Allocation of medical resources: Never fair. Never mind?
This is turning into a series – I hope you can indulge me?
In my most recent post here, I outlined the view that political parties have the potential to work against the general tendency towards the centralisation of government, that their decline mirrored an increasing centralisation, and that anyone who wanted to reverse this trend has to recognise that political parties are a powerful potential ally.
The corollary to this is that we need to think twice before we do anything to damage parties. But just to prove that I’m not a one-note blogger, let’s look at the other causes of centralisation, and think about how the changes in the way that media and communications are conducted can impact on this:
Part of the process of globalisation has been the demands of pro-market reformers for a ‘level playing field’. It is, after all, an essential pre-condition for any move to increase the volume of the exchange in goods and services: a harmonisation of regulatory frameworks, standards of measurement, trades descriptions, tariffs and taxes etc.
Historically, this demand can even be said to have speeded the consolidation of the nation state, and, of course, the EU is largely the result of the post-war European demand for growth and stability through increased inter-trading. Anyone who has ever spent time in the European Parliament can confirm that it isn’t a UKIP fantasy of nasty bureaucrats seeking to wipe Her Majesty off our banknotes. In reality, it’s a spectacularly mind-numbingly tedious ongoing debate about food labeling.
Similarly, this finds an echo in public demands for ‘fair’ standards of public service. If a Mancunian can get that boil on his bum lanced by a pretty nurse within an hour of presenting it, why the hell can’t a Cockney expect the same service? Thus we commonly hear of popular campaigns against postcode lotteries – campaigns that are always bought-off with centrally-set targets.
Harmonisation of labeling is partly a response to the fact that consumers have very little information about the products they are offered. Perhaps reputation management and collaborative filtering services can offer us a glimpse of what the alternative to bureaucratic standards agencies could be?
The demand for postcode lotteries arises out of us only having one measure of accountability – that of fairness. No-one really believes that the choices the make at an election determine how scarce resources such as drugs or radiotherapy treatment are allocated. At the same time, I’d be prepared to bet that politicians would find a genuine public conversation on these issues – one that was based upon trade-offs (the kind that ‘revealed preference‘ exercises can throw up) would be not only a useful resource in making decisions on this matter – but a fig-leaf to hide behind when they face the inevitable cries from those whose priorities are not met by the spread of expenditure.
Both of these causes of centralisation could be reduced by an effective use of social media – one that can start conversations that are not yet really happening.
