Last night I caught a bit of the Queen’s Speech from the UK on CSPAN. This is an interesting tradition. It’s a bit like the State of the Union, except with more pomp and circumstance. But you’ve got the Queen, who’s a non-partisan figure, sitting up there reading what’s basically a partisan political speech written by the Prime Minister and his staff all about how “my government” is committed to doing this and that.

But one thing that the Queen told me Gordon Brown wanted to do was reform the House of Lords to create a second branch of parliament with “real democratic legitimacy.” Sounds like a bad idea to me. Pretty much the best thing about the House of Lords is that its complete and utter lack of democratic legitimacy has made it possible over the years to strip it of all its legislative powers. Now the U.K. has a de facto unicameral regime and I think it’s working just fine. Bicameralism arises for some understandable historical reasons—the legacy of aristocracy in the U.K., an 18th century political compromise in the U.S.—but in this case it looks a lot like a solution in search of a problem. Maybe Brown should ask Barack Obama about some of the hassles involved in an upper house with actual power. Watch what you wish for!

From Bryan Curtis’ profile of Rick Hertzberg:

With Obama in office, Hertzberg says he will turn his attention to another of his long-time obsessions: the byzantine structures of American government. Triumphant Democrats have discovered that big victories in 2008 haven’t instantly led to policy outcomes like, say, health care reform. In the British system, the public option would have been a fait accompli; in what Hertzberg calls our “ridiculously undemocratic” Senate, health care can be single-handedly dynamited by a Max Baucus or a Joe Lieberman.

“Right now, we have a situation where the human occupants are about as good as we’re going to get,” Hertzberg says. “So my attention goes back to the structure they’re trapped in. That’s what Obama and the Democrats are in the grip of now. And that remains to be fixed.”

Hertzberg is the inspiration for my own fixation on these issues, so I completely agree with him that this is where the temperature needs to be raised. That said, I think the particular counterfactual should be specified more precisely. One of the less remarked-upon consequences of our nutty system of legislation is that presidential campaign promises exist in this kind of odd state, mixing memory and desire. Some promises look back at presidential actions not taken—an EPA endangerment finding, signing SCHIP expansion, signing Fair Pay Act, signing minimum wage increase—and promise to do them. Others constitute a vague pseudo-promise to gin up legislative support for ideas that don’t have the votes needed to pass the Senate—EFCA, a public option with Medicare rates, a 100 percent auction of emissions permits.

Precisely because sophisticated observers understand that these “desire” promises aren’t really promises, interest-groups and voters who have strong feelings about these things don’t need to act on those feelings during a campaign. Consequently, candidates can make unrealistic promises to interest-groups or ideologues without fully facing the wrath of the other side. Ultimately, I think this not only breeds worse policy, but it breeds an unnecessarily childish political debate. If we knew in advance that election-winners would be basically able to implement their agendas, then it would be more necessary for party leaders to campaign on agendas that they think are compatible with electoral victory and governing success. One thing you see in Britain is that opposition parties with a realistic chance of winning tend to put forward relatively modest platforms full of explicit commitments to not change certain aspects of the policy status quo. Precisely because you can have wild swings in policy, leaders who want to win can’t just kinda sorta promise their base that they’ll get everything they want.

Guess who said this?:

We have a vision of a different America. It is a vision of an America in which our cars run on electricity; high speed trains whisk us from North to South in less time than it takes to get across greater New York; we produce much more but use much less energy to do it; our power suppliers no longer depend to any great extent on imported oil and gas; our homes require less energy, produce far more of their own energy and are heated by gas we produce from our own agricultural and domestic waste.

It is a vision of a United States which leads the world in new green technologies. Secured against interruptions of supply and volatile prices, our industry can plan for growth. Our national security is guaranteed, regardless of decisions by volatile governments elsewhere to close pipelines or restrict supply. It is a decentralized vision rather than one in which all decisions about our energy future are vested in the government. Through it we play our full part in protecting our planet against the effects of man-made climate change.

Well, nobody said it. Instead I changed the words “Britain” and “centralised” to “America” and “centralized.” But it comes from the UK Conservative Party’s low-carbon economy white paper.

I mention this because David Brooks has a pretty good column urging Republicans to learn from David Cameron that, disappointingly, doesn’t mention anything about climate and energy issues. But if you want to make the point that at the moment European center-right parties are both much more politically successful than the GOP and also much more substantively sensible, then climate and energy is probably the topic where you’ll find the biggest contrast. After all, it’s not just that the Conservatives’ climate and energy issues page looks very different from the Republican one—the Republicans don’t have one at all.

