Truth and love must overcome lies and hatred: The contemporary relevance of John Macmurray

Below is the introduction to an essay I’ve written about a Scottish mid-20th-century philosopher John Macmurray. Like my essay on Polanyi, this was partly a way for me to go through his work and set it down for myself. But the interest is through the lens of aspects of Macmurray’s philosophy that were prophetic for our times. This is brought out in the introduction which is reproduced below. The last couple of sections also outline the way in which our society is increasingly built on pyramids of lies. So you can also skim through the sections on Macmurray and just read the intro and the concluding two sections — which I’ll also extract at some stage and write up as their own essay.

I’d be grateful if you’re interested in having a look at the essay and if you email me on ngruen AT Lateral Economics, I’ll send you a link with commenting and suggesting permissions.

Truth and love must overcome lies and hatred: The contemporary relevance of John Macmurray

Sometimes the problems which life sets … men or to nations … have a philosophical side to them. That happens particularly when the driving forces of a nation or even of a whole civilization are spent.

John Macmurray, 1930.

Introduction

On December 10, 1989, Czech dissident Vaclav Havel improvised a line at the end of his speech which, like Martin Luther King Jr’s improvised conclusion of his “I have a dream” speech, burned itself into popular consciousness far more effectively than his prepared remarks. “Truth and love must overcome lies and hatred.” Havel had become famous in the West as a dissident anatomising the system of official lies that drew everyone into complicity with them.

He insisted that Stalinist totalitarianism had been replaced by post-totalitarianism, which must be understood as a set of institutions rather than the dictatorship of one man. And he drew parallels between post-totalitarianism and Western consumerism. Today we all ponder the dramatic speed with which our own public lives are transitioning to new ‘post-truth’ realities. And, as we look around for their antecedents, we find them well beyond political campaigning. For instance, here are the opening paragraphs of a recently published report from the front published anonymously by a local council employee. The recognition may be recent, but it’s been decades getting here:

I spent 10 years of my life writing. I wrote neighbourhood plans, partnership strategies, the Local Area Agreement, stretch targets, the Sustainable Community Strategy, sub-regional infrastructure plans, funding bids, monitoring documents, the Council Plan and service plans. These documents describe the performance of local government and its partners.

I have a confession to make. Much of it was made up. It was fudged, spun, copied and pasted, cobbled together and attractively formatted. I told lies in themes, lies in groups, lies in pairs, strategic lies, operational lies, cross-cutting lies. I wrote hundreds of pages of nonsense. Some of it was my own, but most of it was collated from my colleagues across the organisation and brought together into a single document. As a policy, partnerships and performance officer in local government, this was my speciality and my profession.

Why did I do it? I did this because it was my job.

Against this backdrop, this essay introduces some of the central aspects of the thought of a mid-20th-century Scottish philosopher. Though both inspire us with their extraordinary courage, Havel’s and Macmurray’s thought and life experience were very different. Nevertheless, John Macmurray’s central ethical vision aligns perfectly with Havel’s catchcry quoted above. Macmurray saw all human relations and human culture as a dialectical relation between love (through which we find our way to a truthful and productive relation with reality and with others), and fear (which leads ultimately to solipsisitic, and duplicitous self-absorption, and thus to atomised isolation). Continue reading

Posted in Democracy, Economics and public policy, Innovation, Philosophy, Public and Private Goods, Social Policy | Leave a comment

Do lockdowns work in Europe?

Let us divide the countries in Europe that have at least 1 million inhabitants into three groups: the ones that had high movement restrictions in 2020, the ones with almost no restrictions, and the ones in between. The graph below gives you the punchline that countries with more restrictions had higher numbers of covid-deaths, but in order to discuss the many other implications, I need to explain how the graph was put together.

I take the data on restrictions from the Oxford Blavatnik Stringency Index that gives a daily severity level for all countries in the world since January 1st 2020. This stringency index combines information on nine government policies: school closures, workplace closures, cancellation of public events, restrictions on gatherings, closure of public transport, restrictions on internal travel, restrictions on foreign travel, and the presence of a covid-cautioning public information campaign. The lowest value is 0 and the highest 100. One can think of a lockdown as having a score above 70. By that metric, the UK spent 4 months of 2020 in lockdowns and Australia about 3 months. From January 1st 2020 to now, the average world citizen spent about eight months in lockdown.

