But What About…? Part 4b: Healthcare Introduction, Part 2

In Healthcare Introduction, Part 1 yesterday, I started talking about the doctor/patient relationship, and how third-party decision makers (government, insurance companies) shift the medics’ accountability from you to them, shifts the decision-making ability from you to them, and I touched on how this drives the price up. I ended the post introducing another third party, how things become more complicated when an employer gets in on the mix.

When an employee gets paid, that money is the employee’s, and the employer has no reasonable right to any say in how the employee spends the money. Prior to that, there’s things the employer must pay for. Various insurances, Social Security. Various storms flew up with some employers that provided health insurance, when they were suddenly forced to pay for some coverage they found to be morally dubious.

And there’s the distinction. Some have argued that it’s the employees’ health insurance, and the employer should butt out of it. But as the employer is actually paying, they are morally complicit. This didn’t seem to be a big issue until the government stepped in with a gun to the employers’ head, saying “You don’t get a conscience! You must do these things!” On the other hand, if there are options you would choose but your employer won’t, that would obviously be frustrating.

Interestingly, there’s a conversity we haven’t seen much of: if an employer provides insurance that the employee considers morally dubious. I think there’s reasons for this getting less coverage, I also suspect there’s many who suck it up and live with it so as to not bite the hand that feeds them. “It’s better than nothing, there’s good in it that I don’t want them to take away.” Still, the same enforced moral complicity that I mentioned above exists here.

Another problem with third parties choosing what treatments you can and cannot have, is the value judgments. Does someone even deserve treatment. It’s understandable (but heartless) not to want to treat a smoker for lung cancer, but it sucks if you’re the smoker and you’ve paid your NHS taxes/US insurance. Or refusal to do a proper examination on a fat person until they’ve lost weight (a scientifically dubious demand in itself).
Patient: My knee’s shot, I think I might need a joint replacement
Doctor: Lose weight first
P: How?
D: Exercise!
P: On a joint that needs to be replaced?

There are kinds of treatments that the NHS won’t cover, rightly or wrongly. Even rightly, it robs patients of say and choice. To be free, one must be free to make mistakes. Grown-ups capable of making their own decisions should be treated like grown-ups capable of making their own decisions.

In conclusion, the greatest moral freedom, the greatest choices, the lowest cost, and the best care, come when you cut out all the middle men.

Although, a word of caution from the great philosopher Malcolm Reynolds: “About 50% of the human race is middle men, and they don’t take kindly to being eliminated.”

But What About…? Part 4a: Healthcare Introduction, Part 1

Having lived in England for most of my life, and America for a significant number of years, I have had some experience of the different medical systems, some good and some bad. Thus, this subject of healthcare is somewhat personal to me, and it’s easy to get wrapped up in it. I might be a bit more opinionated than usual. There’s a chance your reactions will be more charged than usual (I have seen many heated posts on my Facebook feed when someone dares threaten the sacred cow that is the NHS). Please grant me some extra patience, then, as we discuss this topic.

The US and UK healthcare systems are, in some ways, vastly different. In other ways, they are very similar. Some of the ways they are similar aren’t very good at all. I’ll talk about these some over a few posts.

A pitfall of both the NHS system in the UK, and the insurance system in the US, is it disrupts the business/customer aspect of the doctor/patient relationship. Broadly speaking, the business answers to the one who pays the bills, and if you’re not paying the bills directly, then your say is greatly reduced.

Take birth, for instance. You might not like the hospital version of birth (put you on a clock, monitor so you can’t move like you need to, drugs to speed you up, drugs to stop the pain, highly unscientific breaking of waters, you’re taking too long so cut the baby out). My experience of hospitals in both countries, were that they tended to be like this.

The World Health Organisation put out literature saying that a caesarean rate of more than 10-15% was not medically necessary. I think the 15% was a concession, I seem to recall another document being more hardline with 10%. I checked up on the UK hospitals we used, they were higher than that.

In the NHS, and in the US insurance system, there are people who decide what kinds of treatments they will pay for. Insurance in the US might very well not cover safer, cheaper, maternity alternatives. VBAC is even worse. The NHS at least on paper supports homebirth, though the vibes we got from some of the midwives we were dealing with led us to not trust them.

In neither country are the hospitals and medical staff accountable to you for an unnecaesarean.

I find the “cascade of interventions”-style treatment unethical. Profitable for surgeons and drug companies, yes, ethical, no. I have no desire to fund or support it. If you like it and want to use it, that’s your choice to make. I don’t want to force what I think is best onto you.

But statism doesn’t return the favour. In the UK, I must fund the system I don’t like, and if I want something better, I pay for that on top.

In the US, the governmental interference (“Affordable Care Act”) has caused all sorts of problems. People required to have some coverages they don’t need or want.

