Friday, 29 July 2011

Poor form

OK enough serious, wannabe-grown-up, pretending-like-I-understand-the-issues, boring discussions about politics. And back to something that I know a bit more about, and that I am fairly sure everyone can unanimously agree on: That government forms are silly. I also think they are hopelessly and unnecessarily complex, but that is a failing I have already lamented in an earlier post. Today I want to concentrate on their silliness.

I don’t think this silliness is confined to government forms in the USA. In fact I have experienced first hand the silliness of government forms throughout the world. The application for a Kenyan passport is gloriously silly in places, asking the applicant to list their “Colour of eyes”, “Colour of hair” and “Special peculiarities”. Honestly, what are you meant to put for this last question? “Er…well…where do I start? I have an inexplicably ardent passion for golden raspberries, a phobia of Tuesdays, and…I am a little sensitive about it…but since you ask…I have really pointy ears that people always say make me look like an elf”. But the last silly government form I filled in was an American green card application, so American forms will bear the brunt of this savage assault.

Well actually, hopefully it’s not that savage (he said, tittering nervously, and hoping that the government official reviewing his pending green card application can’t somehow access his blog…).

But here are some questions that I had to answer in my form. For each of them you had to check either a “Yes” or a “No” box:

Question 4

“Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to any person or organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity?”

Who checks the “Yes” box to that question? You would have to be a pretty honest terrorist to own up on a government form, right? I don’t know which is sillier – the form’s naïve optimism that a former or aspiring terrorist will confess his crimes, or that an expensive attorney clearly racked up significant fees drafting a wording for the question that was absolutely watertight.

Attorney: “Aha! I’ve got it! We won’t just ask them if they have engaged in terrorism or if they intend to engage in terrorism. We will ask them if they have conspired to engage in terrorism as well!”
Government official: “That’s inspired!”
Attorney: “Why thank you my good man. (That will be $4,000 please)”

Question 5 a)

“Do you intend to engage in the United States in espionage?”

Honestly, you would have to be THE WORST SPY IN THE WORLD to answer Yes to that question. Surely that is the first thing they teach you in spy school. “Do not admit to being a spy, as this will blow your cover”. You might imagine particularly stupid spies getting caught up by this question if it is asked in a really clever, subtle way, and they have to give an answer really quickly. But the form asks it in a really obvious, straightforward way. And the form-filling spy has all the time in the world to answer it. At least we can reassure ourselves that, even if stupid spies get help from their spymasters in answering this question on the form, we can reasonably assume that they might be tripped up when they arrive at the US border:

[A man wearing a long trench-coat, a pair of dark glasses and an obviously fake moustache, and carrying a magnifying glass and a newspaper with two eye-shaped holes in it, approaches the immigration counter]
Immigration officer: “Hello…Mr…er…Schmidt. Now I want you to think very carefully before answering this question. Are you a spy?”
Herr Schmidt: “Yes”. [4 seconds elapse]. “Vait…Vait…Vait…I mean Nein. I mean No. I meant No.”
Immigration officer: “Sorry I am going to have to take your first answer. Which was that you are a spy. Please go and join that line over there, which is composed of other confessant spies, saboteurs, political assassins, hijackers and other terrorists.”
Herr Schmidt: “Scheize! Alvays the same qvestion every time!”

Question 7

“Did you during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion?”

If you committed genocide on March 22, 1933, or May 11, 1945, in you come. (As long as you are not still spying for the Nazi Government of Germany – please see question 5a ).

And another silly thing about forms. They never leave enough space for your e-mail address. I am still waiting to hear back about my green card. And I am completely in the dark about whether that’s because I accidentally ticked “Yes” in the “Do you plan to indulge in espionage?” box, or because the e-mails they send to Jonathan.Pri_x@_____ keep bouncing back.

Toxic Debt

Again, speaking from the wonderful position of outside observer (wonderful because it justifies my complete ignorance), a few ramshackle thoughts on the grave debt crisis facing the “United” States of America.

I think it is generally the right thing for a country (and an individual) to maintain a balanced budget. I don’t think this is always the case. When a budding doctor is in medical school, they might be running up debts, in the reasonable assumption that they will pay them off once they are qualified and well-paid. And when an economy is in recession, my (again, limited) understanding is that a budget deficit is more reasonable, given a) the lower tax revenues that result from the contraction in the economy, and b) that government spending can help to pull the economy out of recession, or at least ease the downward dip (the G in C + I + G + X – M). But generally, budgets should balance.