I take the claimed numbers of covid deaths by countries from the Oxford Blavatnik website as well, which essentially reports the daily data as claimed by countries themselves (so sometimes when a country revises downwards you see negative numbers for that day). I define the high-restriction European countries as those with at least 60 days of lockdowns in 2020. That includes 92% of the population and most of the large countries. I define minimal restriction countries as those with average restrictions in 2020 below 40, which turns out to hold only for Belarus and Estonia. The pragmatic countries in between are all the Scandinavian countries (Denmark, Sweden, Norway, Finland), Switzerland, Bulgaria, Serbia, and Latvia. Interestingly, the Scandinavian countries all had very similar average restrictions. Denmark, for instance, had an average restriction level of 51 whilst Sweden scored 54. Only Sweden had no lockdowns at all in Scandinavia, whilst Finland had 18 days of lockdowns and Norway 34 days in 2020, for which the Norwegian health authorities later apologised.

The total deaths per million till July 26th was 1449 for the lockdown countries, 1123 for the pragmatists, and 433 for the minimalists.

The graph and the data shows and suggests many things:

  1. Lockdowns in Europe ‘do not work’ to prevent covid deaths. Rather, the data shows that the more restrictions in 2020, the more covid deaths in both 2020 and in 2021. So the data strongly suggests lockdowns lead to more recorded covid-deaths. At the very minimum the data shows that countries without lockdowns do not experience the covid-Armageddon that is even today prophesised by doom-medics in lockdown countries. That alone makes liars out of an entire layer of government advisers, model builders, and politicians throughout much of Europe who daily fan the flames of covid-hysteria.
  2. The lockdown countries have less flat curves in spring 2020 (March-June) than those of the pragmatists and minimalists.
  3. Covid-deaths are highly seasonal, with the numbers going down in summer times. This was not clear in 2020 when many suspected (including myself) that covid was ‘done’ in much of Europe. Now we know that new variants and differing circumstances lead to another winter peak.
  4. The covid-death numbers in the lockdown countries in the summer of 2021 look very suspect: we are now talking about vaccinated populations in a season where in 2020 there were very few recorded covid deaths, and where in the pragmatist countries there are again almost no covid deaths in the summer of 2021. One has to strongly suspect that the lockdown countries are counting people as covid deaths that in truth died of other causes, but who tested positive at some point in time. [You btw also see in the excess death graphs a total lack of any summer excess]. The suspicion has to be that we are now looking in the lockdown countries at artificial claims, either because of false positives in tests or due to counting of minimal covid-levels as the cause of death.
  5. The rest of Scandinavia does not ‘disprove’ Sweden: restriction levels are similar across Scandinavia and none of them are lockdown countries.
  6. In most regions of Europe, there is some country close by to which those who enjoy their personal freedoms can move to if they want to. Central-Europe can go to Serbia or Bulgaria. North-East can choose between Latvia and Estonia. North-West can go to Denmark or further up still. Southern Europe can head for the Swiss alps to taste freedom (what does that remind me of?).
Posted in Coronavirus crisis, Dance, Death and taxes, Health, Medical, regulation, Science, Social | 20 Comments

Our superannuation system

I compiled a list of thoughts about our own superannuation system in response to a journalist from elsewhere thinking about pensions in their own country and asking me for a rundown on Australia’s system.

Via various accords with their union and business partners, the Hawke/Keating Government brought all regular employees within the super net, requiring compulsory contributions of 10% of payroll — up from 9.5% on 1 July this year. It will rise by 0.5% to a target of 12% over the next four years.

  • defined benefit schemes became of less and less importance and the whole compulsory system is built around defined contribution — I think the Commonwealth Government has also been winding down its defined contribution scheme towards something that looks more like a defined contribution scheme, though I expect it contains hybrid elements.
  • While some tax and regulatory incentives encourage people to take annuities, this is nevertheless funded from defined contributions. Beyond that, I don’t think it delivers any ‘defined benefit’ attributes of the old schemes.

