Ed Miliband recently stated that there should be a link between NI contribution and service. I thought “Well done Ed, you've invented health insurance”.

The NHS is an outdated model and cannot provide quality services. Its approach towards healthcare on the demand side and a ‘provide everything’ mentality on the supply side, with no regard to cost (or some would say, quality), has created the perverse incentive for it to be abused, as has been reported recently in the mainstream media.

The biggest organizational problem with the NHS, however, is, once again, size. The NHS has a very centralized nature; it is effectively a command economy with an unlimited, taxpayer-funded, budget. Once again, we see a commonality between failure and large command and control structures.

For this reason the NHS will have to be broken up. Its time has passed. However, that does not mean that healthcare will become out of reach for everyone but the few, as the left will incorrectly state, and there are two reasons for this.

The first is the free market principle on which Smallism is based. Lots of smaller units create more competition than a few large ones, and competition is the key to advancement in science and technology.  Lots of smaller units also promote greater specialization and, thus, higher quality operation, maintaining competitive edge in a global marketplace. 

A distributed model such as this is common in engineering where small workshops specialize in very niche work, often involving a considerable amount of investment capital for much larger companies that create products or research from the work of these specialists.

The argument against this stance is that there needs to be large organizations to fund cutting edge research. However, in the modern age of commerce, competing companies have become very adept at collaborating on some projects and competing on others.  Many use similar delivery methodologies (PRINCE2, ITIL, ISO9000) enabling them to inter-operate smoothly.  In addition, academia is to be given a far more prominent role across innovation, which will again promote collaborative but competitive business.

Once again the principle of locality comes into play. If an area suffers a disproportionate amount of a particular illness then the insurance company and the people in the area have a greater incentive to find the cause and cure of that particular illness.  It makes no sense for an area with little demand for treatment in this area to fund and research it. 

Because of this, universities will collaborate with healthcare provider companies and insurance companies to find cures for illnesses. 

This change in funding method for research takes away any possible perverse incentive the large pharmaceutical corporations might have to find treatments, rather than cures. 

Research associations and funding would become one of the metrics used by wards when choosing a particular insurer, provider or even university, based on their residents’ majority preference.

Hospitals and wards have a broad range of options for transition. 

A union of wards may decide to buy the hospital and take over the running of it themselves. Wards (or groups of wards) will provide a mandatory group health insurance premium in the annual bill that ensures services are paid for by people who are eligible to receive them and this further encourages members to become part of a community through property ownership.

As we discuss in 3.1 Raising Capital and Entrepreneurship for People should a healthcare professional want to 'go it alone' then their should be no barriers to entry as are currently enforced for the NHS by state regulation.  Furthermore, professionals are free to enter education to run their own courses as discussed in 2.7 Education.
This is not to say there won't be 'any' regulation, of course the surgeon will still have to be qualified and provide an environment to a relevant standard but in order to innovate and prevent abuses of power in monopolistic positions we must allow and encourage competition.

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So far, we have designed a system that allows people of all points of view to create and find a place they feel comfortable, and as we will examine shortly the definitions of left and right are academic but for the conversation about managing rogue wards let's define a left and right wards.

A typical Progressive Ward

Educational standards will be low as everyone works to the ability of the lowest achievers, however, the lowest achievers will feel good about themselves. Education will focus on Citizenship (including Sex and Death education) and the arts.  Disruptive pupils will be tolerated and left in mainstream classes.

Local unions look after the members who, for example, empty the bins, by making demands for higher pay and better working conditions and suing companies that wish to sack union members.  These demands will be happily met by the ward and charged accordingly and progressive bosses will keep inefficient workers to prevent costly union action. The progressives will happy accept lower service levels because they know they are looking after the working man.

Drugs, prostitution, membership of cults, under-age sex, abortions will all be tolerated because the members of the ward are progressive.  The costs of the externalities of these will of course be met by a the local ward.   Schoolgirls will be given contraception pills for free and abortions on demand. Homeless drug users will be provided housing and food.  Anyone not working will be paid a living wage and provided housing by the ward members. 

