Friday, 6 December 2013

Nelson Mandela

Nelson Mandela was the greatest statesman of my lifetime.  I'm glad that he enjoyed such a long life.

Meanwhile, I learned in a bar tonight that the International Rugby Board retains the rights to BBC radio's commentary on Nelson Mandela awarding the 1995 rugby union world cup to Francois Pienaar, but will graciously allow the BBC to use it for the next 24 hours, or perhaps longer.  Which is good, but why have we allowed such ludicrous extensions of intellectual property rights?

Thursday, 5 December 2013

Do markets improve healthcare?

Tim Worstall's UKIP-supporting blog is where I go to get a different angle on the news.  He didn't disappoint me with his spin on a Guardian story from which he quotes "More than 2,000 people have died of dehydration or malnutrition while in a care home or hospital in the last decade".  "Just shitty care" he concludes, "Wonder of the world."  Which is his stock sarcasm about the NHS.

My immediate reaction was that it's foolish to blame the NHS for this.  It's not the hospital's fault if a usually elderly patient is too weak to be saved when admitted with dehydration or malnutrition.  Nor is it the hospital's fault if a patient refuses to eat or drink.  And, while there have reports of patients becoming dehydrated or malnourished while in hospital, I doubt that accounts for more than a few of these two thousand cases, if only because the doctor completing the death certificate will usually rely on the medical problems detailed in the patient's hospital notes.  Hence this statistic tells one little or nothing about the quality of NHS care.

So what did the original story have to say?  The headline in the Guardian story is "Dehydration and malnutrition led to 2,162 deaths in care since 2003", wrongly suggesting that the deaths occurred in care homes, as most of them did not.  Worstall must have read past this, since he's blaming the NHS.  The body of the story is more careful about the statistic, but concerns itself entirely with care homes not hospitals.  And it links prominently to a story in the Telegraph.

Now, Worstall's usual choice of newspaper to link to is the Telegraph, so why has he chosen to use the Guardian for a story it's lifted from his favourite paper (and not even had a go at its misleading headline)?  Because, I suppose, the latter's story doesn't mention hospitals at all.  And Worstall wants to bash hospitals, which are mostly in the NHS, not care homes, which are mostly privately run.

The source of the numbers in both newspapers' stories is this spreadsheet published by the Office for National Statistics, "following an ad hoc request by the Sunday Telegraph".  (The spreadsheet notes that it does not distinguish between state and private provision of either care homes or hospitals.)  Only 14% of deaths in the last year "where either malnutrition or dehydration were mentioned on the death certificate" took place in care homes, but the newspapers are quite right to concentrate on the role of care homes because they are unambiguously responsible in a way that hospitals are not.

We should be cautious in assuming that poor care is likely to be involved in all these deaths.  There may be cases in which dehydration or malnutrition are unavoidable.  And it may something be better to keep a dying patient in familiar surroundings rather than dispatch them to hospital.  But assuming, to oblige Worstall, that the statistic is telling us that some care homes are providing "shitty care", then what?

Care homes in the UK are a mixture of private for-profit (72%), not-for-profit (14%), and local council or NHS provision (14%, numbers from here).  A meta-analysis in the BMJ has reported that "the evidence suggests that, on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes".  And an unscientific online survey suggests that most (but not all) cases of alleged neglect which reach the press occur in the private sector.  So we can't just blame poor care on state provision.

Advocates of private provision of health care have achieved a massive shift from state to private provision of care homes in the last 30 years (page 13).  Even those sceptical, like me, about how well markets can work in healthcare provision can see potential for their application to care homes.  Relatives of a potential resident can visit several care homes, talk to the staff, see the residents, and smell the air - I've done it.  They can ask themselves whether they'd be content to live in the home if need be.  They can choose to pay more for better care too - while local authorities cover the basic cost for many residents, that's at a standard rate which one can choose to top up.  And if a care home proves unsatisfactory, you can move to a different one.  All this should allow market mechanisms to work better than they can in the choice of doctors or treatments, where the patient has no good way to compare competing providers.  So if in fact the care home market is not working - if care homes are killing their residents through neglect - then that calls into question the whole notion of markets in healthcare.

Let's find out whether care homes are doing an adequate job, and if not why markets are failing to work their magic, before we spend any more money and goodwill on introducing competition to the NHS.

Tuesday, 19 November 2013

National Service

The actor Hugh Grant wants Britain to reintroduce National Service, which was phased out at about the time he was born: he says that his "father and grandfather both served and it shaped them".  Grant comes from a military family of some distinction: his father was a Sandhurst-trained officer and his grandfather was awarded the DSO following the Second World War.  So neither of them was subject to National Service.  Whereas I come from an unmilitary family, my father spent two years on National Service, and he describes it as an utter waste of time.

Grant's proposal puts him in the unlikely company of Philip Hollobone, a Tory MP who has presented a Bill to implement the idea.  But it's not going to happen - what would a modern army do with large numbers of unwilling, short-term recruits?

