On the reputation of British hospitals and doctors

April 26, 2024

On the one hand, a Newsweek survey (largely based on reputation/peer judgment) suggests that Britain’s best hospital is St Thomas’s, placed #36 in the world. It looks like there’s one more-or-less ‘world-class’ hospital (St Thomas’s) for the use of idiot Prime Ministers and then…It looks like there’s one more-or-less ‘world-class’ hospital (St Thomas’s) for the use of idiot Prime Ministers and then…

I don’t think you can blame American prejudice here – Israel, Finland and Brazil(!), all of which are violently ‘socialized’ systems by American standards, have higher-placed entries than we do.Seems that we really do need more money for development and quality improvement.

The situation for doctors is not so clear, but this source indicates that British doctors are the third best in the world, after those from the US and India.

The Newsweek tables give rise to some interesting conclusions, including that private medicine here is really not worth it (London Bridge at #14 in the UK rankings is some kind of code-sharing operation with Guy’s at #2).  In general, the specialised tables have the leading British representative at about #7 (which is what you would expect – and UCL is the second best hospital in the world for having babies in.  To me that implies that the leading clinicians here fine but there just isn’t the money to efficiently run large general hospitals.

I suggest that people think very carefully about whether they are willing for the NHS to degrade or whether they are willing to adopt something like a hypothecated Wealth Tax

PROSPECTUS: THE PEOPLE’S HYPOTHECATED NHS WEALTH TAX

April 3, 2024

Introduction

This prospectus outlines a solution to the problem of how to maintain the NHS as a universal tax-funded service free at the point of delivery. This problem was proposed to me by one of the consultants while I was in the Critical Care Unit of Guy’s Hospital.

Limitation

This proposal addresses the problem as stated, and takes no account of questions such as what the optimum funding model for the NHS is, or what the wider economic implications of the proposals might be, or how the UK tax system should be improved in general.

Background

It is thought that the NHS requires a funding increase of 4% per annum (Social Care 3.9% per annum). There is also resistance to increased taxation, and services are essentially financed by working-age taxpayers for retired service users.

In a longer-term perspective, returns to capital are increasing as against those to labour (earnings). At some stage capital will need to be taxed or one will be left with a steadily shrinking tax base.

Proposal

We propose a recurrent hypothecated wealth tax in the region of 0.5% to 1% to develop and expand (not completely finance) the NHS.

Advantages

The yield is likely to grow in line with or faster than NHS expenditure. Hypothecation would be for a popular cause – the NHS. It raises money from a sector of the population (elderly property owners) that tends to use services and not pay much tax. It also raises the prospect of being able to abolish CGT and IHT, two rather ineffective ways of taxing wealth indirectly.

Principles of a wealth tax

No carve-outs

Revaluation

A recurrent wealth tax

An LSE report points up many (allegedly fatal) problems with the recurrent wealth tax but fails to notice that Switzerland has successfully operated one for many decades. (Note that Gini coefficient for wealth inequality is very similar in UK and CH.)

Outline

The idea would be to adopt and adapt the Swiss model (note: one model per canton). Include tradeable assets (money, property, stocks & shares) above a certain limit. Note Swiss model excludes pensions (in Pillar 2 and Pillar 3).

Features of the Swiss model

The Swiss model seems to differ from others that have been tried in that:

I) it is successful, or at least tolerated;

ii) the rate is low (no more than 1.1%), as is the cutoff (no more than about 150,000 CHF)

iii) the coverage is quite wide – in Bern, 41% of married households pay some wealth tax.

So your friendly local tax curled up by the fire. In fact, the idea of just for once allowing some local variation so that areas could vary their wealth tax parameters in response to perceived NHS needs is not entirely without merit – have a local referendum, in fact…

We further note that Switzerland does not really levy taxes on inheritance or capital gains. In the UK, CGT is expected to raise £18 bn in 2023/24 as against £ 7 bn for IHT. But a 1% wealth tax is projected to raise £ 57bn/year, so it would be quite feasible to abolish IHT and CGT, which are rather ineffective attempts to tax wealth indirectly.

