So, in the last couple of days I think we’ve safely established that Daniel Hannan is a complete and utter twat. That said, the full extent of Hannan’s outright twattery only becomes fully apparent when you examine the background to his assertion that the NHS should be replaced with a Singapore-style system of personal health accounts because…
The Singapore system produces better outcomes than ours for half the price.
Taken at face value on a comparison of key health indicators and taking into account the relative proportion of GDP spent on healthcare in the UK and Singapore that’s perfectly true but it rather ignores a very important and somewhat unusual feature of the Singaporean system, one that makes it very different from healthcare systems in both Britain and the US.
When it comes to providing healthcare to its citizens, both the supply and the price of healthcare in Singapore is actively regulation by the Singaporean government, in both the public and the private sector in order to control costs and avoid the kind of significant inflationary pressures that pretty much every other healthcare system in the world has had to deal with.
Now that’s a great trick if you can pull it off but not one that I’d suspect forms part of Hannan’s grand plan for doing away with the NHS given his fondness for anti-state rhetoric and free markets in just about everything else. Indeed, for someone who is so vehemently opposed to state involvement in just about anything, Singapore is a rather curious exemplar to hit upon.
60% of the country’s GDP is, for example, generated by government-linked corporations in which the state is, at least, a major (50%+) shareholder. The state, often indirectly, owns or controls the country’s airline, its public transport system, all seven television stations and all fourteen radio stations (it’s illegal to own a satellite receiver that picks up non-state owned, uncensored, transmissions), its newspaper and print media industry, its telecommunications industry (including the provision of internet services), its water and sanitation industry, its sole supplier of electricity and gas and anything up to 90% of all the housing stock in the country, which it citizens can acquire on anything up to a 99 year lease but not purchase outright. 80% of its domestic secondary healthcare services are provide by its 10 state-owned hospitals, although state provision accounts for only 20% of all primary care services.
The Singaporean state is both a major investor in domestic industry and, through its state-owned investment arm, Temesek Holdings, in a wide range of foreign corporations. Its also a major player an number of other Asian economies into which its state-owned have aggressively expanded.
SingTel, in which Temesek Holdings is the majority (55%) shareholder, is the biggest mobile telecommunications provider in Asia, with a customer base of 249 million people and major subsidiaries in Thailand, India, The Philippines, Australia, Bangladesh, Indonesia and Pakistan.
PSA International (100% owned by Temesek) is the second largest port operator in the world with 28 port operations in 16 countries including Argentina, Belgium, Italy, China, India, Japan, and even one in the UK (Great Yarmouth).
Singapore Power has major interests in the domestic supply of electricity and gas in Australia, via SPAusNet (51% owned) and Alinta and the commercial supply market in South Korea, where its subsidiary SPI Seosan is the sole supplier of electricity, steam and water treatment to Samsung Total Petrochemicals, one of the largest petrochemicals companies in the country.
It’s actually difficult to describe Singapore’s in conventional political and economic terms. The country has certainly embraced free-market global capitalism but has done so primarily via state-owned corporations that, at least notionally, operate free from direct political control but, in practice, have close ties to the Singaporean government and to its ruling party, the People’s Action Party, which has won every single parliamentary election in the country since self-government in 1959. In terms of its domestic economy and, particularly the role of state-owned/controlled corporations in healthcare, housing, transport and the telecommunications and media, Singapore falls somewhere between the Japanese Zaibatsu model and what might be described as corporate socialism, a corporate plutocracy with, if not a social conscience, then at least the good sense to realise that dissent and social unrest can be bought off somewhat more cheaply and effectively that it can be repressed as long you can generate enough income from exports and global investments.
Politically, Singapore is notionally a parliamentary republic with a unicameral legislature modelled on Westminster and British-style legal system that mixes statute and common law. It has, however, also been a de facto one party state since self-government in 1959 and one that is best characterised in terms of its effective suppression of political opposition by means subtle authoritarianism and political corruption.
Elections in Singapore are uniformly free from irregularities and ballot-rigging but the political and electoral system is routinely manipulated by the Singaporean government, which directly controls the country’s electoral commission, by means of its outright control of the media and the use of both direct and indirect forms of censorship that serve to deny opposition parties any kind of significant public platform, by the widespread use of politically motivated libel and defamation actions against opposition politicians and by good old-fashioned gerrymandering. Little wonder, then, that Freedom House rates the country as being only ‘Partly Free‘, while Reporters Without Borders places Singapore 144th of 173 countries on its 2008 Press Freedom Index, just below Russia, Ethiopia and Tunisia and only slightly above Egypt.
In that year (2008), a Singaporean blogger, Gopalan Nair, was sentenced to three months in prison for ‘insulting a judge’ and the Wall Street Journal Asia was fined 25000 Singaporean dollars and held to be in contempt of court after publishing two editorials and a letter by an opposition leader questioning the countries judicial system.
Elsewhere, the Singaporean government has, since 2006, been engaged in a long running legal vendetta against the Hong Kong based Far Eastern Economic Review (FEER) after it referred to opposition leader Chee Soon Juan as the ‘country’s martyr’ due to the number of politically motivated law suits he’d had to face and criticised the governments handling of a ‘pay and perks’ scandal involving the head of the one of Singapore’s largest charities, the National Kidney Foundation.
In addition to suing the FEER for ‘defamation’, the country’s Prime Minister, Lee Hsien Loong also instructed the FEER and four other foreign newspapers/magazines – the International Herald Tribune, Time, Newsweek and our own Financial Times – to conform to a state law on newspapers which requires foreign titles sold in Singapore to engage a local legal representative and pay a deposit of 200,000 Singapore Dollars in order to retain their sales licence.
