To downoad a pdf click here is it the economy stupid
We can indeed describe our nation of 55 million people, as an economy and consult economists to interpret it for us and prescribe courses of action. We can also label us as a society and consult the sociologists. Or as people and consult psychologists and anthropologists; people with a history and consult historians, with a sense of fairness (moral philosophers) and a need to distribute power and reconcile different interests (political philosophers and political scientists), with a sense of mystery and awe (theologians and artists).
And we can look at the NHS, too, through these different ‘lenses’ and startle ourselves with the richness of what we see.
Let’s take just one: a Buddhist lens. A secular Western Buddhist lens. If we do so we identify a universal human tendency towards ‘tanha’, craving, the result of the collision between two myths: that of insufficiency (I don’t have what I need to be content) with that of enchantment (over there is the thing I need in order to be content). The constant ongoing restlessness of craving – because the object of enchantment never does fully satisfy us – is the cause of ‘dukkha’, suffering or unsatisfactoriness. The Buddhist aim is to reduce suffering by reducing craving, by becoming mindful of its existence and choosing instead to savour and appreciate what we have and are rather than grasping unthinkingly for a succession of new solutions to our perceived problems.
Suppose we looked at the NHS this way. Suppose we chose to stop believing in the enchantment of: more money; the ability to ration care; to merge hospitals in politically marginal seats; and we stopped believing in the insufficiency of our resources to meet our needs. Suppose collectively we trusted in our ability to meet our needs and behaved accordingly. What would we do differently? How would we behave differently?
No, don’t dismiss this as ridiculous – it’s a thought experiment – just try it.
All sorts of possibilities emerge, possible actions, behaviours, choices, ways of being.
We stop being the demanding consumers or impersonal units of production we become though an economic lens. We become – well you know, you’ve just seen it.
9% of one of the biggest GDPs on the planet is an awe inspiring, mind blowing amount of money. A fantastic phenomenon of collective generosity. If we can’t use an amount that size to deliver good care to all we don’t deserve to be entrusted with it. And we don’t. If we believed we had enough instead of constantly bellyaching for more we would think about how we were going to use it wisely and well, but we’d do so with confidence rather than the despair that leads to idiocies such as QUIPP.
The secular Buddhist is allowed wholesome desire: in this case that might be that all 9% were used productively, creatively and compassionately and not trapped in buildings and services no longer as fit for purpose as they once were, nor wasted in processes that are only necessary if you look solely through an economic lens ( all the processes of commissioning and procurement). So a healthy striving towards changes to the system would accompany a belief that good care needn’t wait for those to be achieved.
The charge of economists is that the NHS (and all public services) have been ‘captured by the vested interests of the producers’. Looking through other lenses we can suggest that a much bigger problem is that the country, or rather its governing processes, its media and increasingly its chattering classes, have been captured by the vested interests of economists – to such an extent that they now structure the debate and dictate its language. The language of consumers and producers, of choice and competition, seeing health care as a set of auditable transactions within a market and not as part of a covenant between the NHS and society.
This results in the people who use different language and concepts appearing naïve and irrelevant. (How are you reacting to this argument?!)
We need to liberate ourselves from the economists’ dismal grip and restore belief in a richness and humanity that they have forced underground. To do so we need to invite the active participation in policy making and policy commentary of sociologists, anthropologists, historians, political philosophers, moral philosophers, theologians, artists and more, and escape from the current intellectual straitjacket. It’s not that the way the economists see things is wrong, just that it’s a dangerously impoverished view that desperately needs enriching
Lets re-familiarise ourselves of these other lenses, and as we do so let’s respond with anger and confidence and a sense of possibility ‘it’s not only an economy stupid’.
Valerie Iles October 2012