SUPPORTING EVIDENCE

NHS Resource Need

For the NHS, to meet cost and demand pressures over the next 15 years, spending needs to grow on average by at least 3·3% per year in real terms; however, to improve the quality of services, reduce waiting times, increase staffing numbers, and invest in capital, spending will need to grow on average by at least 4% per year in real terms

For social care, to meet cost and demand pressures over the next 15 years, spending needs to grow on average by 3·9% per year in real terms; improving financial protection by introducing a means-tested threshold of £100 000 and a maximum contribution of £75 000 in England would require even more in social care spending. Link here.

Household wealth is growing rapidly

So we really need to tax wealth if we are going to keep up with NHS funding needs.

Incomes are not growing (much)

So we really need to tax wealth if we are going to keep up with NHS funding needs.

Initial costing

The following calculation excludes both private and State pensions, in line with the Swiss model – this may well need to be revisited.

Household net worth was revised up by £0.5 trillion to £12.3 trillion in 2021, mainly because of household pension entitlements being revised up by the same amount (link). 

So, 12,300,000,000,000*0.58 [pensions – rethink]*0.8 [fudge factor]*0.01 = £ 57 bn/year

NHS (in fact DHSC) expenditure

Planned DHSC TDEL is £187bn in 2023/24, up from £182bn in 2022/23 in cash terms (a 2.7% increase). The Treasury has set planned totals up to 2024/25, which would see the health budget rise to £190bn in cash terms (a 1.7% increase on 2023/24): link

Interesting spending comparison here.

NICS

In 2023-24 we forecast National Insurance contributions (NICs) to raise £172.3 billion. That represents 16.3 per cent of all receipts and is equivalent to around £6,100 per household and 6.7 per cent of national income.

NICS and the new tax

£57bn + £ 172.3 bn = £ 229 bn, which is greater than the planned £187bn DHSC expenditure.

ANNEX: Pensions

There is clearly a difference between different types of pensions. On the one hand, some are merely tax-advantaged savings products and clearly should be included. At the other end of the spectrum, there is an opinion that the State pension gives the pensioner no legally enforceable right and so it should not be included – it is clearly non-tradeable, in any case.

Private pension wealth makes up 42% of UK household wealth, and in 2021, £115 billion was contributed to workplace pensions by 22.6 million people and their employers.https://ifs.org.uk/articles/private-pensions-explained [Something about public pension not giving enforceable right]

In 2018, pension liabilities of central and local government comprised:

£4.8 trillion of state pension entitlements (224% of 2018 gross domestic product (GDP)) – is this the same as state pensioner wealth?

State pension – it’s difficult: https://www.fca.org.uk/publication/research/research-note-accumulation-of-wealth-in-britain.pdf

As far as I can see, State pension wealth seems to be intractable and will need to be omitted.

Total private pension wealth: £6.4 bn (see here; link)

Pension wealth seems to most significant among the most wealthy:

What kind of tortoise shell lyre did Hermes make?

January 21, 2024

An interesting class on the Homeric Hymn to Hermes in the programme of the H M Classics Academy led to a discussion of what the lyre that Hermes made from a tortoise may have been like. I personally was far from sure what a lyre was and whether it was the same kind of thing as a lute…

I think that this video may be the most relevant from the Michael Levy collection – he has many lyre-related videos, but this one seems most directly to respond to

The image in the corner leads to this sensible-looking Wikipedia article, which distinguishes it from the kithara. Both of these are types of lyre (there are many others).

There is a freely-available article on academia.edu here (you may need to create an account) here on acoustic analysis of a reconstructed chelys which begins with an informative discussion of the reconstruction. And there is a lot of other material in the Internet that is either marked by imagination rather than scholarship or not freely accessible. But there is a pirated version of M L West’s Ancient Greek Music (1992) here and you can search through it for ‘tortoise’, ‘Hermes’, ‘gut’ and so on.

Possible private school tax measure

January 6, 2024

What is the measure?

There seem to be two components: (a) impose VAT on private school fees (b) remove the relief on business rates for private schools.

VAT measure: What is the tax base?

