Health and recovery

An extract from Chapter 6 of the book Transcending Politics:

6. Health and recovery

On the face of things, the field of healthcare poses a stern challenge to the technoprogressive vision that I am championing. In countries all around the world, costs of healthcare are rocketing. Chronic diseases such as diabetes, heart disease, and dementia are consuming huge resources. National budgets are facing crises under the resulting strains and stresses.

To give one example, Simon Stevens, the CEO of Britain’s NHS (National Health Service), has spoken out on several occasions about the growing financial burden of chronic diseases. Here are his comments in an NHS England news article entitled “Get serious about obesity or bankrupt the NHS”:

Obesity is the new smoking, and it represents a slow-motion car crash in terms of avoidable illness and rising health care costs. If as a nation we keep piling on the pounds around the waistline, we’ll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat.

Speakers in support of a campaign by the British Pharmacological Society emphasised the risks of runaway expenditure on medicinal drugs:

The NHS drugs bill is spiralling out of control and will bankrupt the service unless urgent action is taken, experts say. It jumped more than £1 billion between 2014/15 and 2015/16, to nearly £17 billion. This means the cost of providing medicines is the second biggest NHS expenditure after staff salaries…

The problem is partly due to an aging population, which has more health problems and a wider range of medication to treat them. However, drug wastage is also to blame. Up to 40% of patients prescribed drugs long term do not take them, wasting the equivalent of £350 million a year…

Sir Munir Pirmohamed, the society vice president, said: “We cannot carry on like this. We urgently need to reduce drug wastage and optimise the drugs patients are on to ensure they get the right drugs, and the correct number of drugs, so that they are not being over-medicated.”

Simon Maxwell, chairman and professor of clinical pharmacology at Edinburgh University, added: “This will bankrupt the NHS and is not sustainable.”

In January 2018, stirred to action by a series of fraught experiences in their hospitals over the ongoing winter period, a group of highly experienced healthcare professionals wrote a public letter to Theresa May, the British Prime Minister:

We are writing to you as Consultants in Emergency Medicine, Fellows of the Royal College of Emergency Medicine and as Clinical Leads (Consultants in charge) of our Emergency Departments, representing 68 Acute Hospitals across England and Wales…

We feel compelled to speak out in support of our hardworking and dedicated nursing, medical and allied health professional colleagues and for the very serious concerns we have for the safety of our patients.

This current level of safety compromise is at times intolerable, despite the best efforts of staff…

Meanwhile, in the United States, debt arising from medical fees is the number one cause for people to become bankrupt.

Technology is not enough

In principle, technology ought to be reversing these expenditure trends. Innovative technology has the potential to automate aspects of medical treatment, to provide timely early warnings of ill health, and to deliver targeted new therapies that are more effective than previous treatments. However, rather than being a part of the solution, it seems, worryingly, that technology is part of the growing healthcare budget problem:

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Recent Posts

A reliability index for politicians?

Reliability calcuator

Imagine there’s a reliability index (R) for what a politician says.

An R value of 100 would mean that a politician has an excellent track record: there is no evidence of them having said anything false.

An R value of 0 would mean that nothing they said can be trusted.

Imagine that R values are updated regularly, and are published in real-time by a process that is transparent, pulling together diverse sets of data from multiple spheres of discourse, using criteria agreed by people from all sides of politics.

Then, next time we hear a politician passing on some claim – some statistic about past spending, about economic performance, about homelessness, about their voting record, or about what they have previously said – we could use their current R value as a guide to whether to take the claim seriously.

Ideally, R values would also be calculated for political commentators too.

My view is that truth matters. A world where lies win, and where politicians are expected to bend the truth on regular occasions, is a world in which we are all worse off. Much worse off.

Far better is a world where politicians no longer manufacture or pass on claims, just because these claims cause consternation to their opponents, sow confusion, and distract attention. Far better if any time a politician did such a thing, their R value would visibly drop. Far better if politicians cared much more than at present about always telling the truth.

Some comparisons

R values would play roles broadly similar to what already happens with credit scores. If someone is known to be a bad credit risk, there should be more barriers for them to receive financial loans.

Another comparison is with the “page rank” idea at the heart of online searches. The pages that have incoming links from other pages that are already believed to be important, grow in importance in turn.

Consider also the Klout score, which is (sometimes) used as the measure of influence of social media users or brands.

Some questions

Evidently, many questions arise. Would a reliability index be possible? Is the reliability of a politician’s statements a single quantity, or should it vary from subject to subject? How should the influence of older statements decline over time? How could the index avoid being gamed? How should satire be accommodated?

Then there are questions not just over practicality but also over desirability. Will the reliability index result in better politics, or a worse politics? Would it impede honest conversation, or usher in new types of implicit censorship? Would the “cure” be worse than the “disease”?

Next steps

My view is that a good reliability index will be hard to achieve, but it’s by no means impossible. It will require clarity of thinking, an amalgamation of insights from multiple perspectives, and a great deal of focus and diligence. It will presumably need to evolve over time, from simpler beginnings into a more rounded calculation. That’s a project we should all be willing to get behind.

The reliability index will need to be created outside of any commercial framework. It deserves to be funded by public funds in a non-political way, akin to the operation of judges and juries. It will need to be resistant to howls of outrage from those politicians (and journalists) whose R values plummet on account of exposure of their untruths and distortions.

If done well, I believe the reliability index would soon have a positive impact upon political discourse. It will help ensure discussions are objective and open-minded, rather than being dominated by loud, powerful voices. It’s part of what I see as the better politics that is possible in the not-so-distant future.

There’s a lot more to say about the topic, but for now, I’ll finish with just one more question. Has such a proposal been pursued before?

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