That’s not to say there aren’t people who have been helped. There are those, for example, with pre-existing conditions that can get coverage, who couldn’t get it before. The underlying issue of just why a doctor’s visit and a few tests costed (and still costs) an arm and a leg, has been entirely undealt with. Insurance companies decide what they will or will not pay for, and hospitals charge the insurance companies more because they can afford it.

The waters are further muddied when employers are brought into the mix.

I know I’m kind of cutting off in mid-stream here, but come back tomorrow for more!

But What About…? Part 3b: The Coal Industry, Part 2

If you haven’t read The Coal Industry, Part 1, you should go do that. I’m not sure that this post will make a lot of sense without it.

Hindsight is 50/50. The perspective about a decision at the time it is made, and the perspective from later on, are obviously different. I think that there are aspects of an “at the time” viewpoint that we lose when looking at things after the fact. And I think there’s likely to still be quite a lot that is hidden from either perspective. So things are a lot less clear than the notion “hindsight is 20/20″ would imply.

Yesterday, I talked about a bad situation that government had gotten itself into. It bought the coal industry in the late ’40s, and by the ’80s the industry was no longer viable. The government seemed to be in a lose-lose situation, and chose a “lose” course of action

Could this have turned into a win?

I think so. But given my “hindsight” paragraph above, I’m not saying “they should have done this, they should have done that”. I’m not second-guessing those who made a difficult decision. I’m not even saying that anything I suggest would have been a guaranteed success. I’m giving suggestions that would give a chance of a win. That might not be good enough for some, but it’s a lot better than the guaranteed lose that we got, or the guaranteed lose we’d have had if the government propped up the dying industry.


So the mines were losing money. Land as such has value, but that fact didn’t mitigate the money suck. Selling the land off could recoup some money, but let’s get more risky.

1. Gift the land and facilities to those who worked on-site.

Historically, management and workers had not got on very well. Make everyone (at least those that want to) equal partners. Anything they choose to do going forward, they all have the same vested interest. Anyone who doesn’t want to join in, doesn’t have to.

While the government wouldn’t get money from giving away the property like they would if they sold it, it also would stop being a big money-sink.

2. Exempt the property and new owners from tax, for a time.

How much time? 5 or 10 years, somewhere in that range. Should give them time to get something going.

Like the water analogy from the other day, while the miners may have been paying taxes, they were also paid by taxes, so a net loss on the system. Initial taxing would be taking money that isn’t there. So this would be a better situation for the government (no loss), and for the new owners (the former employees, less drain while setting something up).


I called that a radical start, and it is. The miners would have a lot of responsibility thrust on their shoulders, but they wouldn’t have been shafted.

Continuing business-as-usual coal mining would have been futile, so I hinted that they might want to set up something else. But what? I have some ideas, it’s not an exhaustive list. I think if miners and managers had control and had sat round the table and brainstormed ideas, they could have come up with something even better. I don’t believe for a minute that there weren’t some creative and entrepreneurial minds that could have been put to good use. So, some ideas:

1. A museum

Other kinds of mines have been turned into museums. Sygun Copper Mine in Wales and Geevor Tin Mine in Cornwall are two off the top of my head. A coal mining museum could have become a profitable business, too.

Now, would a museum on its own be enough to sustain that many workers? I suspect not, but other avenues of income could of course be pursued.

2. Educational institute

Presumably, all these people working in the mine knew a thing or two about mining. What better way to teach mining and related topics, than with a hands-on course? Have some classroom subjects, sure, go into the mine for some hands-on stuff. Observe the engineering in action. Practical coursework. You could get a world-class institution out of this.

3. Storage facility

These days, an abandoned mine or missile silo might be used for secure off-site data backup and storage. Refit a tunnel to be climate-controlled. This might be a case of hindsight, but looking this sort of thing up, I found this was going on in the days of storing reels of tape.

Which leads to me thinking, if the coal industry hadn’t been on life-support as long as it had, perhaps more TV shows could have been saved from the mass junking that the BBC (and the various ITV stations) did. May have only caught the tail end of it (the BBC stopped in 1978), but ooh, what could have been.

4. Music

This may seem a bit out of left field, but there were coal mines with brass bands (see Brassed Off). I have Welsh mines linked with Welsh male voice choirs, in my brain. Perhaps the stereotype is inaccurate, perhaps there’s some truth there. Concerts and CDs could have been another income stream (you could function-stack it with the museum idea).

5. Authentic sound effects

Record the ambient noise in a mine. Perhaps not the actual blasting close up, but equipment running, miners talking. This kind of sound effect gets used in TV and film. Could royalty yourself a bit of money by recording a bunch of sounds and making them available. Sound effects CDs of all varieties are sold. So why not add this one to the list?