The Independent Schools Council gave a total of 554,243 pupils at 1,395 ISC member schools (https://www.isc.co.uk/media/9316/isc_census_2023_final.pdf). It also states that the UK independent sector as a whole educates approximately 620,000 children in over 2,500 schools, although no source is given (https://www.isc.co.uk/research/). The ISC census gives 66,325 (11.9%) boarders and hence 88.1% non-boarders. The census gives average (mean) termly fees of £13,002 for boarders in boarding schools, £7,297 for day pupils in boarding schools and £ 5,552 for day pupils in day schools. From the same source, 30.3% of day pupils are at boarding schools and 69.7% at day schools. So the total fee income can be estimated as 13002*0.119*554243 + 7297*0.881*0.303*554243 + 5552*0.881*0.697*554243, or about £3.83 bn per term, corresponding to £11.5bn per year

VAT measure: What is the static costing?

Imposing VAT at 20% would yield £ 2.30bn.

VAT measure: Behavioural response

The IFS (https://ifs.org.uk/sites/default/files/2023-07/IFS-Report-R263-Tax-private-school-fees-and-state-school-spending.pdf) point out that under this regime private schools would be able to reclaim input tax and so the effective VAT rate would be more like 15%. That gives a yield of £ 1.725 bn per year.

Business rates measure: What is the tax base?

This is difficult as you would really need to know the total rateable value of private school premises. A paper at https://bepart.co.uk/wp-content/uploads/2019/09/The-State-of-Independence-Whitepaper-Sept-2019.pdf gives a total cost of ISC private school buildings of £ 6.73 bn. [What about the land?] It might be reasonable to take a rental yield of 6% on commercial property (https://realbusiness.co.uk/commercial-property-investment), so this would give a total rateable value of £ 403 mn. (The present status of the planned removal of business rates relief in Scotland is unclear.)

Business rates: What is the static costing?

For non-small businesses, business rates are levied on the rateable value at 51.2 pence in the pound. In the simplest case then, removal of the business rate relief would yield 0.8*0.512*403 = £ 165 mn/year approx.

Overall: What is the behavioural response?

So, the schools have lost 1.73 + 0.17 = £ 1.90 bn. Taking account of VAT, to restore their position they would need to increase their fees by £ 2.36 bn, or 20.5%.

Then we need to know the own-price elasticity of demand for private education. The IFS considers values between -0.2 and -0.5, though the specific research results they quote are -0.19 and -0.26. We take -0.20 for the sake of simplicity, so a 20.5% increase in fees leads to a decrease in consumption of 4.1% approximately. This can of course include moving to cheaper alternatives within the private sector, but if 4.1% of the ISC population of 554,243 pupils moved to the state sector that would give 22,700 extra pupils.

The total planned net expenditure on schools for 2023-24 is £57.8 bn (https://explore-education-statistics.service.gov.uk/find-statistics/planned-la-and-school-expenditure) so the extra revenue here would amount to 3.3% on top of that.

There were 9.1 mn pupils in schools of all types in 2022/23 https://explore-education-statistics.service.gov.uk/find-statistics/school-pupils-and-their-characteristics/2022-23 ; subtracting the total of 620,000 educated in independent schools (not necessarily ISC) gives 8.5 min pupils in state schools. So an extra 22,700 pupils would amount to 0.27%, which at first sight does not look problematic in a situation where school rolls are expected to fall (https://explore-education-statistics.service.gov.uk/find-statistics/national-pupil-projections ).

Gratuitous careers advice

December 30, 2023

Here is my gratuitous advice to a friend whose arts graduate daughter was looking for a job that did not involve law, accountancy or numbers:

As I said, the last resort  that I know of for an arts graduate who has rejected accountancy and the law would be an Executive Officer post in the Civil Service. It’s not glamorous like the Fast Stream, but once you’re inside you get to see many interesting jobs that are snapped up before reaching the outside world.  Pre-selection is done on the basis of competency examples and you get some feedback on them I think.  Preparing these examples is without a doubt a strange and unusual punishment, but it’s the kind of thing a history graduate ought to be able to do, and I’m sure the young woman’s father can offer some useful comments.

So, if I was Isabel I would put ‘Executive Officer’ in Job grade on https://www.civilservicejobs.service.gov.uk/csr/index.cgi and then discard ones requiring specific skills/experience I didn’t have (unlikely at EO level) and ones I really didn’t want to do and then have a go. 