Here are some things I think there are to like about the scheme:

  • It’s provided a good way of getting savings heavily into equities. A lot of our funds spend a lot of their time about 75% long on equities, including substantial investment in foreign equities which is good from a risk perspective.
  • It provides a way for a substantial amount of self-provision and self-management of investment — which is fine if it’s kept reasonably ‘vanilla’ flavoured — of which more below
  • It provides a mechanism for cranking up national savings — which Australia was very worried about in the 1980s — and it has broad political support — not something that a lot of savings initiatives have!
  • I argued here that the size of our indigenous savings pool plays some role in Australia’s substantial out-performance of New Zealand since the 1980s but the evidence for this isn’t overwhelming.

Things not to like: Continue reading

Posted in Economics and public policy | 3 Comments

Unseen trends and the society we are becoming.

Societies are evolving and complex, which often makes it hard to see at any moment where things are going. It was thus with the move of Northern European countries towards democracy in the 19th century, which seems inevitable and clear in hindsight but blurred at the time by lots of other developments that have now been forgotten, such as an increase in Protestant fanaticism and an anti-technology (Luddite) movement. In the last few decades there have also been many trends, some already waning, like the increase in international migration, and some on a seemingly unstoppable growth, like increased inequality. As in previous centuries, events like covid-mania accelerate some previous trends, like state surveillance, and reverse others, like the growth of international tourism.

Many commentators have rushed towards applying a particular label to the developments of the last 50 years. One hears about neoliberalism, financialization, or unsustainable growth. Though they make things sound neat and simple, such labels immediately make things moral and political, forcing people to take sides, which obscures the breadth of changes and makes a calmer assessment impossible. Let us thus look here at some of the less noticed trends which do not easily fit into existing labels. In this short post I just want to flag some trends in the Western world and briefly mention some instances of misperceptions of trends, leaving analysis for later. I will deliberately not show any statistics, forcing you to engage with the ideas rather than be a ring-side observer. See what you yourself make of these issues. Continue reading

Posted in bubble, Bullshit, Business, Climate Change, Education, Employment, Geeky Musings, History, Humour, Immigration and refugees, IT and Internet, Social, Theatre | 21 Comments

Aborigines and the National Game — by the late John Hirst

Source: Winter in Australia: Football in the Richmond Paddock (1866) is the earliest known image of a football match in Melbourne.(Supplied: State Library of Victoria (Robert Stewart 1866))

Here’s a fine essay I came across by John Hirst.

Aboriginal people make up 2 per cent of the population and 10 per cent of footballers in the Australian Football League. As anyone who has seen them in action will attest, they seem made to play the game; but were they makers of the game as well? Their role in the game’s origins has been a matter agitating the football world and its historians since the appearance in March 2008 of The Australian Game of Football Since 1858, the authorised version of the AFL’s history, as large as a pulpit Bible, though with more illustrations.

The book has many authors. The editor chose Gillian Hibbins, a well-credentialled sports historian, to write the opening chapter on the formation of the game. She made no mention of the Aboriginal game of football, Marngrook. The editor then asked her to deal with the supposed connection between this game and Australian Rules. She produced a one-page supplement to her chapter which completely dismissed any connection. She declared that she would be very happy to find an Aboriginal influence, but sadly there was no evidence for it: it was no more than ‘a seductive myth’.

This got her and the AFL into a lot of trouble. The critics thought that the AFL, having worked so hard to welcome Aborigines into the game, should not have authorised such a firm exclusion from its early history. They had difficulties, however, in making a case for Aboriginal influence, unless it was by the modish assertion that there is no single truth and if Aborigines think they were influential they ought to be allowed to say so. Hibbins 54 insisted very properly that as a professional she had to stick to her reading of the documents.

The Aborigines in Victoria did certainly play games of football, which differed in name and form by region. Marngrook, the name now used for them all, was played by the Gunditjmara people of western Victoria. The ball was made from a possum skin filled with charcoal and tied up with sinews of kangaroo tail; in Gippsland, the ball was a kangaroo’s scrotum stuffed with grass. The players kicked the ball and jumped high to catch it. The play was open and free-flowing, more party game than desperate competition. There were no goals. An individual player who kicked furthest or jumped highest or had most of the play would be declared the winner. James Dawson, an amateur anthropologist, reported that in the games he’d seen, the team that kicked the ball oftenest and furthest won. That would be difficult to determine. Perhaps, like the man who asked frisbee players in a park who was winning, he had difficulty comprehending a team sport without a winner. Continue reading

Posted in Cultural Critique, History, Indigenous, Sport-general | Leave a comment

What is managed care and can it help fix the Australian private health sector?

