Mark Easton in his BBC Blog had a thoughtful piece on the nature of Right wing politics yesterday, in which he was kind enough to mention my post on Andrew Lansley.
Mr Easton was pointing out the fault line that has existed in Conservative politics since time immemorial – between the idea of individual liberty and social responsibility – both ideas dear to the Right. The Government’s whole “nudge” philosophy attempts to bridge the gap between these two. As he said:
The health secretary draws a distinction between the “nanny state” and the “nudging state”. Last summer he told doctors he is opposed to “lecturing people and telling them what to do” preferring to “harness behavioural science…nudging individuals in the right direction”.
Which really begs the question. Who decides what is the “right” direction? The answer, of course, is Mr Lansley and his mates in the Government. Or rather, in practice, it is the civil servants and officials who really run the country most of the time.
There is a moral point here that people like Mr Easton can understand – the question about whether those people actually have the right to decide for everybody else what is “right”.
But there’s a deeper point even than that, which the Chattering Classes who run the BBC absolutely do not understand. And that is that dispersion of decision making leads to more effective decisions.
A market works more effectively than a centrally-planned economy. In part that is because of incentives due to competition. However, it is also because many small decisions are made rather than a smaller number of big decisions. In both cases, some of the decisions will be wrong. But overall, the many small decisions lead to better outcomes.
This principle applies to social matters as well. A smaller number of centrally-made decisions will lead to worse outcomes than a mass of small decisions made by individuals for themselves. Politicians like Andrew Lansley, and indeed David Cameron, completely fail to understand that, simply because they don’t even notice that those central decisions can be wrong.
I’ve mentioned before the baby deaths that were caused by poor advice from health professionals to lie babies on their fronts to sleep. That was a “nudge” from the State if you like – and it led to hundreds of preventable deaths. The advice was simply wrong. If that decision had been left to individual mothers, most would have put their babies on their backs. Sure, some would have got it wrong and put their babies at risk. But overall fewer would have died.
All of which means that the “nudge” ideas that Mr Cameron seems to favour so much are not just immoral, but likely to be harmful as well and lead to worse outcomes than if they minded their own business.
Mark Easton finishes his post thus:
Here are a few of the estimated annual health costs which, it is argued, a public health strategy might help reduce:
• smoking-related illness – £2.7 billion
• alcohol-related illness – £2.7 billion
• drug-fuelled crime – £13.9 billion
• noise – £5-8 billion
• poor air quality – £9-19 billion
• working days lost to sickness absence – £13 billion (2007)
• hip fractures – £1.4 billion
• poor mental health – £77.4 billion (2003).
Nudge or nanny? Faced with the bills for all of this, one can imagine why Mr Lansley is reluctant to let go of the apron strings completely.
Even this is wrong. A moment’s thought will tell you very clearly that these figures are completely made up nonsense. Let’s test them:
Smoking- and alcohol-related illnesses – well, it’s been pointed out before: if people don’t smoke or drink themselves to death, they still die of something eventually. So if you don’t treat them for lung cancer or cirrhosis of the liver, you end up treating them for something else. What’s more, if you stop them smoking or drinking, they live longer – which actually costs the NHS more. And that’s before you even start on the taxes they pay on their cigarettes and booze. Epic fail – reducing drinking and smoking might be “desirable” but it will cost money not save it.
Drug-fuelled crime – hey ho, that’s a good one! The fastest way to stop that is to legalise the drugs. (Which I don’t support, by the way, because like all good Conservatives I hold those two contradictory principles, of individual liberty and social responsibility, at the same time!) In fact, though, economically speaking, the figures are rubbish anyway. Most of that money that is supposedly “cost” by drugs, is made by criminals – who then spend the money on things that have nothing to do with drugs. When a car company sells a nice shiny new car to a drugs baron, the money goes back into the legitimate economy.
Noise – eh?! Not sure what he’s on about there. How on earth can noise cost £5-8 billion?
Poor air quality – the vagueness of those figures (£9-19 billion) tells you all you need to know about how much you can rely on them.
Working days lost to sickness absence – that’s a good one. First, some of those were actually shirking and not real sickness. Second, some of the work not done was caught up when the person returned to work. Those figures are nonsense as well.
Hip fractures – assuming that is the cost of treating them on the NHS, how much would the government need to interfere in people’s lives to reduce that? And when do we, the people, get to choose whether to do whatever it is we’re doing that leads to the fractures, and pay the extra taxes to fix them, or whether not? Never of course. Mr Lansley will decide for us.
And poor mental health. £77 billion!! Good grief, that’s somewhere near the entire cost of the NHS. That figure too is complete rubbish.
Overall, then, Mr Easton’s figures of potential savings from “nudging” are not worth the paper they’re printed on (or the computer screen they’re displayed on). They are typical public sector “facts” – nonsense dressed up as fact by being uttered by supposed experts who often actually have no clue about anything much. Those people always – always – have their own agenda in producing the figures, just as people in the private sector do. And those are the people, remember, that Mr Lansley wants to make those decisions about what is good for us.
“Harness[ing] behavioural science…nudging individuals in the right direction” is actually the same as “lecturing people and telling them what to do” – except that it’s done secretly and not openly.
Basically, nudging is stealth lecturing. That is why it is both immoral and likely to damage our society.