She could also try filtering by history-grad type things like ‘Policy’, ‘Strategy’ ‘Administration’, ‘Communications’, ‘Governance’, in ‘Type of role’ but I wouldn’t recommend it because there’s a definite tendency to label things ‘[Project/Operational] Delivery’ even if they aren’t.

Now that I think of it, I think that other non-CS refuges for beached arts graduates would be Corporate Communications and Public Relations, but I have no special knowledge in these fields.

Hope this helps!

At last, a speaking club!

December 22, 2023

So after having first offered my services on 29 May, I finally got to run an online ‘Speaking Cub’ with students from Kharkiv (Ukraine) on 21 December. There were six student participants – at about B1 level – and they were well pleased with the opportunity to talk to a native speaker in a session that lasted about 60 minutes.

Helping students in Kharkiv

November 26, 2023

The Oxford Kharkiv Association newsletter of 23 October had this request for native English speakers (possibly having some connection with Oxford) to conduct online sessions with students from Kharkiv.

Buying Russian books, not from Russia

November 19, 2023

If you want to buy a Russian book without directly supporting the Russian economy you can just put “[ISBN]” -site:.ru  into Google and that will give you Internet pages outside the .ru domain where that ISBN occurs.

So in the case of the book illustrated “978-5-02-026520-2” -site:.ru. It’s also worthwhile trying differing formatting of the ISBN, like “978-5-02-026520-2”, “978-5020265202”, “9785020265202”.

Hope this helps!

Summary of ‘Psalom’ by Fridrikh Gorenshtein

November 18, 2023

The novel consists of five parts – each one describes one of the plagues of the Lord that fell on the earth, as predicted by the prophet Ezekiel.

Part 1

Part one, “The Parable of the Lost Brother,” tells the story of famine, the second plague. The setting is famine-stricken Ukraine during collectivization in 1933. In a rural teahouse, Maria, a beggar girl, tries to beg something for Christ’s sake [~alms for the love of Allah] , but no one gives her anything, except for a Jewish boy who shares with her the unclean bread of exile [Ezekiel 4:12-13]. The villagers are outraged by the stranger’s action and the girl’s bread is taken away. The boy who gave his bread is Dan, the Asp, the Antichrist, brother of Christ the Messiah. Through the revelations of the prophets, he is in communication with the Lord, who has sent him to earth, to Russia, since this people belied the Lord, abandoned Him – and so replaced the wooden yoke with an iron one.

Then Maria and her younger brother Vasya return to their starving village. The mother decides to break the family up – to leave some of the children to strangers and to simply abandon the others; she herself leaves to work in another town. Before leaving, she takes Maria and Vasya to the city. The stranger again gives the hungry children bread, but their mother throws it away since it is alien and un-Orthodox. Later, in the city, the children will once again ask the Antichrist for alms, but this time they will be stopped by a policeman, since begging is prohibited.

Abandoned by their mother, the children end up in foster care. They are given a guide so that with his help they can return home. On the way, the guide rapes Maria and runs away. The children are put in the orphanage again. At night, a watchman tells them a story about “God’s child,” “Jesus Christ,” who was tortured by the Jews. Maria is taken somewhere out of town. She runs away. Finding herself alone in a snowy field, she wanders through it, crying with God’s cry, and her heart is filled with light. Maria then finds her older sister Ksenia and lives with her for about a year. One day she becomes an accidental witness to family problems (her sister cheats on her husband with her lover), and she is sent back to the village. No one is happy to see her there either; crying from injustice, Maria again wanders through the field; there she meets Dan, the Antichrist. When asked about the reason for her tears, the girl replies: “Because the Yids killed the Son of God and he is now in heaven, and Vasya, my brother, is on earth, in the city of Izyum.”

Thus the prophecy of Isaiah is fulfilled: “I was revealed to those who did not ask about Me; those who did not seek Me found Me.” [Isaiah 65:1]

Maria goes to Kerch, to her mother. After some time, the mother dies, Maria becomes a dockside prostitute. One day, hungry, she encounters Dan again, who gives her more of the unclean bread. Maria repays him with her body. The Antichrist goes further: for belying the Lord this land and people are destined for a second punishment – the sword. Maria, convicted of prostitution and vagrancy, gives birth in prison to a son, Vasya, by Dan. In 1936 she dies.