All the same, mightn't it be a good thing if politicians at least had some experience of soldiering and its dangers before they became empowered to send soldiers off to war?  Or would politicians-to-be find a way to avoid it?  The thought has led me to look up the Vietnam War records of all the main-party US presidential and vice-presidential candidates who were of an age to be drafted.  I present them in order of date of birth:

John McCain, 29th August 1936: son and grandson of US Navy Admirals, naval aviator, shot down, badly wounded, tortured and held for over five years as a prisoner.  Unaffected by the draft.

Dick Cheney, 30th Jan 1941: awarded deferments while taking six years to complete four years' worth of study, and then because his wife was pregnant.

Joe Lieberman, 24th February 1942: awarded deferments to attend college and law school and then because he had a child.

Joe Biden, 20th November 1942: awarded deferments while studying at college and law school, and then reclassified as unfit due to asthma.

John Kerry, 11th December 1943: pre-empted the draft by enlisting in the US Navy Reserve when his college deferments ended.  Commanded a "swift boat" in Vietnam and was decorated for gallantry

George W Bush, 6th July 1946: avoided the draft by joining the Texas Air National Guard

Bill Clinton, 19th August 1946: avoided the draft by joining the ROTC

Dan Quayle, 4th February 1947: avoided the draft by joining the Indiana National Guard

Al Gore, 31st March 1948: pre-empted the draft by enlisting when his college deferment ended.  Spend only five months in Vietnam, where, as the son of a Congressman, he was kept well out of harm's way.

John Edwards: 10th June 1953: only just old enough to have been drafted, awarded deferment to attend college.

Of eight prominent politicians who might have been drafted (I'm leaving out McCain as too old and Edwards as too young), three avoided the draft by spending enough years in college, three avoided service in Vietnam by finding safer military options, one went to Vietnam but was kept out of danger, and one - John Kerry - actually fought.  Following his experiences in Vietnam, Kerry became a strong opponent of the war.  This made him enemies within the US Navy, who participated in a smear campaign against him when supporters of GW Bush wanted to muddy the comparison between Kerry and their man.

So the conclusion, albeit from an inadequate sample, is that most politicians will avoid meaningful service, and the few who don't will be the relatively honourable ones.  And those are the ones who lose elections.


Tuesday, 23 July 2013

The pendulum swings

On a long drive home last night, I was annoyed to find the airwaves filled with the not very interesting news that a baby had been born in London - three or four hundred are born there every day, but this one gets particular hereditary privileges which I suppose make it worth a few seconds of one's attention.

So I turned the radio off, and wondered - I like to exercise my critical faculties - what the news was lying about.  The suspicious part was the claim that the sex of the baby had been a surprise to its parents.  That could be true, but it doesn't follow that no one knew.  Ultrasound scans will certainly have been performed as part of the mother's care, and the ultrasonographer will certainly have observed the fetus's genitals.

The sex was of unusual importance (that is, fractionally more than none) in that the Succession to the Crown Act 2013 makes "succession to the Crown not depend on gender".  So, had the baby been a girl, it would have been likely eventually to become queen, and, contrary to long-standing practice, that would remain the case if brothers were later to be born.  Which would make the ratification of the Perth Agreement a matter of some urgency, at least in the minds of courtiers who care about such things.  It follows that they would have strained to discover from the ultrasonographer the sex of the fetus, and, had it been female, to publicize the fact so as to concentrate the minds of the other Commonwealth Realms.  Whereas had it been male, as it was, there would have been no hurry.

It could therefore be deduced from the secrecy about the child's sex that it was male.  I recognize that this analysis would be more impressive if I'd written it without knowing the result.




Saturday, 6 July 2013

Foxy Lady

The women's final of a relatively important tennis tournament is being contested this afternoon in Wimbledon by Sabine Lisicki and Marion Bartoli.  The English broadcast media have settled on pronouncing the former player's name as "Sabeena Lizikee".  That sounds horribly wrong to me: Lisicki is a Polish name (meaning something like "foxy"), and 'c' in Polish is pronounced 'ts'.

However, Sabine is a German name: she's a German with Polish parents, so perhaps the name is pronounced differently in Germany.  I checked on Forvo, which helpfully offers both German and Polish pronunciations: "Luzitskee" and "Leeshitska" respectively (I'm not sure about the first vowel in the German version).  (The Poles are in fact pronouncing "Lisicka" which would be a feminine form of the surname: I suppose the family has chosen not to use this variant.)

Would the player herself prefer us to use a German or a Polish rendering?  Here she is pronouncing her own name: she calls herself "Sabeen Lizikee".  Evidently she is content to follow the local (US) pronunciation - this seems to be common practice among Eastern-European tennis players, cf. Navratilova and Sharapova.

So what should the BBC do? If it wanted to please me, it would adopt the German pronunciation.  I can understand its not caring about that, but I can't see why it should have chosen to pronounce her forename in German and her surname in American.
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I suppose the name Sabine comes from the Italian tribe, remembered for the abduction of its womenfolk, known to me and other admirers of Saki as the "shabby women".
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Update: here's a German chat-show host using the BBC pronunciation.