I also think it is fairly clear that the huge debts that the US Government faces today ($14,548,054,858,928 last time I checked). Are the result of both Democrat and Republican presidents. The deficit has increased substantially in the last couple of years under President Obama (from $10.0T in September 2008 to $14.5T today). And the deficit increased substantially under President Bush II (from $5.6T in September 2000 to $10.0T in September 2008). It increased substantially (by around 350%) under Reagan and Bush I, and slightly under Clinton. The point is, that for Republicans to lay sole blame for the crisis at Obama’s door displays an acute medium-term memory loss.

But “how we got here” is less important than “how we get out”.

In my opinion, the way to do that is gradually. I understand that economies prefer subtle, barely perceptible adjustments to the rudder, rather than sudden, sharp shocks, or violent, lurching changes of course. These subtle adjustments should have been made over the last ten years, and the sad fact that they haven’t, and that we therefore now face such an imminent “do-or-die” moment, reflects poorly on the short-sightedness of the current administration, and the last years of its predecessor. But “we are where we are”, and from here, the best solution seems to me to be to wind down the deficit smoothly and gradually, over a number of years. Restoring a deficit of over $1,000,000,000,000 overnight appears to be more politically motivated, than economically sound.

I also believe that these adjustments should be on both the revenue and the expenditure side. That is, the best solution will encompass both tax increases and government spending reductions. I think this is both good economics (because it mitigates the severity of changes to either taxation levels or government spending required to balance the budget), and good politics (because it involves compromise between Democrats and Republicans). I believe that you can be for tax cuts and against balancing the budget, or against tax cuts and for balancing the budget, but that you cannot be for both. Especially if you are determined to balance the budget in the immediate term.

But what if no compromise is possible, and no deal is reached in the next 4 days?

Given that there seems to be little historical precedent for the largest economy in the world defaulting on its debt, we can only guess as to what the implications of such a default might be. But I think it is safe to say that they will be “bad”. Stocks will undoubtedly crash, as they have been doing for the last week (the Dow Jones has declined by around 5% during this time). And US interest rates will climb, making already steepling interest repayments even more expensive. And perhaps the psychological impacts of such an unprecedentedly gargantuan economic catastrophe on consumer and investor confidence will be even more profound, and permanent.

To my untrained eyes, the tragedy here is that it is not just economic ill-discipline that has brought us to the edge of this precipice, but political recklessness. It seems as though American politicians, of both colours, are more interested in playing political hardball and petulantly digging their heels in, than saving the nation from economic catastrophe. I would say it is a “dangerous game”, but it’s now far beyond a game.

Wednesday, 27 July 2011

The Bipartisan Ship

In England, politics is really dull.

Everyone seems to agree on most of the major issues. Neither the Labour Party nor the Conservative Party would ever dare challenge the existence of universal health-care, for example, and so the only debate is around how reforms to the National Health Service should proceed. The last instance of capital punishment occurred in 1964, and David Cameron is about as likely to reinstate the practice, as he is to immediately promote Rupert Murdoch to the position of Chief Communications Officer. Everyone in the country believes in the dangers of climate change, I can not remember the issue of abortion ever entering the political arena, and there are 6 guns per 100 English people (compared to 89 per 100 American people), so this debate is extinct too. American Democrats and Republicans hold genuinely and significantly differing opinions on all of these issues, whereas In England, the opinions differ more by degree than direction. English politics feels more about the personalities than the issues.

I think the American version is a lot more interesting.

I get much more excited and passionate about politics in America than I do about politics in England, despite (or perhaps because of) my minimal understanding of the political landscape, history and factbase here in my adopted home. I could (and often do!) talk about American political issues for hours. I would be about as interested in talking about English political issues for hours, as I would be in inviting George Galloway to be the godfather of my first child – even if I could find any English political issues to talk about.

But I also think the English version is “healthier for the nation”.