Part 2

The second part begins with a discussion about imitation of the Lord – instinctively or through reason. The author defends the idea that Jews are a people no better or worse than others; but they are marked out by their prophets who knew how to listen to the Lord.

The “Parable of the Torment of the Wicked” tells the story of Annushka. She lives in Rzhev with her mother and two brothers; one of the brothers perishes through her fault. One day, thieves steal from the room occupied by Annushka’s family and during the investigation she identifies an innocent man, who is sent to prison. The mother is given a new apartment.

One day Dan, the Antichrist, visits Annushka. Looking at the walls (Annushka lives in a former church building and the face of Christ appears on the wall from behind the wallpaper), he reflects on the fact that the Church Fathers replaced Christ with an idol, an emaciated Alexandrian monk [that is, Jesus was a corporeal male Jew and the Christians made him something different]; now, in the spring of 1941, this monk, in turn, has been replaced by the “Assyrian bathhouse attendant” – Stalin. Over the Rzhev barracks, the Antichrist has a vision of a sword – the words of the Lord come true: “Woe to the city of blood, and I will build a great fire.” [Ezekiel 24:9].

The war begins. Annushka’s mother is killed and she herself ends up in an orphanage. Annushka, who learned to have dealings with the Germans during the occupation, has come to hate the Jews. Shulamith, another girl in the orphanage, annoys her. Envious that during the evacuation the Jewish girl had a good foster mother, Annushka informs the Germans that Shulamith is non-Russian. They kill her and Annushka is sent to Germany to work.

Before her departure, Dan comes to the train and asks her to read aloud the text that he hands her once she gets to Germany. The Antichrist must curse the Germans, just as the Lord once cursed Babylon through Jeremiah. The prophet himself cannot enter unholy land.

One of the women taken into slavery along with Annushka asks Dan to take her child, Pelageya. The Germans try to kill Dan as being a Jew, but it is impossible to kill the Antichrist.

Annushka fulfils Dan’s instructions – the wicked Germany that hates God and His beloved people is cursed. Annushka herself soon dies of a fever.

Part 3

The action of “The Parable of Adultery”, which describes lust, the third plague, takes place in 1948. The Koposov family – Andrei, an ex-serviceman, his wife Vera and two daughters, Tasya and Ustya – live in the city of Bor on the Volga. A strange Jewish family lives nearby – Dan Yakovlevich and his daughter Rufina, who doesn’t look Jewish at all.

[She is Pelageya and she isn’t Jewish.]

Vera Koposova, whose relationship with her husband is very complicated (he believes that his wife cheated on him during the war), having met Dan, falls in love with him. (К) Realizing that she cannot directly seduce a Jew, she uses her daughter Tasya instead. Tasya also falls in love with Dan, and they begin meeting regularly. The father finds out about these meetings. Together with the informer Pavlov, he tries to kill the Antichrist, but this turns out to be impossible.

Vera tells Dan she will intercede if he sleeps with her. The Antichrist, who loves the daughter, is forced to commit adultery with her mother. Rufina has accidentally witnessed their meeting, while Tasya sees everything and tells her father about her mother’s sin. He first tries to kill his wife, then on the same day he dies of grief. Rufina, meanwhile, runs off into the woods; there she is almost raped by the lustful anti-Semite Pavlov; but she is saved by the appearance of of two bears [?2 Kings 23-25]. After her experience, Rufina realizes that she is a prophetess and makes peace with her father, who has been cleansed of his sin by a curse.

Part 4


Part four, the basis of which is “The Parable of the Sickness of the Spirit,” describes the persecution of the Jews [in the Soviet Union] in the early 1950s. The parable is preceded by an introduction – the author’s reflection on Russian anti-Semitism. For this spiritual illness, God sends the fourth plague – disease, pestilence.

Two children, Nina and Misha, from Vitebsk, come to Moscow to live with the the Ivolgin family, consisting of a Jewish art critic, his Russian wife Claudia and their son Savely. The children are Claudia’s nephews; their parents have been arrested on charges of Belarusian nationalism. But the Ivolgins, people who are afraid of everything, who hide their Jewishness in every possible way, refuse to shelter these children. The Ivolgin family is silently watched by two of their neighbors in their shared apartment – Jewish janitor Dan Yakovlevich and his daughter. At this time, mass denunciations of cosmopolitan Jews are taking place in the country [Jew ~ rootless cosmopolitan ~ traitor]. The cowardly Ivolgin, who is trying to protect himself from arrest by participating in the persecution of his own people, is soon also arrested. During the his first interrogation, the investigator kills him.

