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Next Saturday sees the Lib Dems gather in London for a special one day conference entitled "Setting the Agenda " which will be looking at shaping the next manifesto.  I'm due to be on duty in halls at the weekend, though I have Friday night off and so could come down for most of the day on Saturday but will need to be back in Oxford by about 6pm so will miss half the afternoon sessions.

Looking at the agenda, there's probably only one of the morning break-out sessions on a subject I really want to help shape the manifesto on, if that's really the idea:

IPPR/Re-inventing the State Group: Life Chances and Equality
How far can the Liberal Democrats ensure that there are real equal
opportunities for all? Speakers will include: Prof. Richard Wilkinson
(Nottingham University), Duncan Brack and a speaker from the IPPR –
Room H103 seating up to 50.

This is the area in which the Liberal Economic Tradition can really make a difference whilst reducing the size of the state.  I know that a couple of years ago the IPPR looked into the feasibility of Land Value Tax at a conference in Oxford, but overall I can't take them terribly seriously as I view them as one of the most egregiously Blairite "managerial state" think-tanks around.  So, what do you reckon...is it worth £40 for the conference and another £20+ for travel and so on, plus all the stress of visiting London twice in two days to get maybe a couple of sentences in at a break-out session that's likely to be biased towards ever more complicated state welfare?  Is this the last opportunity to influence the ethos behind the next manifesto or to spark investigation into alternatives that may not have been considered yet?

Someday I'd like to see the Institute of Economic Affairs or someone similar being the sort of partner we'd choose for this sort of discussion.  That would properly challenge those in the party that instinctively think that big state solutions (localized or centralized, delivery by politician and bureaucrat is still "big state" to me) to things like "life chances and equality" are the answer.  I worry that there's not going to be any of these groups next Saturday to present an alternative, liberal viewpoint. 

The BBC reports that in the US an ex-defence adviser attacks Bush:

[Richard] Perle says in hindsight he would not have backed invasion

It seems to me that this was one of those neo-cons specially brought in to sell the war against all the evidence. Three days before elections too! That's gratitude for you.

...who seems as appalled as I am at the relish with which our party has taken to banning a four hundred year old "pleasure": Forceful and Moderate: Smoked out....

Now, I accept the public health arguments, and I accept in particular (as a member of UNISON how could I not) the arguments about the dangers to staff. Yet still there are ways round having to illiberally ban something. Many people take on jobs that have risks to their health or personal safety. Health and Safety legislation tries to get employers to minimise those risks in most cases (for example with protective gear) but in some cases, when all that's done and risks still remain, employees can command a premium.

If 80% of people really want to eat and drink in smoke free places this is plenty incentive for the industry to give them that option. Since more than 20% of people smoke anyway (and it's higher amongst the young adult population), isn't there a good chance that only those who do would be prepared to work, for more money if possible, in an establishment that permits smoking - I know almost everyone in my SU bar are smokers - they get extra breaks!

As a party we have, or had at least, policy in our "abolish regulation" stuff to replace the national minimum wage with a more flexible arrangement negotiated and enforced thropugh trade and workers associations on a region by region basis so it could reflect the costs of living in different places. We could add into this premiums for working in smokey bars perhaps. A real liberal response to this would be to try to level the playing field in favour of the workers, not outlaw something (especially something that is still so very, even if inexplicably, commonplace).

Incidentally, does anyone know how this affects hotel bedrooms? I have a get around in my mind already. Small hotel, bedroom suites rented by the hour with more settees and tables than beds, room service delivering booze. Get the picture? The wealthy can get round anything.

Health seems to have become the theme of the day in the Lib Dem leadership debate, at least amongst bloggers (John Dixon's "A Radical Writes" here, and Tristan's "Liberty Alone" here as examples). The two candidates themselves have both now produced manifestos of sorts with Chris Huhne (page 9) promoting "the principle of universal access on the basis of need" and Nick Clegg earlier (despite John Dixon's interpretation otherwise) setting down the principle that "our universal public services must be free to use and accessible to all".

Both have admirable reasons for wanting to retain this universality and free access; that if we choose any other paradigm the poorest will miss out by not being able to afford to pay in a non-free system. But, as I've said about education, and more recently touched on in my piece about protectionism last week to me this seems, if you pardon the terrible health-related analogy, merely a sticking plaster. The ideal revolutionary liberal position surely would be to ensure that everyone had the financial wherewithal to participate properly in a market system and then to trust them to make their own choices.