This is an edited version of a piece published in Crikey on 2 July 2021. 

It looks like Australian health funds will get more say in how care is delivered in the future if the ACCC’s draft decision giving health fund Nib more leverage to negotiate contracts with providers, and Medibank  purchasing a stake in both a private hospital and a chain of medical practices are anything to go by.

This is a pretty major shift in the private healthcare sector and providers are worried. The Australian Medical Association (AMA) is reacting strongly, claiming that such “managed care” will reduce care quality and compromise outcomes. These claims are made as self-evident and tend to escape proper scrutiny. This isn’t right given what’s at stake.

Not only is the current private health model financially unsustainable, but there’s a lot to suggest that medical decisions often don’t reflect the best interest of the patient. The Royal Commission into Aged Care Quality and Safety demolished the wisdom of leaving providers of an asymmetric service to it with little oversight. We may have a similar problem in health care and it needs to be addressed. Greater involvement of those who pay the bills is among several options that include fee transparency, outcomes data, and newer remuneration models, but it needs to be debated.

First, let’s examine if under the current arrangements Australians receive quality health care based on their medical need and their personal preferences.

In the absence of reliable data on outcomes (an ongoing hindrance to good practice and policy), one way to flag potential problems is by measuring standardised differences in service provision between regions. While some variation is warranted, dramatic disparities can indicate problems with medical practice and/or lack of access and facilities.

Analyses by the Australian Commission on Safety and Quality in Health Care suggests  situation that can be described as a medical postcode lottery.

For example, an adult living in Dubbo is 56 times more likely to undergo a heart perfusion scan than someone residing in Onkaparinga, South Australia. This is after adjusting the data for demographic differences. Neither region is classified as remote, so lack of service availability is unlikely to be a major factor.

Is it down to levels of heart disease? Perhaps, but it’s very unlikely to explain such magnitude. In fact, a 2016 variation study (using the larger geographic units of Medicare Locals) found surprisingly little geographic association between the rates of coronary angiography — another cardiac investigation — and levels of heart disease. However, a strong association between angiography and private hospital admission was found. This suggests factors other than medical ones play a part.

In addition to unwarranted variation, too many “low value” procedures and tests with little proven clinical benefit are commonly performed in the private sector. Some of these have now thankfully been amended or removed from the MBS as part of the recent review.

And then there’s questionable adherence to clinical standards and guidelines. Two peer-reviewed Australian studies looking at common adult and child health conditions found that clinical encounters complied with best-practice in fewer than 60% of cases on average.

While such problems are not unique to Australia, the causes can be distilled to the changing nature of healthcare and a private sector funding model that encourages volume over value.

So why is this happening and what can be done?

Firstly, healthcare is not a cottage industry any longer. Good care is more than the sum of individual medical interactions. Not only are patients now medically more complex — with multiple health problems that require sustained management across disciplines and professions — but biomedical science and knowledge is vast and expanding rapidly.

Safe, high-quality care is now a team sport and the collaborative model works best when GPs, specialists, nurse practitioners and the patient use the same electronic platform to communicate and view results and medication updates.

This approach is highly suited to “provider networks”, which can offer the necessary central administration and management. It also happens to be a key feature of managed care and a departure from the quaint sole practitioner model of yesteryear.

Secondly, the Australian private health sector is characterised by a fee-for-service payment model along with a firm separation between payers and providers.

This combination encourages growth in activity and in fees, with little incentive for restraint or value. There are currently no limits on what providers can charge, and ample evidence suggests that they will lean towards options that generate the most revenue rather than alternatives that are more conservative but equally effective.

To put it bluntly, every dollar of expenditure is a dollar of income so it’s unsurprising that providers will resist changing the current arrangement. It’s worth recalling that Nye Bevan, the creator of the British NHS – when asked how he managed to persuade medical specialists to sign up to the scheme – remarked that he “stuffed their mouths with gold”.

Medicare expenditure is outpacing GDP growth

DATA FROM MEDICARE STATISTICS AND WORLD BANK

Moreover, there’s also little association between medical fees and quality. Higher costs, meanwhile, are borne by insurers, patients and — via Medicare — the taxpayer, reflected in growing premiums, out-of-pocket costs and Medicare expenditure.