Thursday, 20 June 2013

PMQs

Charlie has been watching Prime Minister's Questions (h/t Rebecca), which yesterday included a revealing reply to a question from Caroline Lucas, the UK's one Green Party MP.
Caroline Lucas (Brighton, Pavilion) (Green): The Government’s own research shows that there is a link between the portrayal of women as sex objects in the media and greater acceptance of sexual harassment and violence against women. That being the case, will the Prime Minister join me in trying to get our own House in order and calling on the parliamentary authorities to stop The Sun being available on the parliamentary estate until page 3 is scrapped, and will he have a word with his friend Rupert Murdoch about it while he is at it?

The Prime Minister: I am glad the hon. Lady got her question asked after the dazzling T-shirt that she was wearing last week failed to catch Mr Speaker’s eye. I am afraid I do not agree with her. It is important that we can read all newspapers on the parliamentary estate, including The Sun
(Text from Hansard.)
The contrast with Cameron's approach to other questions is striking.  The political point-scoring from Labour members he answered with point-scoring of his own, but other questions he dealt with courteously.  Here for example is his reply to a question for Labour MP Hazel Blears about unpaid internships:
The Prime Minister: The right hon. Lady is doing some important work in this area. It is a difficult area to get right, because we all know from our own experiences that some short-term unpaid internships—work experience—can be very valuable for the people taking part. On the other hand, unpaid interns should not be employed instead of workers to avoid the national minimum wage. That is the balance that we have to get right, and I commend the right hon. Lady for the important work that she is doing.
It's as if he thinks that stopping exploitation of interns is important, but violence against women is an issue best addressed by making jokes about what one's questioner was wearing a week ago.

Rather than read the text, one can watch PMQs on video.  That takes much longer than is merited by what is said, but one can enjoy the demeanour of the front benches.  In this broadcast, Theresa Villiers, sitting four to the left of Cameron, is the one to watch when she comes into shot.  She seems reasonably enough to think she's got better things to do than listen to boys calling each other names, but she does her best to listen politely.  At 4:17 she smiles at Cameron's cutting remarks about Ed Balls.  At 10:19 she smiles in support of his congratulations to Edward Leigh on his knighthood.  At 16:49 she looks bored with Cameron's reply to a question about child poverty (he blames Labour and the Speaker cuts him off), and at 20:21 she's no more interested in an exchange about William Cash's Gender Equality (International Development) Bill (Cash invites Cameron to support the Bill, and Cameron does so, but not to the extent of encouraging anyone to vote for it).  At 26:02 she's interested enough in a question about the Health Service to exchange a few words with Jeremy Hunt, the Health Secretary.

Lucas asks her question at 26:10.  At 26:56 Cameron steps back, having finished his reply, revealing Hunt and Kenneth Clarke smiling at his jest, and Villiers between them glowering stonily.

I'd like to think that she had a quiet word with him after, pointing out that he could have expressed his abhorrence at violence against women while still supporting freedom of the press and the right of MPs to inform themselves by looking at the pictures in The Sun.

Wednesday, 5 June 2013

Starbuck's Profit

At the end of last year there was a hoo-hah about the Starbucks coffee chain, which doesn't pay corporation tax in the UK because its accounts say it makes no profits here. Kris Engskov, Starbucks' UK Managing Director, quieted the row by promising that in future the UK company would reform its accounting practises such that profits made here would no longer be transferred to Starbucks' operations overseas by means of brand royalty payments, mark-ups on coffee beans and high rates of interest on intra-company loans.

Meanwhile, Lisa Pollack at the FT published a series of articles on Starbucks' tax affairs, looking at its apparently inconsistent statements of profit and loss, its transfer payments, and its offer to pay more tax.

Having examined the transfer payments, Pollack wrote that
So that’s a £33m loss less £26m of royalties less £2m of interest, which gets one to a figure of £5m… which is still a loss. Some of the mark-up from the Swiss bought coffee would have to go too to get the company near profitable in the UK.
Which makes the punchline — that Starbucks has agreed to pay £10m of ‘tax’ voluntarily over the next two years — even weirder.
This analysis was seized on by commentators hostile to corporation tax in general.  But Pollack, in an otherwise informative series, has made a mistake.  The profit and loss for reporting purposes is not the same as the profit and loss for corporation tax purposes.  (I started on a post about this at the time: real life supervened.  But Tim Worstall has today repeated the claim, so I'm going to try to put things straight.)

The £33m is Starbucks' reported UK loss for 2010-11.  Pollack's point is that even if it reported results £28m better it would still be making a loss, and so (she implied) not paying corporation tax. But as the Financial Statement makes clear on page 19, some of the items contributing to the stated loss - depreciation and impairment in excess of capital allowances, and non-deductible expenses - are not allowable for corporation tax purposes.  They come to about £16m apiece.  Adding these back in, Starbucks' UK loss is reduced to £1m.  So with the £28m in royalties and interest payments the company would have a taxable profit of about £27m.
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Two additional points for clarity:
- the numbers on p19 are the affect of each item on corporation tax payable, which was 27% of the gross
- Starbucks has got past losses available to set against future profits.  So it may still not need to pay corporation tax.