In a typical conservative ward

Education will focus on Maths, Science and English. Disruptive pupils will be expelled and pupils will be streamed according to ability.Children will not have sex, death, or rights education as this will be left to the parents discretion.

There will be no unions, and employees who are unhappy in their work will be free to find other work.

Drugs and prostitution will always exist so making them illegal is futile but a low key management and tolerance by mutual understanding on both sides will be possible. For example, if you have a joint in your house in the evening, no one should care, but if you're wasted on pills in a public place, then you are providing an inconvenience to your neighbors and will be dealt with according to local methods (noting that these methods will have been agreed by the ward themselves)

A rogue ward 

These two wards live side by side and those who believe in each are happy. So what happens now if a third ward is full of 7th Century barbarians? Whatever happens within the ward is their own business and if there are heads on spikes down the high street well that's their choice.  And it is a choice, because if the people living in that ward feel heads on spikes is too much, then they can move to a more suitable ward.

However, once the heads on spikes starts to encroach on the liberties of another ward how can this be managed?

Firstly there is regress to national law. What damage is being caused and how much can be recompense? 

Secondly there is a more direct form of action.  Because the neighboring wards provide essential utilities, say one provides water, the other provides electricity then these can be cut off or provide reduced service in an effort to get the damaged ward to change it's ways.  The idea being that once services are unavailable, more people will move away, until the problem has gone and the neighboring wards can expand into the space left behind.  It might even be possible that the third ward becomes a single house with the Bean family living in it, the family are so barbaric that the neighboring wards have erected walls to protect themselves from the Beans, and the Beans, have no access to utilities whatsoever. 

This is a form of social action that cannot be achieved under current governance frameworks that rely on laws being specific to particular problems, which of course they can never be as societies modern problems are somewhat new in nature.  The current system simply tries to retrospectively write laws and regulations as each new and unique case comes up.  But in actuality, nothing changes except some people have money taken away and a criminal record. This does not actually change the root problem of behaviour.

This is exemplified by council estates where the number of unruly people outstrips the number of 'normal' people and so unruly behaviour becomes the norm and there is nothing that the 'normal' people can do about it.  If they are in state provided housing moving can be very difficult, if not impossible, but if those people had the ability to make life difficult for the unruly people by withdrawing essential services then behaviour will change.

For example, if a large number of people in the ward drink and fight too much, the ward, having control of its own hospital resources may decide to charge for admissions on alcohol, or refuse treatment for minor drink-fight related injuries.  Once those guilty of such behaviour start to realize their is a sanction for their behaviour, their behaviour should change.  Alternatively, the ward could simply tolerate the behaviour and absorb the costs through it's local administration.

But what happens if the two wards hate each other?

This is a good question and one that needs to be addressed. Firstly the interconnections of utilities between wards will moderate any action. For example if water flows through one to the other, and electricity in the reverse.  There would be consequences to cutting off water supply, or electricity that would be bad for both wards. (Remember that a core feature of Smallism is to remove any possible monopolistic power any person, ward, corporation can have).

But should this happen, the distributed nature of the utilities services means that a ward can choose to select another provider.  If the ward consuming electricity has its supply cut off, it can go to another ward to resume its supply.  This is the same process that governs service levels. If you are not happy with the provider you simply find another one.  If the nearest supplier is two or three wards away (because the neighboring wards use the same supplier) then part of the management of the service is to get a transit agreement across the wards.

A caveat to the descriptions of the left and right wards is that ward design means that traditional left and right values become irrelevant, as each ward will do what it feels is right for them.  Much of the debate about what situations are now, and what they will be after implementation are invalid because Smallism completely changes the paradigm.

For example, because wards can now use their resources for profit it is in the interests of the most unruly of neighbors to behave because they directly benefit from being a member of that ward.  Let's say our 3rd ward has a swimming pool that services all three wards.  When the high street has heads on spikes they directly lose money that would be offset against their membership charges by reducing the number of customers to their swimming pool.  In our current system, they don't care because there is no direct cost to themselves for putting heads on spikes.

On education the paradigm for education also changes under Smallism so using the typical state sanctioned syllabus under a left/right government is also not realistic. Read more about educational changes here 2.7 Education 


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