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The 2020 Public Services Trust Blog

Sunday, January 17, 2010

Fear and Loathing: the future of social democracy?

By Henry Kippin

My brother Sean sent me a fantastic article by Tony Judt from the NY Review of Books. The article is adapted from a lecture, in which the author rattles through a history of the European social democratic model, a consideration of why social democratic institutions have been resisted in America, and some thoughts about ‘where next’ for a model under serious economic and moral strain today.  It rewards a good (but challenging) read, but some of argument is also a bit troubling:

“We…have lived through an era of stability, certainty, and the illusion of indefinite economic improvement. But all that is now behind us. For the foreseeable future we shall be as economically insecure as we are culturally uncertain. We are assuredly less confident of our collective purposes, our environmental well-being, or our personal safety than at any time since World War II. We have no idea what sort of world our children will inherit, but we can no longer delude ourselves into supposing that it must resemble our own in reassuring ways.

If social democracy has a future, it will be as a social democracy of fear. Rather than seeking to restore a language of optimistic progress, we should begin by reacquainting ourselves with the recent past. The first task of radical dissenters today is to remind their audience of the achievements of the twentieth century, along with the likely consequences of our heedless rush to dismantle them.”

Surely he is right about the insecurity we are currently living through – and right to suggest that our notions of what is ‘good’ or should provide a grand narrative for society are fragmented and contested.  But I don’t agree that a ‘social democracy of fear’ – based on the idea that we must do everything to preserve what we have in the face of those who would dismantle it – is the inevitable future.

Yes, recognise the collective benefits social democracy has fostered – especially the idea of collective, public goods and collective responsibility for participating (through citizenship) in a society that sustains and protects these goods.  But does questioning some of the organising principles of our social democratic system really constitute a ‘dismantling’ of this ethic?  And is hanging on for grim life the best way to think progressively from now onwards?  I’m not arguing for creative destruction, but I think that our social democratic model can cope with some serious internal reform (electoral reform, decentralisation, more plural funding models, greater citizen autonomy and agency) and still retain the ethic of social citizenship and shared identity that Judt is concerned with.

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Posted by Henry Kippin at 11:31 am
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Wednesday, June 24, 2009

Obama, Healthcare & the Hard Choices facing Progressives

By Henry Kippin

Today’s Wall Street Journal carries an opinion piece by Robert Reich on the progress (or otherwise) of Obama’s health care reform plan through Congress.   Ive been meaning to write about this for a while, and this mornings article prompted me into action…. 

 

Obama is effectively trying to re-model a system by inserting a public player into an already (mis)functioning market.  The problem is essentially two-pronged: first, lots of Americans (Reuters estimates 47 million) do not have access to health insurance; and second, the cost of the existing private insurance system is both expensive and variable.  A lengthy article in the New Yorker recently set out the issues at stake here. 

 

So Obama’s intention is to establish a public insurance plan.  This would compete with private providers, providing a new cost and quality bar for private competitors.  The American public would theoretically then be able to purchase their medical insurance from a truly competitive (and thus better value-for-money) marketplace. 

 

This sounds like a good plan.  As Reich suggests, it is driven by tinkering with the incentives that underpin the private insurance market.  Currently, these are quite self-serving, resulting in a steady increase in costs for the consumer.  Reich contests that “those opposed to public opinion should ask how private plans can ever compete (with the public option).  The answer is they can and they should.  It’s the only way we have a prayer of taming health-care costs.” 

 

There are other benefits to establishing a public player within a mixed market like this (as I argued in a New Statesman piece a couple of months back).  As well as potentially reducing entry costs to health insurance, access to the information that a public provider will generate can help re-configure a market around new measures of quality and outcomes. 

 

The obvious question hanging over all of this is cost.  How will a public plan be paid for?  And where will the burden fall in terms of potential tax rises?

 

According to Reich, “no one wants to raise taxes or even be accused of thinking about the subject. But honest politicians have to admit that universal health care will require additional revenues. The likeliest sources are limits on certain tax deductions and a cap on tax-free employer-provided health care.”  So for the plan to be realized, the Obama administration will have to annoy the pharmaceutical giants, US employers and the middle classes.  Good luck. 

 

Whilst we observe this debate from afar, we should recognize that this is a living, breathing example of the ‘hard choices’ spoken about so often – by politicians, and by thinktanks like ourselves.  We should all watch with interest, and hope that a progressive approach in this case can set the benchmark for creative reform in other areas. 

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Posted by Henry Kippin at 8:18 am
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Friday, May 29, 2009

Health-Check for a Responsible Britain

By Henry Kippin

The RSA hosted a packed lecture yesterday from Andrew Lansley, Shadow Secretary of State for Health.  He talked on the subject of ‘Improving Health Outcomes for All’, sketching out a blueprint for a future Conservative Party policy agenda. 

 

Overarching themes were ‘responsiblity’, ‘reform not reorganisation’, ‘choice and empowerment’ and ‘efficiency’.  Some were better explained than others.  Anyway, here are my quick reflections on the main points:   

 

Empowering Frontline Professionals

The Shadow Secretary placed considerable emphasis on the need to empower frontline professionals – the most obvious example being GPs who, under Conservative plans, would be far stronger guardians of quality control, holding hospitals (for example) to account.  Questions here concern potential variation in service levels, and the potential capacity of GPs.      

 

From Targets to Outcomes

This shift of responsibility downwards would be representative of a broader move towards an outcomes-driven approach to public services.  Mr Lansley was unequivocal about the need to do away with top-down ‘tick box’ targets, and towards broad public health outcomes.  But as Matthew Taylor notes, one danger is that broad outcomes can simply become umbrellas for ‘proxy targets’.  And some targets may be necessary - does the Shadow Secretary’s position risk throwing the baby out with the bathwater?

 

Choice & Competition

The Shadow Secretary talked about the need for more and better in this area, as a means to make essential efficiency savings, and to drive up quality. There is broadly consensus across parties on this.  But this will be contingent upon…

 

Access to Information

The lecture set out access to good quality, comprehensive information as key to making a choice agenda work.  But as my colleague Matt Grist pointed out, Robert Shiller and even George Osborne have recently spoken on the need to get past the assumption of rational, economic decision-makers.  I can’t help feeling that more thought needs to be given to appropriate choice architecture in this area. 

 

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Posted by Henry Kippin at 2:41 pm
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