6. TV/movie sets

May be an occasional use, but hey, if you want tunnels, we got the finest! Black “alien planet” terrain, we got that, too! (There are times when Doctor Who could just move in, ha ha.) There are places that get an income from this sort of thing.

7. TV show

Related to 6, collate every anecdote and humorous situation you can from all the people who work there. Pitch it to ITV (at this point, it’s not going to be the Establishment BBC, is it?). And it function-stacks perfectly with 5 and 6.


There was a great deal of untapped potential in the situation. I think that “in the box” thinking is difficult to break out of, and even if there was some entrepreneurial genius working deep in the pit, that genius would have faced enormous hurdles to influence any decision makers. Not that I think things would necessarily have been better in a company, management and boards can be just as entrenched in a mindset (so can workers, for that matter). It would take some humility, “Look, guys, the writing’s on the wall for this industry, can any of you think of anything we can do to get some cash coming in?” The suggestion of giving the mine to those who worked in/at it is the best that I could think of to maximise the chance of profitable brainstorming.

Had the government not taken control of the coal industry, I believe that layoffs and closures would have happened over a much longer period of time, which would have softened the impact on the “safety net” (social security). The pit closures started somewhere between 1981 and 1984 (I suspect earlier in the time frame), full privatisation happened in 1994. The last deep coal pit closed in 2015, open cast mining is still going on. Unemployment rose above 10% in 1980, and dipped below that in 1987 (source for unemployment figures, source for other dates).

More conventional methods could have been employed, like diverting funding to retrain the workers, which only works if there’s a job to go into: some places the coal industry was keeping everything else afloat.

If some of the above worked, plus whatever the mine workers came up with, then perhaps government interference would have brought about a better result for everybody than if they’d stayed out of it in the first place.

The way things happened, though, I don’t think the case could be made for that at all.

Come back next week for something different.

But What About…? Part 3a: The Coal Industry, Part 1

I thought long and hard about what topic to pick to kick this series off with. One of the “usual suspects” that always get dragged up when talking about taxes, like healthcare, police, education, roads, state-provided post-retirement payouts? Or perhaps something that hides behind these things, like warfare or the surveillance state?

I decided to start on a different tack. Something vaguely remembered from childhood, and now better remembered from movies.

In 1947, the coal industry was commandeered by the British government. At the time, it was an important resource.

By the 1980s, the industry was in trouble. Coal wasn’t as important a resource as it once was. Coal from abroad was cheaper than British coal (in part, the true cost of the coal was obscured through subsidies). Far from being a contributor to the economy, it became a drain.

The government of the time, then, was in a difficult position: continue to prop up a dying industry at the expense of all the other taxpayers, or cut them loose and put the workers, and the local economies built around them, in severe jeopardy?

A theme of this series is “Should the government be doing that?” In this case, should the government really be running the entire coal industry?

I think it is obvious that my opinion is “no, they shouldn’t”.

But consider, if the earlier government hadn’t taken control of the industry, the later one wouldn’t have been saddled with the problem. If the industry had been exposed to market forces, then it would have had to react earlier to the changing conditions. Would there still have been closures and layoffs? Most likely, but they would have come more gradually rather than All At Once, thus not overloading the safety net.

The problem government faced in the ’80s, was caused by the government of the late ’40s. It was also affected by foreign governments of the ’80s.

I can’t claim any particular fondness for Thatcher or her government, but never have I heard anyone suggest how this apparent lose-lose situation could have been turned into a win-win, or even a potential win-win.

Tomorrow, I will throw some ideas around to suggest how a better outcome could have been achieved.

But What About…? Part 2: Further Foundations

One further note that seems to be relevant. We need to talk a little bit about types of economy.

*Communism: In theory, the people as a whole own the means of production. the power is shared. In practice, the power and control get taken out of the hands of the people, and into the hands of a small number in government.

*Fascism: In this system, government and industry are in bed together. The difference between classical fascism and what has been termed “neo-fascism”, is who has the upper hand.

**Classical fascism might be evidenced by the government dictating what to make, where to make it, how to make it, and how much to make. So, perhaps, why is high fructose corn syrup in so many foods in America? Because farmers make a lot more corn than is warranted by the market. Why do they grow so much? Government interferes with the supply-and-demand economy by subsidising corn production.

**Neo-fascism might be evidenced by corporations having a large say over law and policy. So prominent CDC positions might be filled with people from high positions within large pharmaceutical corporations, and then return to the corporations after their CDC stint, and so the large pharmaceutical companies gain great influence through the CDC. And also through lobbying.

I feel the economic model has a bearing on the question of “should government be doing that?” Socialism, Communism, and Fascism essentially believe that government should be in control of everything. Neo-fascism puts corporate monopolies in charge of everything.

