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I am finding it increasingly difficult to keep going. The work (or lack of it) situation is a few short months away from critical and things are not looking any better. Its not just the financial situation, I feel increasingly marginalised, out of touch and irrelevant. Physically things aren't too good either. I need to get back into shape but its so hard. I ran yesterday but it was pathetic. I ran maybe a mile, slowly and painfully. This time last year before I did the ankle I was running 10km comfortably. It seems so long since I did anything worthwhile or achieved anything.
Jun. 10th, 2003
Waxing philosophical
Jun. 10th, 2003 09:08 amI was struck by something a dear friend, and former Labour Party comrade, who now heads up a Local Education Authority in England said to me last week. Paraphrasing, he said that he merchandised socialist ideas in Tory language. This intrigued me. I confess I find it hard anymore to know what is a 'socialist' idea. The conventional left agenda appears to be anti-globalization, isolationist and pro-producer to the exclusion of consumers (especially in the public sector); none of which appears particularly progressive to me!
The issue I find myself dealing with most often is how best to provide quality healthcare to an ageing population (there are analogues with education though education perhaps doesn't face the same demographic pressures, the pressure to provide more years of schooling generates similar dynamics). There are a number of issues that i don't have easy answers for.
First, I see little evidence that more is better. Marginal investments in health always seem to migrate to the latest, sexiest, high tech treatment, with quite marginal impact on population health. (Education analogue, turning good tech colleges into 3rd rate universities). This seems inevitable under a system of producer control but what is the answer?
Second, the role of the private sector. If the private sector can provide a service better or cheaper, why not? We have an insane debate here about whether private clinics should be allowed to do MRIs. To some its heresy, yet private clinics do over half of the blood diagnostics and no-one complains.
Third, consumer choice. Why is it seen as progressive that patients/students/parents should be denied choices about how and where they receive publicly funded services? The alternative is that the decisions are made by bureaucrats under pressure from producer representatives or, occasionally, other special interest groups. (For example breast cancer is overfunded relative to lung or prostate cancer because of the influence of women's groups).
At times I feel like I am becoming a curmudgeonly old Tory despite still holding essentially democratic and egalitarian views.
Comments?
The issue I find myself dealing with most often is how best to provide quality healthcare to an ageing population (there are analogues with education though education perhaps doesn't face the same demographic pressures, the pressure to provide more years of schooling generates similar dynamics). There are a number of issues that i don't have easy answers for.
First, I see little evidence that more is better. Marginal investments in health always seem to migrate to the latest, sexiest, high tech treatment, with quite marginal impact on population health. (Education analogue, turning good tech colleges into 3rd rate universities). This seems inevitable under a system of producer control but what is the answer?
Second, the role of the private sector. If the private sector can provide a service better or cheaper, why not? We have an insane debate here about whether private clinics should be allowed to do MRIs. To some its heresy, yet private clinics do over half of the blood diagnostics and no-one complains.
Third, consumer choice. Why is it seen as progressive that patients/students/parents should be denied choices about how and where they receive publicly funded services? The alternative is that the decisions are made by bureaucrats under pressure from producer representatives or, occasionally, other special interest groups. (For example breast cancer is overfunded relative to lung or prostate cancer because of the influence of women's groups).
At times I feel like I am becoming a curmudgeonly old Tory despite still holding essentially democratic and egalitarian views.
Comments?