If we ignore the undecideds, this seems to make it quite likely that the Tories will secure a majority in parliament even as more voters prefer left-of-center parties. In Canada’s 2006 election a majority of people voted either Liberal, New Democrat, or Green but the Conservatives wound up with the most parliamentary seats and they’ve been running a minority government ever since even though it’s pretty clear that the median Canadian was supporting the Liberals. Most countries with strong multi-party politics have a substantial element of proportional representation in their system which helps iron out these kind of bugs. Canada and the UK, however, do first-past-the-post elections in single member districts.

This is basically without precedent in U.S. history. And it’s worth noting that even though the general ups and downs of the economy are largely a global phenomenon, this specific issue isn’t. The UK is now mired in a recession and Labour will almost certainly lose the next election. But during the expansion, inequality declined in Britain and Labour took a huge chunk out of child poverty. Both countries floated up and then down on the strength of a finance bubble, but Britain put its boom years to good use. In the U.S., even the boom was not very favorable to most people.

For all that high-speed rail opponents in the United States like to cite misleading statistics about population density, I don’t think anyone can seriously deny that the United Kingdom is a densely populated country. And yet, the land from whence the railroad originates doesn’t have a proper high-speed rail network. Plans are afoot, however, to remedy that:

Network Rail’s proposed new line linking Glasgow and Edinburgh with London, on which trains could travel as fast as 200mph, would also serve Manchester, Liverpool, Preston and Birmingham.

A spokesman for one of Manchester’s biggest employers, Kellog’s cereals, said: “This is great news for business in Manchester, just as London is going to be more accessible for us, Manchester will be for those in the South East.”

The new line would cut the journey between London and Birmingham to 45 minutes, from a best time of one hour and 22 minutes currently.

One thing to note here, and something that’s generally the case with HSR, is that there will benefits to this scheme even for people who never take the train. Right now there are tons of London-Glasgow flights taking up space on runways. Developing a better rail link between those cities will reduce the need for air travel between them and allow airport resources to be focused on those routes that really can’t be served adequately by train. And that, of course, is a lot of routes—especially for a country located on an island.

Norfolk and Norwich University Hospital (wikimedia)

Alex Massie writes:

There are, I think, two essential truths in international health policy. No-one sees fit to copy the National Health Service and no-one sees fit to copy the American system…. The relevance of the NHS to American health care plans seems pretty limited anyway since, as best I can tell (though I try not to pay too much attention to these things) Obama doesn’t actually plan on copying the NHS.

And Kevin Drum adds:

But with the exception of a few outliers, the liberal community really, truly doesn’t want a fully government owned and operated healthcare system like the NHS. We want a government-funded healthcare system like Medicare or most of the world outside of Britain. And unless I’m mistaken, this isn’t a ruse in any way. That’s really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.

I can assure everyone that Kevin is right, because I’m actually one of the rare outliers who thinks the NHS is a pretty great model and the British are on to something. And try as I might, I can never find anyone who agrees with me. That said, the case for the NHS is quite strong. As Ezra Klein says, the UK method saves a ton of money:

But the British system is extremely cheap. Uncommonly cheap. Weirdly cheap. About 41 cents for every dollar we spend per capita cheap.

Now it’s definitely true that to an extent the Brits are getting what they pay for here. If you look it up, the research shows that British health care is not especially effective by international standards. That said, the difference is subtle enough that you actually do need to look up the research. It’s not as if people in the UK are just dropping dead of the plague all the time. To the casual observer, it all looks about fine, and the 59 cents on the dollar they’re saving is quite a lot. The fact of the matter is that health care is not an especially important determinant of health outcomes. Genetic predisposition is hugely important, and we can’t do anything about it. The biggest issue is “behavioral patterns” which are hard to change. But even “social circumstances” and “environmental exposure” (which is really a kind of social circumstance) swamp health care as a factor.

Which is to say that if you were actually able to get British levels of care for British price levels you could redirect that other 59 cents to trying to improve the social circumstances of the poor, trying to reduce exposure to health hazards, and building infrastructure (trains, sidewalks, bike paths, even the dread parks) suited to less sedentary lifestyles. We’d be much better off that way. The collective social determination of the industrialized west to dedicate large and increasing volumes of resources to trying to be healthier makes a lot of sense, but dedicating vast sums of money toward health care services just isn’t a particularly smart way of accomplishing that.