Firstly, for reasons of national unity. Because Elephants and Donkeys are so deeply divided on so many fundamental political debates, over the years their ideological positions have become more and more entrenched, giving rise to more and more distrust, resentment and anger directed at “The Other Side”. (And while this is just a hunch, I fear that this ill-feeling and resentment has escalated in the last decade – although perhaps the Civil War of the 1860s suggests otherwise). Republicans despise Obama. Democrats hated Bush, and don’t even get them started on Sarah Palin. Such mutual resentment is clearly a “bad thing” for the unity of the country. After Obama’s election, it feels like 47% of Americans were “furious” about their new head of state, and intent on seizing every opportunity to undermine his position. In England, after Cameron’s election, anyone who voted for Labour was simply “slightly peeved”. And crucially (I suspect), keen for the new Prime Minister to succeed. People were willing to give him the chance that it doesn’t seem to me that most American Republicans were willing to give Obama.

And secondly, for reasons of effective governance. The partisan battles that now scar the American political scene mean that every policy proposed by a Democratic President is invariably vociferously vetoed by the Republican opposition (and vice versa). If everything that the Obama Whitehouse enacts is swiftly unwound by the next Republican president, and then reenacted by the subsequent Democrat, no progress will ever be achieved. If corporation taxes are lowered and then raised and then lowered and then raised, businesses’ uncertainty will hinder their investment and economic growth. Staunchly entrenched divisions prevent compromise, which in turn prevents real progress.

I don’t think that either side is any more to blame than the other for the hostilities that now characterize American politics and society – but I do think they are ugly, and unhelpful.

Maybe this simmering antagonism (which now, with the current debates over the debt ceiling, is veritably boiling over) is unavoidable, given the stark differences in opinion between the two camps. But I would hope that it can at least be mitigated.

As always, the key is to strive for a balanced approach. For Democrats to admit their mistakes, and for Republicans to admit theirs. For Republicans to compromise on raising taxes, and for Democrats to compromise on reducing spending. I think the media plays an important role here. While newspapers in England are clearly left-leaning (The Guardian) or right-leaning (The Telegraph), the coverage is nowhere near as biased as the polemic of Fox News, which I suspect plays an important role in exacerbating inter-party conflicts. I am not advocating that we impose mandates on what TV channels can broadcast, but I might venture to suggest that we reward more impartial media coverage with our viewing figures.

And as always, the power to effect change lies with individual people. By taking the other side’s perspective, by seeing the planks in our own eyes before the specks in our brothers’, by striving for and rewarding compromise. And by making it clear to our political leaders that stonewalling and steadfast refusal to find any middle ground is ineffective and unwanted.

The road to unwinding the distrust that has been building up in American politics for decades will be a long and bumpy one, but I believe that it is one the country should embark on. Soon.

Thursday, 28 April 2011

The Ugly Game

Sadly, I no longer think football can be called the beautiful game.

Barcelona are a wonderful team to watch – they may well be the best team in the history of football – but their performance yesterday was completely blighted by what I hate most about football – this.

That clip shows that Pepe didn’t even touch Dani Alves, but the latter writhed around on the floor for several minutes, was carried off on a stretcher(!), and then returned to the field a few seconds later, remarkably recovered.

How can you be carried off on a stretcher when you weren’t even touched?

For a professional stretcher-bearer, the guy on the far left of the photo is employing an alarmingly poor lifting technique, and you could easily envisage him pulling a muscle in his back. Maybe Alves fancied his chances with the girl with black hair. But I can’t imagine that she will be impressed when she sees the video footage, and discovers that her suitor had about as much need for a stretcher as Qatar has for some more natural gas reserves.

How did Dani Alves sleep last night? Knowing that his shameful cheating probably earned Pepe’s red card. Does he have no pride? Is Pep Guardiola as disgusted by his player’s behaviour as everyone else in the world is? As far as I am aware, no other sport has as much blatant and rife diving as football, and it is, quite rightly, ridiculed by fans of other sports.

Depressingly, I recently saw an extension of this pitiful trend to the soccer fields of San Francisco. Playing in a seven-a-side co-ed game of a quality that makes this guy look like Lionel Messi, one of our opponents got brushed in the stomach, and collapsed holding his face. He flawlessly executed seventeen commando rolls, and then gestured for the referee to give my friend Blake a yellow, or even better, red card. It was hilarious…farcical…tragic.

FIFA – if you are listening – firstly, why on earth did you give the 2022 World Cup to Qatar? And secondly, please can you up your efforts to eliminate diving and play-acting from your sport?

