yuck' factor therefore requires rational justification. I've seen, countless times, the cost to the NHS of a particular behaviour used as justification for a prohibition on that behaviour, a ban on advertising or a new tax. Even if some people are just disgusted by the obese and using the cost to the NHS to rationalise the ability to do so is still important. Rational debate is still relevant to politics even if it is, too often, bent out of shape.

"Matt misunderstands wilfully Mill's argument and consequently misinterprets the zone of Mill's freedom. Mill's concept of freedom is very tricky to understand- but if it were as Matt suggests inclusive of all actions that affected others in any way, the area of free rights would be tiny. Afterall all our actions in some ways effect others- even actions taken in complete privacy- a choice of job afterall effects others sometimes more than a choice of lifestyle does (even in a system with an NHS)."

This seems to be an argument that I should be wrong rather than an argument that I am wrong. Gracchi's criticism is the one that makes Mill's sphere rather weak in theory. However, the harm principle, as summed up by Mill himself, is pretty much exactly how I expressed it:

"The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign."

It is highly imperfect. All of our decisions do affect others in some way. If I am unhealthy and die as a result then no matter the healthcare system others will be affected as they will feel bad, if only for a short while. However, that weakness has not prevented the harm principle becoming vital to effective liberalism. Non-financial externalities that affect friends, family and other close acquaintances tend to be socially internalised in a manner described by the Coase theorem. If I live in an unhealthy fashion and it risks my health those who care for me risk an emotional loss. However, their closeness to me allows them to influence my decisions. Whose mother doesn't check that they're eating well and hassle them if they're not? The more people care the more they will socially police behaviour.

These kinds of strategies allow for the harm principle to function despite its theoretical weaknesses. As a result, an approximated version of Mill's sphere, allowing choices that have societal effects smaller than a certain magnitude, is an important popular justification for liberalism. It is the best simple guide to what the liberal position is in the first place. It is what people mean when they say "it's none of your business".

The NHS makes people's decisions over diet, smoking and drink, and a massive host of other choices, the business of everyone other Briton. The fat man in Glasgow concerns me because I will contribute to paying if he becomes unwell but there are few practical ways for me to influence the health behaviours of him and millions of others socially and without enlisting the power of the state.

We might still allow people some unhealthy choices, taking a stressful job for example, but perhaps that is just the way the societal cost/benefit analysis plays out? We don't respect people's right to take a stressful job - it is just good for us if they do.

"Genes matter as much as environmental factors- would Matt accept a system in which companies were allowed access to our genetic code and set different premiums based on that for various people, sometimes prohibitive premiums."

People don't choose their genes. That means you can't incentivise people. It makes the public policy debate completely different to the one I was addressing. Being genetically predisposed to poor health is more analagous to having a pre-existing condition or being old than to eating an unhealthy diet or smoking. There is an interesting debate to be had over whether insurance companies should be allowed to take account of things like genetic predispositions but none of the logic in my original post pertains to that debate at all.

"What about such premiums actively discouraging people for example from performing various important jobs- take for example those who volunteer to be part of the royal lifeboat association (something that involves them in great risk for a real public good and for free)- that would incur them a higher premium is that fair- the same thing might be said about special constables."

These would not be among the unhealthy behaviours that you would want to allow providers of compulsory social health insurance to attach a price to - just as it isn't one of the activities that might, under Government proposals, get people denied NHS treatment. I don't think this flaw is critical even if you want to implement a system that allows insurers to present higher premiums for any reason at all but, for the purposes of the debate we're having right now, it just isn't relevant. There is no reason why the slope, allowing certain information about health behaviours to affect insurance premiums, should be so slippery that any case for greater flexibility is a case for allowing perfect information.

The NHS cannot properly incentivise healthy behaviours and creates a very real imperative and justification for lifestyle illiberalism. A reformed healthcare system need not create those pressures for a less liberal society. I hope this post has helped to flesh out why.

Wednesday, January 02, 2008

If you go down to the woods today...

Cry of existential affirmation to greet the New Year or bad movie in-joke? You decide...

Went on quite a fun little trip yesterday. First, Baconsthorpe Castle which was nice but a little too small and ruined to make a full day out. Then, on the way back, traipsing around Thetford Forest causing trouble.

The NHS and lifestyle choice

Threats to deny NHS care to those who don't maintain a healthy lifestyle are a paper tiger. We're not going to see smokers, the overweight and drunkards dying in the street with Gordon Brown standing over them wagging his finger and saying "look at the NHS Constitution". Even if the politicians were hard headed enough to do it, which they aren't, they'd struggle to bring the medical profession along with them.

The only thing that might actually happen is the denial of certain forms of treatment - particularly expensive treatments. Even that probably can't be institutionalised as their are too many borderline cases. Smoking aside, most lifestyles will contribute to health risks instead of obviously causing a condition and in uncertain cases it will be hard to deny treatment. Consider the pretty common case of a man who is somewhat overweight but not morbidly obese and also has a stressful job. We wouldn't want to punish someone for having a stressful job so it would be a moral nightmare to deny that man treatment. Cases like that will be very, very common.

That means decisions over whether to deny treatment will have to be, from the point of view of the public, highly arbitrary. The threat of denying NHS treatment is too idle, too vague and too uncertain to have much of an effect on incentives. It can't get around the problem that a taxpayer funded healthcare system makes each person's lifestyle choices a public good or bad.

