September 16th, 2004


Choice as an alternative to responsibility

A recent study in the UK indicated that one of the reasons that teenagers were having more mental problems than they used to was choice - they weren't being presented with a way forward, there was no life path awaiting them, instead there was a huge number of choices, none of which offered any kind og guarantees.

In the old days you could choose apprenticeship, or a degree, or just get a job at the age of 16 and feel that you were fairly secure that you had just become something that you would be for the rest of your life. This wasn't always the case, but it was so often enough that you weren
t left stressing yourself into nervos collapse that the choices you made at age 16 were going to leave you in a complete mess 10 years later because your chosen path didn't lead anywhere.

Survey after study has shown that most people have no idea about and no interest in the things that are going to affect them in the longest term. It may even be beyond them to understand them. If you asked most people about pensions and investing in their future, they wouldn't have any idea how the different options worked, the underlying factors in the market, etc. Nor do they want to know about them - they just don't want to starve to death on hitting 65. Which is (one of the reasons) why the attempts to get people to invest in pensions have by and large been complete failures.

It also doesn't explain why the government is so incredibly big on choice in the NHS. Unlike some countries, we're lucky enough to have a system that guarantees treatment for all. We all contribute towards it, we all live safely in the knowledge that we wont be bankrupted by medical payments or die because we couldn't afford them. It's not perfect by a long way, but it's a vast stress reducer (just talk to an American without health insurance...)

The last thing people want to do is _choose_ where to have their medical procedures take place - they want a qualified professional to book them in with another qualified professional so that the correct care can occur. So why force choice on them? How many people would have the first idea how to even start choosing a hospital to be treated in? It's just a bizarre route to take the NHS in and nobody seems to understand why they want to do it.

I had a sudden realisation this morning that it's because they have no idea how to run the NHS any better. In market-driven sectors, choice allows the public to promote services they like and destroy ones they don't. We choose Pizza company A over Pizza company B because they make better/cheaper pizza and so A flourishes while B goes bankrupt. We don't have to personally analyse the management structure and weed out waste, or look at the supply chain to see what their ingredient sources are like - we judge the end product and the market magically causes better pizza to appear (over long periods of time, with any luck).

So the feeble hope of the Labour leadership is that providing a similar choice to the public over hospitals will cause good hospitals to flourish and bad ones to vanish and they won't have to be responsible any more. This despite the fact that hospitals can _never_ be a commodity product - they're a luxury product; and luxuries operate under very different market conditions.

NHS Choice isn't their way of making your life easier, it's their way of abdicating responsibility for making the hospitals run well.

Suddenly I've gone from not being sure what to think of it to being dead set against it.

Computer Amnesia

Ed found this site while googling for my name - it's an Andrew Ducker at the Berkman Centre for Internet & Society at Harvard Law School.

Amused, I sent him an email via the webform.

Very shortly afterwards I received... my own email.

I'd completely forgotten that I had an account there from discussions I'd taken part in a couple of years back.

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