Here are a few practical suggestions:

1. Make it a red card for diving.
2. Insist that if players pretend to be hurt, they are forced to spend 10 minutes out of the game.
3. Enable retrospective punishments for diving (e.g. Dani Alves could now be banned from the next two Champions League matches).
4. Ban diving training sessions (let’s cut the problem off at source).
5. Compile a list of dives like this helpful guy and hand out an award at the end of the season (similar to the Ballon d’Or) for the most persistent and vilest offender.

Yesterday, Jose Mourinho commented: “Sometimes I am a little bit disgusted to live in this world”.

I would have to agree.

Monday, 25 April 2011

Banned Aid

Several inter-connected things have happened over the last couple of weeks, to provoke me into resurrecting this blog:
  1. I read a small paragraph on the last page of the April 9th issue of The Economist, ranking a number of rich countries according to the proportion of their GDP that represents their Net Official Development Assistance – which is defined as (a) being undertaken by the official sector; (b) with promotion of economic development and welfare as the main objective; and (c) at concessional financial terms.

  2. I saw the film God Grew Tired of Us – which I would highly recommend.

  3. I read Josh Weinstein’s blog on US intentions to cut foreign aid to try to balance their budget.

  4. I finished my consulting project, and found myself with 12 minutes of free time.

  5. I received an overwhelming flood of e-mails from avid fans and followers imploring me to take up my pen again, and re-inject my “unique blend of wit and poignancy” into the humdrum of their daily lives*.

* OK, so I might have made point 5. up, but the first four did actually happen.

The thrust of this blog is this – that the United States gives an embarrassingly small amount of Official Development Assistance (ODA) to the poorest countries in the world.

In 1970, a UN General Assembly Resolution pledged that “each economically advanced country” would “exert its best efforts” to give at least 0.7% of its GDP to “developing countries” as ODA “by the middle of the decade”. By my maths, the “middle of the decade” would have been 1975.

It is now 2011.

Some countries have risen to the challenge of this UN target. Norway and Sweden devoted 1% of their GDP to ODA in 2010. And of the other countries mentioned in the Economist article, the Netherlands has also met the UN target of 0.7%.

Then come Britain (0.6% of GDP), Ireland and France (0.5%), Spain and Germany (0.4%), Canada and Australia (0.3%), and the United States, Japan and Italy (0.2%).

Josh’s article discusses whether US government plans to reduce ODA spending even further might have potential detrimental long-term impacts on US foreign policy interests. I think this is an interesting and important question. I could certainly be persuaded otherwise, but my personal belief is that poverty breeds civil unrest and terrorism, and that foreign aid strengthens a country’s long-term diplomatic standing in the world. The best example that I know of US development assistance strengthening its long-term geopolitical interests is in the case of the Marshall Plan. As I foggily recall from an all-too distant history degree, huge amounts of US investment in Western Europe in the aftermath of the Second World War helped to stimulate an astonishingly fast economic recovery, and prevent the westward expansion of Soviet influence, at a time when the Communist party posed a very credible threat in Germany, France, Italy and other Western European nations.

But for me, there is an even more fundamental issue at stake – which is that, regardless of US self-interest, it is not right that the US gives such a small proportion of its GDP as ODA.

It is not right that one third of American children are clinically overweight or obese, while 22,000 developing world children die from poverty every day.

And it is not right that the US spends 4.7% of GDP on military expenditure, and only 0.2% on Official Development Assistance.

I believe that the income gap between the developed and the developing world is so obscene, that we in "the west" have a moral obligation to try and do something about it.

But does it do any good?

There is significant scepticism amongst academics that ODA actually has any / a positive impact on economic development.

This is a scepticism that I most definitely share. The story of NORAD and the Turkana is a prime example of how aid budgets have been mis-spent and wasted over the last 50 years.

But there are many other examples of foreign aid success stories, and I would see citing its failures as proof that “it does not work” as akin to citing the thousands of SME bankruptcies every year as evidence for the failure of capitalism.

At the end of the day, I just do not believe that building a Tanzanian hospital, school or highway network will not have a positive impact on that country’s people in the short-term, and economic development in the long-term.

We absolutely need to get smarter about how we spend ODA. But let’s invest time, effort and resources in determining what types of ODA are most efficient and effective, and focus investment in these areas, rather than abandoning hope and limiting what little efforts we are currently making.