Now, there is no question that health professionals believe that they act in their patient’s best interest. But they are human, and healthcare is very complex. Research shows that they are often unaware that treatment may be inappropriate or even harmful, and that medical decisions are driven by a range of incentives, including financial ones.

This, along with the provider protestations, remind me of a story recalled by Archie Cochrane, the father of evidence-based medicine (and an irreverent Scot).

Cochrane was speaking to a group of eminent cardiologists about a clinical trial comparing clinical outcomes of coronary care units with normal home care. Preliminary results suggested a slight numerical advantage to home treatment. He decided to have a bit of fun. Before the official presentation, he showed some of them a reversed version of the results (suggesting slightly higher mortality in home care). They condemned the study, called him unethical and beseeched him stop the trial at once. After hearing them out he apologised, saying that he had mixed up the results and it was, in fact, home care that appeared to be slightly more effective. This was met with dead silence.

While concern about insurers owning hospitals is understandable, the opposite is also true: provision that is completely decoupled from financial risk can generate overtreatment and higher costs with little value added.

This can be tempered if the payer has some say in what and how care is provided. For example, joint replacement using a short-stay model produces the same outcomes as a longer, more expensive admission. Patients prefer it and it’s cheaper overall, but many private sector providers resist it — despite it being routine in the public sector.

In fact, there’s nothing radical or dangerous about removing the payer-provider separation.

Israel’s health system is considered among the best in the world. It’s also comprised entirely of health maintenance organisations (HMO) — payer-provider entities that are a feature of managed care.

Clalit Health Services, Israel’s biggest HMO, looks after 4.6 million people who receive excellent care when needed, but also cutting-edge preventative interventions designed to keep people healthy and out of hospital. It is in both Clalit’s and the patient’s interests to do so. The excellent analytics are due to an enviable, all-encompassing dataset on enrolees’ health, care and lifestyle factors (which, incidentally, enabled the lightning-fast observational study of the Pfizer vaccine). This is unimaginable in the Australian system.

Under the much-maligned US system, the payer-provider model has actually been a success. Kaiser-Permanente delivers evidence-based, efficient care and excellent outcomes without breaking the bank (or bankrupting the patient). US health professionals are actively involved in generating patient care pathways and enjoy being part of a system that is focused on outcomes. The result? Coordinated services involving screening, prevention, primary care, outpatient care and hospital care — again, impossible under the fragmented Australian system.

An we already have good examples of payer-providers here in Australia. Public hospitals are both funded and managed by state and territory governments and perform very well considering their casemix and community obligations. Plus, let’s not forget that the aged care royal commission found that public facilities provided better quality care than their private counterparts.

Giving payers more say in how care is delivered is not a silver bullet. If we really wanted to improve patient choice and care quality we could enforce much more transparency on medical fees, mandate routine data on actual outcomes, and explore remuneration models that reward value over volume.

But it isn’t a radical change, either. It’s how public hospitals are managed and Medicare already dictates what can and can’t be done privately.

Dismissing it without debating the evidence has a whiff of “nothing to see here” and is a wasted opportunity to explore on option for improving Australian healthcare … without stuffing any mouths with gold.

This piece benefited from input by orthopaedic surgeon Ian Harris, professor at UNSW medical school and honorary professor at the University of Sydney‘s School of Public Health.

 

Posted in Uncategorized | 1 Comment

Lockdowns and privilege

Consider three graphs that really on their own tell the story of the groups in the US/UK that did well and that did badly economically out of the lockdowns.

On the super-rich:

Image

On the workers, particularly the bottom 25% (meaning those who in their characteristics like education and experience look like the bottom 25% in January 2020):

And for the UK on who is expecting trouble with paying the bills:

You btw see the same picture when it comes to whose children are worst affected by the school closures, who is more banned from travel than others, whose business is less essential than others, or whose sports are less essential than others. Basically the same story in all realms.

Who is “in this together” again? Methinks the top group. Why on earth the left is in favour of all this emerges as a puzzle some true left-wingers have also asked. I think the answer is simple: there is hardly any real left left, which is doubly surprising given the top graph.

Posted in Coronavirus crisis, Employment, Humour | 38 Comments