Times of resistance

When All Else Fails: THE ETHICS OF RESISTANCE TO STATE INJUSTICE

The economist Albert O. Hirschman famously argued that citizens of democracies have only three possible responses to injustice or wrongdoing by their governments: we may leave, complain, or comply. But in When All Else Fails, Jason Brennan argues that there is a fourth option. When governments violate our rights, we may resist. We may even have a moral duty to do so.
For centuries, almost everyone has believed that we must allow the government and its representatives to act without interference, no matter how they behave. We may complain, protest, sue, or vote officials out, but we can’t fight back. But Brennan makes the case that we have no duty to allow the state or its agents to commit injustice. We have every right to react with acts of “uncivil disobedience.” We may resist arrest for violation of unjust laws. We may disobey orders, sabotage government property, or reveal classified information. We may deceive ignorant, irrational, or malicious voters. We may even use force in self-defense or to defend others.
The result is a provocative challenge to long-held beliefs about how citizens may respond when government officials behave unjustly or abuse their power.

Food for thought.

Docuncert Txarango 

Welfare State apocalypsis

WILL POPULATION AGEING SPELL THE END OF THE WELFARE STATE?

Too many people argue over the end of the welfare state. There are reasons for concern, but apocalyptic views are unnecessary. A new book reviews the ageing process and the implications for the welfare state. The message is a balanced perspective:

Upon closer inspection, available evidence suggests that caring for a growing older population may not be so costly to finance and that older people provide significant economic and societal benefits, especially when healthy and active:
– Population ageing has a modest and very gradual effect on health expenditure forecasts, compared
to traditional cost drivers such as price growth and technological innovation.
– Demand for long-term care is expected to increase substantially due to population ageing but it is coming from a low baseline currently. However, projected increases in long-term care spending do not account for the economic cost of informal long-term care, as this is not captured in international statistics (nor fully understood).
– Many older people continue to provide paid or unpaid work beyond official retirement age and continue to make a positive economic and societal contribution. The value of unpaid work provided by older people is considerable but not regularly quantified.
– While in Europe older people's consumption is mainly financed by public transfers, many older people pay for (part of) their consumption from private sources, including from incomes from their own continued work or from accumulated assets.
– Accumulation of asset wealth also benefits the economy indirectly through its contribution to productivity growth; health is a key predictor of asset accumulation.
– Older people, even if not in paid employment, continue to pay consumption and other non-labour-related taxes, and thus contribute to public-sector revenues.

 Mostly, I agree with this view. The retirement funding issue is the largest challenge for the welfare state and our politicians are playing with fire.

At a glance

Health at a Glance: Europe 2018

Every two years OECD publishes this report for the European Union on the state of health. The new one has an interesting thematic chapter on mental health. It says:

According to the latest IHME estimates, more than one in six people across EU countries (17.3%) had a mental health problem in 2016  – that is, nearly 84 million people.
The most common mental disorder across EU countries is anxiety disorder, with an estimated 25 million people (or 5.4% of the population) living with anxiety disorders, followed by depressive disorders, which affect over 21 million people (or 4.5% of the
population).An estimated 11 million people across EU countries (2.4%) have drug and alcohol use disorders. Severe mental illnesses such as bipolar disorders affect almost 5 million people (1.0% of the population), while schizophrenic disorders affect another estimated 1.5 million people (0.3%).

And the second thematic chapter is about health expenditure: Strategies to reduce wasteful spending: Turning the lens to hospitals and pharmaceuticals. It says:

For hospitals, reducing or eliminating unnecessary investigations and procedures, many of which expose patients to unnecessary risks without the prospect of clinical benefit, is an obvious target for direct intervention. Expanding the use of day surgery can also be instigated at hospital level. However minimising avoidable admissions, particularly for ambulatory care-sensitive conditions, reducing unnecessary length of stay, and improving discharge processes require broader perspectives. Enhanced primary care services, expanded postacute care facilities, post-discharge care coordination, and in home care services all require health system reforms that cannot be initiated by hospitals  alone.

For pharmaceuticals, creating and supporting competitive markets and promoting the uptake of generics and biosimilars can generate substantial savings. That said, reducing waste does not necessarily mean spending less; it may equally be achieved by gaining better value for money from existing expenditure. Both supply and demand side levers offer scope for better value. Using health technology assessment to inform selection, pricing and procurement of new medicines facilitates an understanding of the true opportunity costs of therapies and helps avoid the displacement of high value interventions with ones of lesser value.

This is not new. We have already heard the same for years. Therefore, current inertia is supported by strong incentives that prevent change (either in policy or management). This is the key challenge.