Public vs. private philanthropy

I have heard several friends cite US private philanthropy as being extremely high, and reason that official, government development assistance should, and must, be lower as a result.

I do not have, and would welcome, more information on this point, but if US private giving is very high compared to the rest of the world, it would be my suspicion that a lot of this is going to colleges, churches and domestic institutions, rather than to the poorest countries in the world.

More importantly, even if my suspicions are misplaced, and US private giving to developing countries more than compensates for the paucity of official aid, I believe that the US government should still be significantly increasing its ODA. I would accept arguments that the 0.7% target could equally be a target for the proportion of government spending dedicated to ODA, rather than the proportion of GDP. But even allowing for differences in government spending between OECD countries, the US still ranks down at the bottom of the list of donor countries (see chart below).

But we can’t afford it!

“We are struggling to balance our own budget and keep our own government functioning – how can we be expected to give anything to anyone else?”

The US was the sixth richest country in the world on a per capita basis in 2009, according to the World Bank (and the richest in terms of total GDP). US GDP per capita was $45,989. The average GDP per capita of the poorest 50 countries in the list was $1,519 – that is 30 times less. Imagine dividing your annual income by 30…

It is not that the US “can’t afford it”. It is that we don’t want to spend it.

An embarrassment of riches

According to, in 1960, US GDP per capita was 40 times bigger than the average for the 20 poorest countries in the world. In 2006, that figure had increased to 169 times. That is, already vast income inequalities have significantly increased over the last 50 years.

If this difference in growth rates had occurred despite significant attempts to redress this imbalance on the part of OECD countries, that would have been one thing.

But when even such a low target as 0.7% of GDP is being consistently unmet, I think we should feel collectively embarrassed and ashamed by our laziness and apathy – as Brits, as Frenchmen, as Italians, and as Americans.

The US is the number one country in the world at the moment – economically, militarily and politically. In the sphere of Official Development Assistance, it is time she started acting like it.

Monday, 13 December 2010


I was a little baffled to learn this week of FIFA’s decision to host the 2022 World Cup in Qatar. I think it might be the most ridiculous decision FIFA has made since its decision to host the 2018 World Cup in Russia. But actually, I think it might even be worse.

OK, so Russia is ranked 148 out of 169 countries according to the United Nations Development Programme’s Empowerment and Governance index, and envisaging the opening ceremony conjures up images of tanks rolling past the Kremlin on a grey and rainy day, with hordes of the gruel-fuelled proletariat a little over-enthusiastically cheering at the unfurling of a 50m-high photo of Vladimir Putin shaking hands with Stalin, whilst nervously glancing over their shoulders at a posse of trench-coated neo-KGB types lurking in the background, menacingly encouraging appropriate displays of “exuberance and patriotism”…

…But at least it’s a country with a footballing history (world class linesmen, for example). Qatar has about as much footballing history as a small island in French Polynesia, that was completely isolated from the rest of the world until a Mitre Size 5 floated over there last week, and the chief of the island’s tribe cut it in half, and used one hemisphere for a large bowl, and the other for a hat.

And if Russia ranks pretty low on most human rights indices, The Economist’s Democracy Index puts Qatar in 144th place out of 167 countries – 8 places below Google-banning China, and 1 place ahead of Iran. And then there’s gender relations. Personally, I don’t think it’s right that women should only show their eyes and not their face in public, or that they should have to walk 5 paces behind their husbands (I think it should be at least 8). Qatar is ranked 142 out of 143 countries on “Gender” by the UNDP. But then again, women never liked football anyway…

I lived in Qatar for 8 months, and I was also pretty appalled by the Qatari people’s attitudes towards the immigrant population of Indians, Pakistanis, Sri Lankans and Filipinos who basically ran the country. I sensed a severely racist attitude on the part of local Qataris – not a great quality in a World Cup host. Another thing I notices whilst living there was that the people are really unfriendly, going on down-right rude. Everywhere I have travelled in the world, I have without a single exception found the local people to be very friendly and welcoming (it’s probably because my point of comparison was England). Except for the single exception of Qatar, where I found the opposite to be true. This is verging on vitriolic, but if I could use four words to describe the Qatari people I met, it would be “lazy, conceited and rude”. (Although I should point out that the aforementioned immigrant populations were fun, friendly and fantastic folk). If I could use 13 words, they would be “what the hell were we thinking letting these guys host the World Cup?!”.