Now, every healthcare system that pools risk faces this problem to a certain extent. If you have a compulsory social insurance model and mandate that all insurance policies are available to everyone (as the Dutch do, for example) so that no one is going to be left without treatment and the vulnerable (thanks to age or existing conditions) are looked after you might also wind up subsidising unhealthy lifestyles. However, there is a key difference.

When individuals, rather than taxpayers, are paying for their health insurance it should be possible to allow adjustments in their premiums for healthy behaviours. As Wat Tyler describes this is already happening in the private health insurance market. It doesn't face any of the problems that I've mentioned above and prevents unhealthy behaviours imposing a cost on the health conscious.

Sin taxes are a clumsy substitute that have to make do without price signals (the level of tax is arbitrary whereas the correct level for lifestyle compensation in an insurance fund can be discovered by a market process). They are an easy way to raise revenue rather than a serious attempt to internalise the externalities associated with poor health. They will always be inferior to a solution that stops unhealthy lifestyles being an externality.

Pooling the costs of bad health and turning lifestyle into a public good is a problem for the NHS that leaks into the rest of public policy, turning it in a distinctly illiberal direction. There are few individual choices that don't have some kind of impact on a person's health. Unhealthy behaviour is controlled in an ever more draconian manner through taxes, regulation and outright bans. The Millian sphere (the set of decisions that don't affect others and should be left to individuals) is always unstable but completely dissapears with socialised healthcare. Liberalism becomes almost entirely untenable.

One quick aside: If the Liberal Democrats were an intellectually serious bunch they'd take this issue very seriously. The contradiction between healthcare socialism and lifestyle liberalism is one more example of the kind of issue that makes an attempt to marry their attachment to Britain's socialist institutions with a notional commitment to 'liberalism' a complete farce.

Liberalism isn't just undermined by the real externalities to unhealthy behaviour, created by socialised healthcare, that I have discussed so far. It is also politically expedient to exagerrate the problems associated with unhealthy lifestyles. The NHS, as it is currently organised, just can't deliver the performance that people expect and that would warrant the huge amounts of taxpayers' money that politicians have spent. That is a political nightmare for any political party that can't countenance calling for serious reform. They can dilute perceived responsibility for that institutional failure by announcing measures relating to people's lifestyle.

That is how we should understand this new threat to deny care to people living unhealthy lifestyles. It isn't even a serious but vain attempt to address the problem that the NHS makes everyone's health a public good. Instead, it is another attempt to avoid criticism for the ongoing failure to deliver quality healthcare and value for money in the NHS.

Monday, December 31, 2007

Grizzly Man

I watched Grizzly Man last night. Gracchi's review of the film is superb and there's not a lot I'd like to add to it. He gets to the core of the film with admirable clarity and perceptiveness. There's little sense repeating him except to confirm that this film is well worth watching.

All I'd add is that I found the footage of Timothy Treadwell (the Grizzly Man of the title) with the foxes more distinctive than either Gracchi or Werner Herzog (the filmmaker) did. The bears did seem totally uncaring with their only real reactions to Treadwell a hostility if he got too close and, finally, killing him when they were hungry. By contrast, I do think there was a genuine reaction from the foxes. They are animals with a social instinct that, as we do with dogs, humans can, I guess, become a part of. At times he did seem to have formed a connection with them more genuine than the one with the bears that were more central for the film and Treadwell himself.

I would guess that the foxes weren't enough because the relationship was more genuine. As Gracchi says Treadwell wasn't after an authentic, reciprocal relationship but something unreal. He found love that could not be requited safer. While the relationship with the fox was not real in the sense that human relationships are I still get the sense he preferred the complete fantasy of his relationship with the bears.

Sunday, December 30, 2007

The Closing of the American Mind

I've just finished reading Allan Bloom's The Closing of the American Mind - just twenty years after it was written. While its title and content is directed towards Americans Harry Mount is right to argue that the disease now afflicts us and all the Western nations.

Bloom's masterpiece is hard to precis. It begins discussing his students and how relativism has closed their minds; how a doctrine of 'openness' has perversely undermined serious dialogue between different opinions and cultures. It then goes on a tour of Western philosophical thought illustrating the struggles that brought us to where we are now. My understanding of his critique is that we have lapsed into nihilism without taking the condition seriously. We cannot take seriously old visions of the good life and have broken the processes and destroyed the environments in which new visions might flourish. He sees this as a broad problem for Western civilisation but sees the crucial centre of the problem in the decline of liberal education within the Universities.

This isn't a book to discuss in one post and I'm sure it will be brought up frequently on this blog in the coming months but what I thought I'd note right now is how it relates to Dalrymple. Theodore Dalrymple's social conservatism has been a frequent topic of mine over the last year and relates in a very interesting way to Bloom's work. Dalrymple discusses (most effectively in this essay - which I will keep linking to until I'm satisfied every one of this blog's readers has read it) how the relativism of the elite creates desperate social problems for the disadvantaged.
Dalrymple's work is excellent but if you only read Dalrymple and look at the problems of the poor it is as if you are studying an oceanic earthquake by measuring coastal waves and understanding the misery of those they make homeless. You need to understand the problem at its source. The source of the awful problems Dalrymple describes is in the elite and their intellectual decline. A philosophical decline in the West. Hopefully Bloom can provide a valuable first step in understanding that source of our problems.