As you’ve probably heard, British newspapers don’t maintain the same standards for scrupulous accuracy as we have here in the US. Thus sometimes you read a UK press report that, while interesting, you just know has to be false. For example, there’s this from The Guardian:

The NHS is developing a simple blood test that could save the lives of hundreds of unborn babies who are put at risk when doctors try to establish whether they are developing healthily in the womb, the Guardian has learned.

The test could put an end to the use of invasive procedures such as amniocentesis, which cause some women to miscarry.

Yes this seems like an interesting story about a potentially useful medical innovation. But the discerning reader will note that this is all allegedly happening in the United Kingdom, and funded by the National Health Service. The NHS, however, is a socialistic system and the UK a socialist land. And everybody knows that under socialized medicine, medical innovation will cease. Therefore, the story must be made up.

Larry Bartels has made somewhat similar findings in the United States indicating that there are huge distributive implications for whether the president is a Democrat or a Republican. Economists have tended to be dubious that Bartels is identifying a real causal relationship, since the underlying mechanism isn’t totally clear, but the presence of similar patterns in similar societies should tend to increase our confidence that Bartels is on to something important.

During a short-lived stint as a summer camp counselor, I was playing basketball on one of those short hoops—this one must have been 6′6″—that they have for kids. I was playing defense in the low post, and didn’t realize that I’d actually positioned myself directly below the rim. I jumped, smacked my head into the rim, and the little loops of metal that hold the net in place cut my scalp. It didn’t hurt too badly, but I was bleeding like crazy. Someone drove me to the emergency room in Augusta, ME and I was holding a towel on top of my head to try to minimize bleeding. We got to the ER, and fortunately someone was available to see my almost immediately, but first I had to fill out some insurance forms. So I was standing there at a counter, bleeding from my head, struggling to fill out the forms without the ability to use my left hand to stabilize the sheet of paper. I used the left elbow instead, then kind of contorted my head and neck somewhat so as to be able to hold the towel in place. Naturally, with my head tilted there was blood dripping onto the counter and the forms wound up being filled out with a less-than-ideal degree of eligibility. But, damnit, this is America where we have our priorities in place. First you fill out forms, second you get treated.

If the Queen needed a band-aid, she would call it an elastoplast.

Conversely, one time I was in the UK and sort of randomly cut my leg. It wasn’t especially bad, but it’s the kind of thing you want to clean properly and put a band-aid on. But I was far from my hotel and didn’t have any of the relevant equipment on me. I hopped around a bit, hoping to find a pharmacy, but I actually saw an NHS clinic first. So I limped in there, a nurse saw the problem and quickly and politely dealt with it with no fee or forms or anything. The only problem was a minor miscommunication around the fact that I had no idea what an “elastoplast” is.

Back to the US, where about three years ago I stepped on something in bare feet and cut myself. It didn’t seem like a problem at the time, but it got infected which created a painful “I can’t walk on my left foot” kind of situation. Naturally, I called my doctor to see if he could help me out with that. And because this is America where we don’t have waiting times to see doctors, was told that he could see me in two days. Fortunately, the very next day somebody canceled his appointment and I got a call and was able to cab it over to the doctors office and get the situation treated relatively swiftly. And since I’d been to this doctor before, the forms and such had already been filled out. It was practically an NHS level of service, except since this is the United States of America an extremely minor problem was dealt with by an expensive MD rather than a cheap nurse.

Now as I said yesterday we have hundreds of millions of people in the developed world and thus tens of billions of anecdotes about health care. Under the circumstances, a dueling battle of anecdotes is not going to reach any definitive conclusions. But people think about the world in terms of stories, so these kind of things matter.

Royal Gwent Hospital (NHS Photo)

One thing I always wonder about critics of government involvement in health care is how is it that the British system is so terrible, nobody seems to have told the UK’s population? Here, for example, is the Conservative Party’s policy statement on the National Health Service:

In its bricks and mortar, people and services, the NHS embodies something which is truly great about Britain. That something is equity: the spirit of fairness for all and the equal right of everyone regardless of age, background or circumstance to get the healthcare they need.

It really is one of the most precious gifts we enjoy as British citizens, providing a lifeline to families up and down the country. That is why the Conservative Party has made the NHS its number one priority. We back it, and want to built it and improve it for everyone. [...]

This document sets out the Conservative Party’s plan to renew our bureaucratised NHS. At its heart is an unambiguous commitment to give the NHS the funding it needs. [...]

We should be proud that, in its sixtieth year, people are beginning to look at the Conservative Party as the party of the NHS. But we’ve got to live up to that honour.