But perhaps this is just my own personal impression. What is less subjective however, is the fact that Qatar is a very hot country. The average temperature in Qatar in July is 106 degrees Fahrenheit (41 degrees Celsius). If my mental image of the final in Moscow in 2018, is of an old-school orange ball being kicked around a snow-laden pitch in Siberia, my mental image of the final in Doha in 2022, is of the English team collapsing about the centre circle from heat exhaustion, and Wayne Rooney having to wear a baseball cap for the whole tournament to mitigate against sunburn. OK, so that's not strictly true. Even I am no longer naive enough to hope that England will make it to the final.

And another point on the objective front – Qatar is a really small country. Its landmass is slightly smaller than that of Connecticut, which is itself the third smallest American state. By 2022, there will have been 17 World Cup hosts. Their average landmass is 229 times bigger than that of Qatar, and most of that is desert. The population of Qatar is about as large as that of Phoenix, Arizona. The second largest city, Al-Wakrah, has 30,000 inhabitants. Given the crass and obscene affluence of the country, they will probably just build some more cities to host some of the games, but at the moment at least, one of the semi-finals is going to be held at the Al-Sharma oasis.

So, no footballing tradition, a pretty average human rights record, an unwelcoming and unfriendly people, a scorchingly hot climate, and an absence of cities – could there be a worse choice for a World Cup host? I can’t think of one. At least North Korea have a footballing history, and I hear the climate is fairly mild in Pyongyang in the summer.

I can only surmise that Qatar paid someone at FIFA a lot of money to host the World Cup in 2022. (With the third biggest natural gas reserves of any country in the world, they have certainly got the cash). And I think that’s a bad and sad way to determine the host of one of the most exciting and anticipated events on the planet.

They say football is the beautiful game. This was an ugly decision.

Monday, 30 August 2010


There are a lot of problems with the National Health Service (NHS) in Britain. I am sure the system could be more efficient. And my mum, who has been a doctor in the NHS for about 30 years, has become frustrated with the ever-growing mountains of bureaucratic paperwork towards the end of her career (I blame the management consultants).

But then you come to America.

I love America. I love the people, their enthusiasm, their patriotism, their sports. The customer service is outstanding and the Bay Bridge looks beautiful right now.

But I do not love the American healthcare system.

In Britain, if you get sick, you do not have to pay for your healthcare. You have already paid for it through your taxes. Everyone has paid for it through their taxes.

In America, if you get sick, you have to pay for a not insignificant portion of your healthcare bill.

Not all of it. Those kind people at the Insurance Companies pay most of it. (And I have never had to deal with them, but I am sure they go out of their way to do this justly, generously and easily, with no hassle or wrangling whatsoever).

But a not insignificant portion of it.

Let's say that healthcare payments equate to taxes. That is, for every dollar that people spend on healthcare payments in the US private healthcare system, the alternative would be to spend an equivalent amount of dollars on taxation to provide for public healthcare (like in Britain).

• Of course, this is not strictly accurate. The taxes that you would pay would be lower, because in a public healthcare system, your taxes would not go towards the profits of the Healthcare Companies.

• But then again, a private system should in theory be more efficient and keep costs down (and I think the word theory is an important caveat here), which would make healthcare taxes relatively higher.

I do not know which of these two effects (profit and efficiency) is bigger, but I have my suspicions and a small selection of rapidly-Wikipedia-assembled facts to support them:

1. The US spends more on healthcare per capita than all other OECD countries. The US spent 16% of GDP on healthcare in 2007, compared to 8% in the UK and 10% in Portugal. That is, healthcare costs in the UK were half what they were in the US as a proportion of GDP per capita. Presumably then, healthcare provision in the US is much better…

2. …Well not according to life expectancy (which I would argue is a pretty good assessment of healthcare provision). Life expectancy in the US was 78.2 between 2005-10, compared to 79.4 in the UK and 78.1 in Portugal.

3. Not according to infant mortality either. The infant mortality rate in the US was 6.3 deaths per 1,000 births between 2005-10, compared to 4.8 in the UK and 5.0 in Portugal. That is the infant mortality rate was more than 30% higher in the US than in the UK during this period.

