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Choice Macht Frei


Posted on 22 June 2011

choice1.jpgThe Nazis – OK, it’s reductio ad Hitlerum time again, and why not – weren’t shy when it came to abusing words. Arrivals at the deaths camps were encouraged to keep their peckers up by a slogan emblazoned over the camp gates. ‘Arbeit Macht Frei’ – ‘Work Makes You Free’. It is hard to conceive of a more gratuitous exhortation on a gate that led not to freedom but to extermination: yet there it was, in all its mocking irony.

Duplicitousness is of course not limited to the Nazis. Closer to home, we have Idiot Duncan Smith rattling the cages of the poxed, the blind, the legless and otherwise variously impaired skivers and shirkers under his own ‘work makes you free’ banner. And even closer to home for all of us, the Tories are railroading through their health reforms under the brightest bluest banner of them all: Choice makes you free! Choice makes you free to choose your GP, to choose your hospital and, of course, choose your treatment! Why, you can even choose to go to Zurich!

The reason the Tories are waving the choice banner is because it is the appealing face of capitalism. As with motherhood and apple pie, choice naturally appeals; it is a ‘good thing’. The five-minute-voter can be relied on to be in favour of choice, just as he/she can be relied upon to be in favour of shorter queues at the Post office, or more seats on trains. What the five-minute-voter doesn’t always consider is why are they being offered the choice no-brainer in the first place. The answer, of course, is in the duplicity, for the real offer is for a punnet of sour grapes, but with a layer of strawberries on top. It looks enticing, but underneath, it is sour and distasteful.

This is not about selling sweet choice for sweet choice’s sake, it is about ushering in that which choice is hand-maiden to: competition. Competition is the engine of the market, and the market is the engine of capitalism; and so too of a big-banged health service where any willing provider competes to be the choice of the customer. But for many health service competition and capitalism are tarnished goods, and so the duplicity arises. The banner has choice on it, because choice is the easy sell, but the banner sits on the engine of competition, an engine that will carry us along the Imperial Road to the market place of a privatised health service.

And so it is that the NHS Mirror Forum, set up by the government to reflect back its own views, has produced a wondrous thirty nine page waffle: Choice and Competition: Delivering Real Choice. The accent, it will be noted, is on choice, and a word cloud (above) generated from the text – itself a triumph of cut & paste over intellect – reveals the usual management-speak guff with, sure enough, choice topping the word count, at 191, compared, for example, to competition’s 133.

Now, it is interesting is to compare the strongly pro-choice NHS Mirror Forum report – produced as part of a listening exercise - with the almost 900 responses still available on the ‘Your Views: Choice and Competition’ website. These responses come not from five-minute-voters giving a snap reply to a poll, but from individuals who have taken the trouble to express their views. Clearly, if we are all so in favour of choice in the NHS, we would expect to find nearly 900 responses extolling the virtues and wonders of choice.

In fact we find rather the opposite. The vast majority of respondents don’t want choice, or competition, they want good local care. And even more interestingly, many of them latch on to the fundamental flaws in health service choice: when we’re seriously ill, we are too unwell to make choices. This in turn is part of the wider flaw, which effectively renders choice meaningless (and so competition and health service markets fatally flawed): it is all but impossible for patients to make informed choices. Tellingly, the NHS Mirror Forum report only contains the word ‘informed’ a paltry six times…against 191 choices…

So, we can conclude, there is no evidence that the Listening Exercise listened, except to those who echoed what they wished to hear, and so no evidence that they made an informed choice about what to include in the report. The Mirror Forum may reflect back to the government that ‘choice makes you free’, but for the rest of us that report is so many wasted bytes on our computer’s hard drive.

2 comments:

Call it "Nudge"

Call it "Social Engineering"

Call it "Action for Happiness"

Happy, shiny "Duplicitousness" is indeed alive and well in the corridors of power.

It will work too unless The Humankind jolt themselves out of "Creep"

Doctor No will be familiar with the case of David Reimer who Professor John "Mengele" Money attempted to turn into a girl with surgery and hormones. He and his brother would have been ten days older than me if only they had lived.

I call him "Mengele" Money because Mengele did precisely the same kind of twin experiments in Auschwitz but Money was operating at John Hopkins.

Reimer's story may be found by googling his name. The latest revelations about the feminine boy experiment at UCLA may be found by googling "Kirk Murphy". They can only find three of the children experimented on by Richard Green and George Rentboy Rekers. They think the rest are dead.

This was not Nazi Germany but 1970s America where the US Government were funding experiments on unconsenting children. Sometimes choice and informed consent are a good thing. Would Doctor No care to comment on the ethics?


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