I guess that Lee Hsien Loong wants to be sure of getting his pay-off, if he does ever decide to sue the FT.
FEER refused and, as a result, is no longer on sale in Singapore. Last year, Singapore’s High Court entered a summary judgement against FEER, which is owned, via Dow Jones, by Rupert Murdoch’s News Corp, and instructed the magazine to pay damages to Lee Hsien Loong and his father, and former Prime Minister of Singapore, Lee Kuan Yew. Notably, the ruling in this case asserted that the public interest privilege that exists in both British and American defamation law is not applicable in Singapore.
Before leaving the subject of media censorship, its also worth noting that anyone suspected of possessing or broadcasting a documentary by film-maker, Martyn See, about the 17 year imprisonment of journalist and opposition figure Said Zahari, can expect a prison sentence of up to 2 years and a heavy fine on the grounds that the documentary threatens “public confidence in the government”.
Even those who commend Singapore’s health care system as a model from which other governments could learn concede that it would be very difficult to replicate elsewhere in the world because its a system that has been developed concurrently with the development of the country over a significant period of years against a backdrop of political ‘stability’ which is derived, in the main, from a culture of enforced political and social conformity to a degree that would be unthinkable in a Western liberal democracy such as the UK.
For all that Hannan and his fans complain bitterly and incessantly about state enroachement in Britain into areas they consider to be either private matters for the individual or economic issues in which an unrestrained free market is, in their eyes, inherently superior to state provision and regulation, it remains the case that you cannot be arrested in Britain just for being a homosexual or for possessing pornography, with the exception of child pornography and, controversially, some forms of so-called ‘extreme’ porn, nor can you be arrested for possessing chewing gum, littering (although you can be fined), jaywalking or for not flushing the toilet after use*. You can, however, be arrested, tried and convicted in Britain, if you rape your wife – but not in Singapore.
That’s not a joke, by the way, Singapore’s Environmental Protection Regulations (Public Cleansing) really do make not flushing the toilet a criminal offence.
We have a free and independent press, one that is, arguably, subject to too little independent scrutiny and regulation due to the manifest shortcomings of the Press Complaints Commission.
Our broadcast media is, for the most part, entirely independent of the state and only modestly regulated, by an independent regulator, with few restrictions on content and rules on political broadcasting designed to ensure that opposition parties have fair access to the media and to limit the scope for undue political influence and bias during election periods. Even our state-funded broadcaster, the BBC, is bound to a code of political neutrality and balanced reporting on domestic matters, for all that routinely attracts accusations of bias from those whose concept of bias amounts to ‘anything I personally disagree with’.
As abysmal as our libel laws might be, at least our politicians are not in the habit of routinely throwing politically motivated defamation actions at their opponents in an effort to suppress legitimate criticism nor, I fully expect, would our independent judiciary have any truck with such behaviour.
We’d all like an efficient, responsive healthcare system but no matter where in the world you look such a system comes at a price. America’s acute medical care is, as John Crippen points out, the best in the world – if you can afford it out of your own pocket or you’re insured up to your eyeballs. But if you’re poor or even moderately well-off but unfortunate enough to contract a long-term chronic condition then you either won’t get the care you need or you’ll likely be driven into bankruptcy in the process of trying to get it.
The NHS has its faults. It is bureaucratic and often inefficient – although rarely, if ever, is it mentioned that much of it current burden of bureaucracy stems directly from the string of quasi-market reforms put in place by successive governments, since 1979, in the name of making it more efficient. Since 1979, management and administration costs in the NHS have doubled as a proportion of total annual NHS expenditure, much of which is due to the added bureaucracy that goes with managing and administering internal commissioning systems, service level agreements and other contracts plus all the overheads created by government-imposed delivery targets.
The price of an efficient healthcare system in Singapore is a corporatist state that would have fair warmed the cockles of Mussolini’s heart and level of political and social quietism that would have had the pre-Glasnost Kremlin swooning with envy.
There’s a distinct lesson here for Marxist economists and political theorists, and for capitalists too, if they care to listen.
You can, in the era of globalisation, have a successful domestic economy that, as near as damn it, amounts to state socialism and a command economy in terms of the delivery of the vast majority of public services and public utilities without resorting the degree of overt political repression that was one of the defining characteristics of the old Soviet Bloc and which remains a key characteristic, today, of the current Chinese regime, but only by fully embracing free market global capitalism and by directing a significant proportion of your economy towards generating income from exports and from investments, in and expansion into, foreign markets.
Quite how successfully you can pull that off when you’ve population the size of the UK, or the old Soviet Union or today’s China to contend with, and for how long you can sustain it, is anyone’s guess and you’re still only going to be trading the crushing authoritarianism of a Stalin or Mao Zedong for the more subtle approach of Lee Hsien Loong, but it can be done.
Many vulgar libertarians, particularly in America but also closer to home, i.e. those Tories who found their way to what they think is libertarianism by way of Thatcherism and Reaganomics, like to imagine that free market capitalism is somehow synonymous with liberal democracy, particularly American liberal democracy, and with personal liberty, self-sufficiency and the kind of rugged individualism and ‘frontier spirit’ that forms a large component of the American national myth. It isn’t. Corporate capitalism, particularly when harnessed to the state, is no less demanding of social, economic and political conformity and no less inimical to personal liberty than Soviet-style state socialism, it just applies the pressure to knuckle under by different means.
The opposite of communism isn’t democracy, its plutocracy, which is something that the likes of Daniel Hannan might eventually come to appreciate if their understanding of economic liberty ever comes to amount to anything more substantial than simply grubbing around in the political dirt for tax cuts.