4. According to the IMF, US GDP per capita was $46,400 in 2009, compared to $35,700 in the UK and $20,700 in Portugal.

So in summary, the US is more than twice as rich as Portugal, and a third richer than the UK. And the US spends 3.5 times the amount of Portugal and 2.5 times the amount of the UK on healthcare per capita. And yet the US has lower life expectancy and higher infant mortality rates.

This is obviously a very simplistic, naïve and bullet-hole-ridden analysis, but it does seem clear that in America we are paying quite high healthcare payments for the service we are being provided with – perhaps because we have to pay big bonuses to the already well-paid executives of Healthcare Companies (and let's remember that when Healthcare Companies make high profits, this basically means that they have received a lot of payments from the public, and have incurred relatively lower costs in the provision of healthcare).

And perhaps, on some small level, it’s also related to incentives. In the American medical system, as far as I can make out, doctors are (at least financially) incentivised to treat their patients. Whereas in Britain, doctors are incentivised to cure their patients. I am not for a moment suggesting that American doctors deliberately do the wrong thing by their patients in order to make more money, but I do find the misalignment of social objectives and financial incentives slightly ironic, given that the private provision of healthcare is justified on capitalist principles, which are strongly linked to the importance of incentivisation. And I do wonder if this has something to do with the relatively high costs of US healthcare. If there are two treatments for a disease, the first is 85% effective and earns you $500, and the second is 87% effective and earns you $1,000, as a doctor which would you recommend? What about if they were both 85% effective?

But this is beside the point.

The point is that the American system of private healthcare provision is a regressive tax. Wikipedia describes a regressive tax as one that:

"Imposes a greater burden (relative to resources) on the poor than on the rich".

Now I know that Medicare is available for some people in America, and I think this is a good thing. But imagine that you do not qualify for Medicare. If you are earning $100,000 per year and your medical bills come to $5,000 in a year, this will be 5% of your income. But if you are earning $50,000 per year and your medical bills come to $5,000 in a year, this will be 10% of your income. That is, if you are poorer, you pay a higher proportion of your income for the same amount of medical care. A 2007 study found that 62% of all personal bankruptcies are caused by medical debt.

Isn’t that tragic?

As if poverty of health isn’t bad enough, it also results in poverty of finance. If your income is $5,000,000 your $5,000 is inconsequential. In Britain, in this example everyone would pay more or less the same proportion of their income. And dividing $15,000 by $5,150,000 I make it that the tax rate would be 0.3% across these three examples. Of course, these are made up numbers but you get the point. In my opinion, the British system is fairer because it says that everyone should pay an equal proportion of their income for the medical costs borne by society. (In fact, rich people will end up paying a slightly higher proportion of their income because income taxes increase with annual salary. In my opinion, this is even fairer still).

But it gets worse. Because not only do poor people pay relatively more for healthcare in America, but sick people do as well. If you are healthy, all you pay is your pay-cheque payments. But if you are sick, you have to pay the deductibles, the co-payments, the co-insurance etc. etc. Is it fair that sick people should pay higher taxes than healthy people? If you get cancer, is it your fault? Surely, if anything, sick people should pay lower taxes because they are less able to work. In Britain, sick people and healthy people pay the same amount for healthcare (again, in terms of proportion of their income). That is, healthy people are providing for sick people. My friend Pete once said that he thought societies should be judged on how well they provide for the poor and the marginalised and the dispossessed in their midst. As far as I can tell, the American healthcare system discriminates against the sick in favour of the healthy. I think this is unfair.

I do not know much about it, but I doubt that Mr. Obama's healthcare scheme is perfect. But change of this kind rarely, if ever, happens seamlessly. And given the choice between the maintenance of the status quo, and a suite of changes that, if nothing else, at least raise the issue and catalyse smart people into developing and refining a solution to this problem, I would opt for the latter. I would vote for the latter.

Of course the British system is open to abuse - to hypochondriacs unnecessarily clogging up waiting lists because Mars is not aligned with Venus for example - but I don't really think this happens much. And I definitely don't think it happens to the extent that would justify a system that charges poor people relatively more than rich people for healthcare, and sick people relatively more than healthy people.

And of course I have painted a simplistic caricature here. And I openly confess that I speak from a position of minimal knowledge of either the British or the American healthcare systems. And I would welcome any thoughts and comments and counter-arguments.

This is just an impression.

Except it's not a just impression.