They love socialism! And surely it’s not because nobody in the Party of Thatcher is familiar with the right-wing critique of this model of health care. Nor is it because nobody in the Party of Thatcher believes in the standard right-wing critique of the model. But to the people who actually pay the taxes to finance the NHS and receive the services provided by the NHS, talk of dismantling it and moving to the glories of free market medicine is so politically toxic that even the right-of-center party banishes any such talk. Instead, they promise more money and “establishing an independent board to run our NHS” so that “we can take politicians out of its day-to-day management.”

The Guardian has an interesting profile of Andrew Brons, one of the two new Members of the European Parliament elected over the weekend by the neo-fascist British National Party:

The group he first joined included among its members people responsible for arson attacks on Jewish property and synagogues. According to the anti-fascist organisation Searchlight, which has been tracking his career for decades, Brons appears to have approved. In a letter to Jordan’s wife, Brons reported meeting an NSM member who “mentioned such activities as bombing synagogues”, to which Brons responded that “on this subject I have a dual view, in that I realise that he is well intentioned, I feel that our public image may suffer considerable damage as a result of these activities. I am however open to correction on this point.”

By the 1970s, Brons had moved on the National Front, then the leading far-right group in Britain. He was voted on to the NF’s national directorate in 1974 and, as the NF’s education officer, he hosted seminars on racial nationalism and tried to give its racism a more “scientific” basis. [...]

After drifting out of far-right politics, he became a lecturer in politics and law at a further education college in Harrogate. He joined the BNP in its current incarnation three years ago. Divorced, with two grown-up daughters and four granddaughters, his election platform was that he “would work to expose the activities and corruption of the EU to strengthen Britain’s case for withdrawal” and “would co-operate with patriots in other countries who seek to bring the EU to an end”.

The rise of the BNP is all the more shocking for the fact that UK voters already have a “mainstream” far-right option available to them in the form of the UK Independence Party, so it’s hard to rationalize BNP support as simply a sign of disgruntlement with the establishment options.

Today is, to be honest, a pretty slow news day in US politics. But it’s a huge news day in UK politics. Basically, Gordon Brown’s Labour Party had been unpopular. Then came the financial crisis, which has really hammered the UK, where London’s financial sector is a huge portion of the economy. Then on top of that has come some scandals about MPs abusing their expenses. And then most recently, Labour got absolutely wiped out in local elections. So now a bunch of ministers are resigning, Brown is reshuffling his cabinet and vowing to fight on, but realistically coming under increasing pressure to step down so that Labour can try to find some way to put a new face forward rather than march onward into what looks to be certain electoral apocalypse.

At any rate, spending some time reading about this is a powerful reminder of what the emerging information ecology looks like. The cable networks that we keep on in the office seem to have been covering this story not at all, even though it’s clearly more newsworthy than the latest iteration of “hey! look at what Rush did!” But that’s the way it goes on cable. Meanwhile, thanks to the internet I’m able to read about UK news from BBC, The Guardian, British blogs, etc., and get far more detailed information about what’s happening than I ever would have been before. Banal, I know, but I think worth stepping back and thinking about.

Meanwhile, back to the UK, I suppose from an outsider’s perspective I wonder if at some point there can be a tipping point for the Liberal Democrats. I imagine a lot of people who might have some love for the Lib Dems nevertheless don’t want to “waste” a vote on a third party. But if it’s absolutely clear that the Tories will win no matter what, then that incentive seems to melt away and Labour will start polling even worse.

When Gordon Brown came to Washington, he brought a thoughtful gift with him—a pen holder made from the timbers of the HMS Resolute to match the White House’s famous desk. Barack Obama, by contrast, got Brown a set of DVDs. And as if that gaffe wasn’t bad enough now we learn:

Alas, when the PM settled down to begin watching them the other night, he found there was a problem.

The films only worked in DVD players made in North America and the words “wrong region” came up on his screen. Although he mournfully had to put the popcorn away, he is unlikely to jeopardise the special relationship – or “special partnership”, as we are now supposed to call it – by registering a complaint.

In order to permit price discrimination between different markets, you see, DVDs and DVD players are region-restricted. Normally, a North American disk won’t play in a European player and vice versa. They do, however, make some “universal” DVD players that can play disks from all regions. Maybe the embassy in London can get one for the PM.

One assumes this won’t actually shatter the foundations of the US-British relationship, but still it’s a pretty sorry showing.