On the day that the Marmot report into diet and cancer appeared, and whilst acknowledging that he said that his commission was still to deal with policy recommendations, one can be fairly certain that they are not going to recommend that the government, local or national, takes control of what dietary choices people are allowed to make. And yet our knowledge increases all the time that such choices are likely at least as important to our health outcomes as the treatment we may receive once we are ill. So why do we not do the same for illness care when all the evidence suggests that despite £110bn a year public expenditure, we are still the "sick man of Europe"?

Surgeons operating
Originally uploaded by el Reino

The NHS was, I believe, a fantastic idea at the time, in the context of the war on the five wants. In a near bankrupt nation post-war it was also clearly in the national interest to try to use economies of scale and national bargaining to ensure that you could provide a basic level of universal service to all. But let's face it, right now it is a gigantic protection racket, the mother of them all if you ask me. We also heard today that the average GP salary is now at £110,000 - a ten per cent rise in the second year of their new contracts - and yet the Department of Health today has said that 1200 British medical graduates are unlikely to get training places in the UK this year. So there's almost certainly an economic rent arising from the triple protectionism of the NHS, the GMC and the BMA.

Hopefully at least this and the national bargaining for other staff would end with localization so that those parts of the country where it is difficult (read near impossible) to live on a Grade D nurse's salary can offer decent packages, but I haven't even touched on the protectionism of NICE, NHS drugs contracts, the drugs patenting system as a whole and the stifling bureaucracy surrounding anything innovative by way of ways of treating and so on.

None of this is to say that the "private sector" is necessarily the best solution in all areas. I'm against monopoly and public protectionism, not public service per se - after all the nature of the hippocratic oath is dedication to a public service. And the worst of all worlds could be one in which there's a certain amount of public funding up for grabs by private operators who have no incentive to innovate and be really efficient - that's simply transferring the protectionism to shareholders.

No, the problem is really one of how to ensure that everyone would have the ability to pay for their choice of provider. And I return to the Citizen's Income and the systemic economic imbalances that concentrate unearned wealth, or more correctly the wealth created by the community as a whole rather than by an individual's or firm's own innovation, investment and labour. I'm not a good one to talk on health issues - the last psychiatrist I saw reckoned my attitude to my developing diabetes was one of the "slow suicide". But I'll bet if I was faced with a bigger insurance premium or buying more fruit and veg instead of eating crap, I'd probably plump for the healthier lifestyle to minimize my insurance. Redistribute the common wealth properly to everyone as is our birthright and we have these choices.

Just look at Nuffield Hospitals Group right now - it's buying up private gym firms like Cannons (effectively turning private companies into social enterprises of course). Why would it be doing that? Because BUPA really wants its members to live healthily, not to call on them when they're in a preventable medical condition. I'm also sure that insurance firms are likely to be better, with safeguards against abuse, at sifting out bad clinicians; it's in their interests to do so. Their actuaries will be poring over doctors' success and failure rates to ensure they're not granting accreditation to people whose patients inexplicably drop like flies, or who routinely over-diagnose or over-prescribe. Nor would they be likely to allow their members to spend a single night in a hospital where they're more likely to come out with a worse illness with attendant higher costs, if they come out at all.

One model I've looked at, for example, would see a GP as a "personal health adviser" who advises their clients through the maze of choosing lifestyles, treatments, clinicians and therapies that will be efficient and varied. I'd like to see surgical firms organized more like barristers' chambers with large national firms specializing in different clinical areas ready to hot-foot it to a treatment centre several hours away at the drop of a hat to do an op in their specialism rather than a patient wait on a list for the local, perhaps only semi-specialist to have a free spot in a tight general surgery list. You could have a choice of a large general hospital sized treatment centre thirty miles away in the local city, or a ten bed rural town cottage hospital with one theatre with the same surgeon prepared to visit either for the right fee but with different approaches to aftercare based on different needs of patients and families.

Sure, there's still a role for some kind of local democratic input - most especially in procuring facilities and staff for emergency medicine, but even their funding options could be varied - with some able to provide that by engaging local charitable resources, others perhaps by raising a local tax of some kind, perhaps even through planning obligations, who knows. But one thing is certain: these options and innovations are unlikely to appear when the system is riddled with protectionism and political game-play.