There are many who aren’t fond of either of those alternatives. Many talk about how things go pear-shaped in those systems. Many talk about how things could be done better outside those systems. A lot fewer people talk about steps to get from here to there. I’ll try and talk about all these things.

But What About…? Part 1: Overview

Yesterday I rounded out the series on tax by applying the Golden Rule to the concept. Were this to be a universally shared outlook, then most people would be wishing no tax on anybody, and the multitudes of taxes that we have would be substantially reduced.

The issue then becomes all the things that tax money goes towards.

Imagine there’s a bunch of people with cups of water of different sizes, and imagine there’s a reasonably large bowl. Everyone must pour some of their water into the bowl. If the people get their water from an external source, then the bowl will fill up. If some start getting their water from the bowl, it doesn’t matter if they pour a bit of water back in like everyone else, the others will have to pour more water to sustain the water level in the bowl. The more people get their water for the bowl, the less sustainable it gets.

It is this way with taxes. It’s kind of a deception, a shell game, for teachers and administrators in government schools, for politicians, for police, and so on, to pay tax. They’re paid by tax. The money comes from those outside that system.

There was a poem of sorts that I read in History class, when we were learning about the New Deal. It was describing this concept, though I didn’t get it at the time.

It enumerated the population of the US, then gradually subtracted different tax-funded groups. Those on welfare, teachers, police, Congress, those working for government agencies, those on the New Deal, those in prison, and so on. After each subtraction, “Which leaves to do the work:” (smaller number). Then the next set of people was listed.

The poem ended something along these lines:
“Which leaves to do the work:
2. Me and the President. And he’s gone fishing.”

Of course this was an exaggeration. But I can understand feeling like that. One might think that it doesn’t make a lot of difference whether Joe Public pays for a business or service through direct transaction or through taxation, after all, he’s paying for it either way, right? The thing is, a business must walk a fine line between the various costs to provide whatever it provides, profit, and whether Joe Public thinks it’s worth that price. Under the government, there is less incentive for efficiency (if you don’t spend all your budget, you won’t get as much next year when you might need it), accountability, customer service, or value for money. We’ll get into that in more specifics, later.

If fewer people get their water from the bowl of taxation, the less water will need to be taken from those getting their water from elsewhere. The moral thing to do, then, would be to reduce the number of people taking from the tax bowl.

“Does government really need to be doing that?” is a question that we really need to consider.

Let’s Talk About Tax, Baby: Part 6

End of this series on tax, though as everything is linked, I’m sure we shall return to the subject later. In case you missed it, here’s a link to Part 1.

It is a rare person indeed who doesn’t take every deduction, credit, and legal loophole they can to minimise the amount of tax they pay. They might say how X, Y, or Z thing the government does needs more money, but they don’t put their money (*their money*) where their mouth is, and skip one reduction or another. Perhaps, deep down, they know that the money won’t go where they want it to. Perhaps that many people really do understand, even if they don’t want to admit it to themselves, that tax isn’t all that great.

I’ve mentioned before the contention that “tax is theft”. What is theft? Something is taken from you without your consent. In these enlightened times, you don’t really have the opportunity to consent or dissent, the money is taken from you before you even get it. Unless they underestimated during the year, and decide you owe something extra. Then they take it with interest. If you happen to overpay, they don’t give you your refund with interest.

Now, we might be used to being milked, we might justify to ourselves our property being taken from us. “I’m ok with paying taxes because of X.” But chances are, you’re still unlikely to be that rare person of that first paragraph. If you had the choice between being taxed a larger amount and being taxed not at all, you’d be more likely to pick “not taxed at all”.

So what of the dissenters? What of those (nearly everyone) who wouldn’t pay tax at all if they had a choice? By “have a choice”, of course I mean “able to take that choice without having violent action taken against them”. Arrest, incarceration, possible accidental death during one of those, all violence. We might rail against guns owned by the general population, perhaps even against certain acts of violence inflicted by those employed to enforce the state’s will, but we fail to see that the state can do nothing without the threat of violence.

Someone who gets a large “amount due” notice from HMRC/IRS because of some miscalculation or other clerical error, is rightly frightened (especially if they can’t pay) – not all errors get fixed. Perhaps we can up the charge from “taxation is theft” to “taxation is armed robbery”.

“The Golden Rule” is a title given to the positive version of two sayings. The negative is “don’t do to others something that you don’t want them to do to you”, the positive is “do to others what you want them to do to you.

Purely and simply, do you, personally, want to be taxed more?

If the answer is “no”, don’t wish more taxes on other people.

It really should be that simple, right? Common decency? Basic logic? If you don’t want to be taxed more, don’t wish for other people to be taxed more.

If you want less taxes for yourself, oughtn’t you should wish for less taxes on other people too?

That seems to be the best bottom line to the topic that there could be. Tune in next time as I start a series on the next logical step: “BUT WHAT ABOUT….???”