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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There’s more to democracy than voting

Suppose that the UK held another referendum on the subject of Brexit. Suppose that the numerical result was essentially the same as before: around 52% voting for the UK to leave the EU, and around 48% voting for the UK to remain.

In that case, would that referendum prove to have been a massive waste of time and money?

My answer: not necessarily. Such a vote could actually lead to the healing of the nation, rather than to continued divisiveness and chaos.

politics chaos or healing

It all depends, not on the numerical result, but on the calibre of the arguments raised during that referendum.

If supporters of Leave came forward, during the campaign, with arguments that were less contestable and more compelling than before, this could lead to a healing of the nation. People who voted for the other option in the referendum might still feel disappointed. But they could accept that there were sound arguments in favour of the side that won. And, unlike the case of the first Brexit referendum, they could move forward, reconciled to the outcome. They could tell themselves they had lost a fair battle.

A similar conclusion could apply if, in a variant potential future scenario, it were Remain that won the second referendum, even if just by a narrow margin. Again, there’s no inherent reason why that conclusion would lead to ongoing bitterness. Again, it depends, not on the numerical result, but on the calibre of the arguments raised during the campaigns.

Not just a re-run

Various critics of the idea of a second referendum are doubtful that anything positive could arise from a new round of campaigning. It would just be a re-run of the previous campaign, they say, perhaps with a few people changing their minds. Nothing essentially new could arise. Forget healing. We would just get more chaos.

But I give a much more positive assessment to the idea of a second, better, referendum.

For one reason, people have learned a great deal in the intervening 30 months. Opinions which could be seen as plausible two years ago, have long since been shown up as deeply wrong. As an example, consider the now thoroughly discredited claim that it would be “the easiest deal ever” to negotiate Britain’s exit from the EU (witness “EU trade deal ‘easiest in human history'” and “All the times David Davis said that Brexit was simple”.) On such matters, we’re all wiser now.

But more fundamentally, it’s now widely recognised that it’s in everyone’s interest to cool down the debate, rather than letting matters be inflamed further.

The falsification principle

As a step away from ideology to objectivity, participants in the debate should start by reflecting long and hard about which circumstances would cause them to change their minds. This is in line with the falsification principle of science: people aspiring to scientific methods should set out in advance which experimental findings would cause them to seriously rethink their currently favoured theories.

Therefore, people favouring Remain should describe the circumstances that would cause them to consider switching to Leave instead. In this way, they would identify the potentially strongest arguments in favour of Leave. For example, to my mind, the strongest argument in favour of Leave would be if the structural weakness of the eurozone were shown to be likely to lead to huge financial chaos, of a sort that the UK could best hope to escape by being outside of the EU altogether.

Likewise, people favouring Leave should describe the circumstances that would cause them to consider switching to Remain instead. For example, they might be prepared to alter their vote if they gained confidence in the flexibility and genuineness of EU reform proposals.

Debate participants unable to set out such a “falsifying circumstance” would have to acknowledge they are driven by ideology, rather being open to new findings.

Preparing to build bridges

In parallel, participants in both sides of the debate need to set out proposals for how the UK could unwind from any state of internal hostility after the campaign was concluded.

To this end, supporters of Remain need to acknowledge that many on the Leave side are profoundly ill at ease with what they see as the direction of social development. More than that, Remain supporters need to be ready to commit to a credible programme to address key causes of this alienation, including the bitter perception many people have of being “left behind”.

Similarly, supporters of Leave need to acknowledge that many on the Remain side are profoundly ill at ease with the potential unravelling of processes of multilateral decisions, in a post-Brexit race-to-the bottom world of increasing deregulation.

Towards superdemocracy

That’s the vision – the vision of a better politics being expressed in a better referendum.

It’s a vision that goes beyond democracy-as-counting-votes. It’s a vision of emerging superdemocracy (to use a term that has featured in the last two Transpolitica books – Transcending Politics and Sustainable Superabundance).

Is this vision credible? Or are we doomed to a politics dominated by feelings of vengeance and obliteration?

That is, is a second referendum likely to lead to even greater chaos, or to healing?

Personal leadership

To an extent, the answer will be influenced by the personal qualities of the people leading each side of the debate. Do these people have high personal integrity? Are they open to learning? Are they able to build bridges? Do they have high emotional intelligence? Or are they, instead, obsessive and self-serving?

The answer (chaos or healing) will also depend on how the media conducts itself. Is the media looking for high drama? Will it seek out and amplify the most inflammatory soundbites? Or will it show restraint and care?

To my mind, everyone who cares about the future of the UK has to get behind the processes of healing, rather than the processes of chaos.

That means a commitment to debating honestly – to considering the merits and demerits of different arguments fairly, rather than with a partisan spirit.

This also means a commitment to building bridges – to discovering shared common values, even with people who express views very differently to our own.

It won’t be easy. But the cost of failure would be enormous.

Image source: “Big Ben at Sunset” – Photo by M N on Unsplash

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