This kind of research is at the interface of medicine and social policy: it\’s an accident of history that a few people from a science and public health background got involved in the project and did a trial, to get evidence to see if the policy hunch was correct. Robust trials on social policy could happen routinely, if politicians weren\’t scientifically ignorant and terrified of the possibility that they might have to state – with simple, constructive honesty: "Well, we tried this idea, in all good faith, but it didn\’t work so we\’re dropping it now."
If only politics did indeed work that way.
In fact, I have a feeling that some politics does in fact work that way. Politics at the human level. Politics of a scale where people can actually see and feel what is happening. For example, the Danish and Swedish health care systems are based upon money being raised and spent within a county (there are overarching national structures for specialised care which is not economic to provide on such a scale). In Denmark I think this means units of around 300,000 people (a crude calculation, from memory, of divding the number of counties into the population).
If, for example, the people of North Staffordshire were directly taxed for their healthcare, voted directly for those who administered that money and also saw, through their experience of the local hospitals, what they were getting for it.
Well, does anyone think that what would happen is what did happen when it was all done from the centre? The receptionists doing the triage?
No, I don\’t either.
PJ O\’Rourke tells of the unemployment officer in his rural New Hampshire township. She turns up at 7.30 am to escort the unemployed around their day of job hunting.
Perhaps if we weren\’t in one of the most centralised countries in the world we too could have public services which actually worked…..for there are places where they do.