After 1953, the widowed Claudia has a new admirer – old Ilovaisky, a moderate anti-Semite. He has long discussions with Dan about Russian Christianity. As an example, an old man breaks a cup: intact, it is simple; broken, it becomes complex. Dan, the Antichrist, feels that it is impossible to overcome Ilovaisky in argument- Christianity has become too distorted in Greek and medieval interpretations. The word about which Ilovaisk and St John’s Gospel of John speak in fact only cheapens the meaning.

Part 5

The preface to the fifth part – “The Parable of the Broken Cup” – contains the author’s ideas about the relationship between Judaism and Christianity.

The protagonists of the fifth part are the children of the Antichrist by different mothers: Andrei Koposov, Vera’s son; Vasily Korobkov, Mary’s son; and Pelageya-Rufina, the prophetess, Dan’s adopted daughter. Vasily and Andrei together with Savely Ivolgin are studying at the Literary Institute. Andrei himself comes to the Bible, and realizes that its meaning is opposite to what Christians think. One day, the young people meet at a fashionable exhibition in the Tretyakov Gallery; Pelageya recognises that the militant anti-Semite Vasily is her father’s son. He, cursing the Jews, creates a scandal. Convinced of his resemblance to his father, a Jew, Vasily hangs himself.

His mother, Vera Koposova, comes to see Andrei. She tells him that he is Dan’s son. Andrei, the “good seed,” meets his father; the assembled family quietly celebrates a Jewish religious holiday.

Half-mad from unslaked lust, Savely creates two “philosophical homunculi” in an alchemical flask. In conversations with them, he learns the answers to the most important questions – about the paths to God, about truth, good and evil, about the rational justification for faith in God. He finally descends into madness, and he is taken to a mental hospital.

Pelageya, who is a virgin, feels that the time has come to become a woman. Following the example of the daughters of Lot, she seduces her father, the Antichrist. He, feeling that the plan of the Lord is being accomplished, rapes her while drunk. So the prophetess Pelageya conceives a son by the Antichrist. Dan, who has done all that was destined for him on earth, dies. Before his death, he gives instructions to his son Andrei, who makes his way to God in the most difficult way – through reason and doubt.

The son of Pelageya and the Antichrist, also called Dan, listens to his mother reading from Deuteroisaiah, which contain ideas also expressed by Christ, but a long time before Him.

Andrei, Pelageya and her son Dan, together with Savely who has now recovered, go out of town, into the forest. Looking at the harsh winter landscape, they comprehend the essence of the antagonism of Christ and Antichrist: the first is the protector of sinners and persecutors, the second protects the victims of the persecuted [those to whom evil is done/do evil in return].

The requital for persecution is approaching; this fifth and most terrible plague is thirst for the word of the Lord, from which even Christ cannot save mankind.

The Old Oak, Bromley Picturehose 1415 2 October 2023

October 3, 2023

I actually enjoyed ‘The Old Oak’ – latest Ken Loach film set in the North East – dealing with the arrival of Syrian refugees in a Durham pit village. That was probably because:

i) unlike Newcastle in his previous two films, any solecisms about Durham pit villages passed me by;

ii) since the Syrians were fleeing the Assad regime, Loach couldn’t complete the paranoid circle by blaming capitalists/the West for that, so we were left with the paramount importance of kindness and the need to behave decently;

iii) they had managed to capture the paradoxical mixture of routine aggression and extreme kindness you get in the North East;

iv) who wants narrative coherence and logic when you can have hope and emotional truth.

I did at least consider crying at the scene of the Syrian lass overcome by listening to choir practice in Durham cathedral – though that was an opportunity missed to mention the possible Islamic influence on the architecture there.

I suspect that may be one of the many things about the North East that Loach and his scriptwriter just didn’t know. But then I’d forgotten the word ‘marra’ [like ‘mate’ in Australia]; and I even used to know the corresponding term in Arabic a very long time ago…