It’s a bit hard to tell just by eyeballing the graph what that study said. The answer, however, is that diuretics performed the best. And they’re also the cheapest. In an evidence governed world, their use ought to have exploded — when the best treatment is also the cheapest, you expect it to dominate. As the Times reports:

“It should have more than doubled,” said Dr. Curt D. Furberg, a public health sciences professor at Wake Forest University who was the first chairman of the steering committee for the study, which was known by the acronym Allhat. “The impact was disappointing.”

The crux of the matter is that it’s difficult to spread knowledge of best practices throughout the medical community. And it’s especially difficult to do so when pharmaceutical companies are prepared to spend vast sums of money to ensure that accurate information fails to spread. After all, there are profits at stake. Just because a generic alternative to their treatments is cheaper and more effective is no reason, in the eyes of a sociopathic pharma executive, for doctors to prescribe it. So their marketing and PR teams go to work and, as a result, people die and profits stay high.

But beyond the pharmaceutical companies, the issue here is doctors. People are trusting them to look out for their interests. But doctors have little incentive to really cut through the garbage and stay abreast of the latest science. Ezra Klein observes that “If doctors were paid by capitation — if they got a fixed amount of money per patient, and they kept whatever they didn‘t use, as happens in England — it’s hard to imagine they wouldn’t have been more interested in these study results.” Bobby Jindal has, as I’ve noted earlier, put some proposals on the table for changing Louisiana’s Medicaid system that show some promise of possibly moving in a useful capitation direction. So hopefully we’ll see some experimentation in that direction. It’s tricky to work out capitation in a way that correctly aligns incentives, but fee-for-service medicine in which doctors get paid for doing treatments rather than for producing health outcomes it’s totally impossible.

On the other hand, my grandfather was telling me over Thanksgiving that a proposal along these lines was part of his dissertation many decades ago so it’s not like this insight is new — it’s just that the forces arrayed against it are powerful.

UK Transportation Minister Geoff Hoon knows how it’s done:

In a statement to MPs, Mr Hoon, who took over the transport brief earlier this month, said: “In order to stimulate Britain’s economic growth and support our position as a leading world economy it is essential that we make the right long-term investments in our transport infrastructure and that we plan for future growth, in a way which is consistent with reducing greenhouse gas emissions overall.” [...]

Mr Hoon said he wanted to “accelerate” the work his department was doing on both long and short-term planning for the future of road transport, with more hard shoulder-running to increase capacity, and rail.

Note also that UK residents have the privilege of living in a country with a non-insane right-wing political movement. Thus:

The Tories, who have pledged to build a high-speed rail line and scrap Heathrow’s third runway plan, said the “non-announcement” was “empty words”.

Ah to have such complaints from our GOP.

Gordon Brown has told the Icelandic prime minister that he is considering legal action against the country over the collapse of its national banks.

The prime minister said tonight that Iceland’s decision not to recompense those with savings in the bank was “completely unacceptable” and the British government would do “whatever is necessary to recover the money”.

“I’ve spoken to the Icelandic prime minister, I have told him this is effectively an illegal action that they have taken. We are freezing the assets of Icelandic companies in the UK where we can. We will take further action against the Icelandic authorities where necessary to recover the money.

This talk of “legal action” is nice, but if Brown’s really willing to do “whatever is necessary,” then the UK is one of the few countries capable of projecting substantial military power in Iceland. And, of course, Iceland has no military with which to defend itself. The country’s even been subjected to British military occupation in the past. Before WWII, Iceland was part of Denmark. Then when the Germans conquered Denmark, the British dispatched troops to Iceland to secure the country under a new independent government so as to ensure the viability of the sea and air routes between the UK and North America. Later (but before formal US entry into the war), the United States took over occupation duties. And we continued to maintain a pretty substantial military presence (relative to the size of Iceland) at Keflavik Naval Air Station until a year or two ago. But now Iceland’s defenseless!

Britain under Gordon Brown is doing what a lot of folks — Paul Krugman, Nouriel Roubini, and others to whom I’ve pledged my financial crisis allegiance — have been saying the United States ought to do — putting up a big kitty of money to buy stakes in banks that need recapitalization rather than to buy bad assets from banks. Under the circumstances, I think it’s genuinely unfair to do what the New York Times does and call Brown’s plan a “huge bank bailout.” Private firms don’t ordinarily relish a scenario wherein their partially nationalized at bargain bin prices, and that’s what Brown’s doing.

Meanwhile, my sense is that the nature of this problem is that a medium-sized country like the UK or Spain can’t, fundamentally, do very much to resolve the issues. They can perhaps take stopgap measures to stave off total collapse, but economic globalization has gone far enough that there’s a real need for coordination among all the major countries.