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Reviewed by ANDRE BEAUMONT
16 April 2014
If people want less inequality it is not going to be brought about by coercion. Even the great power of politics has limited ability to bring it about at present. Rather the greatest forces of the time need to be used to get to it by hitching a lift with them.
That, too, means embracing individual choice wholeheartedly.
The greatest of the current forces is technology.
Take a future technological development that of itself is not earth-shattering: Google's Project Ara for modular smartphones, the first of which may appear next January.
This will mean that instead of having to take the standard components of the maker you will be able to choose your own and swap them out as you like, much like you can in theory do with a PC.
So one could swap the front facing camera for a really good microphone that allows one to dictate to the smartphone across a table or give up the GPS in favour of near field communication that allows one to regularly use it as a payment device.
These are unusual choices and probably not the choice of the majority but that is the point.
Some features may be actively unwanted, others wanted.
When you have device you want you become more empowered, more equal if you like. (For the example above, imagine the person whose vision is impared to a degree he or she cannot write a letter or ascertain which change is being given in the shop).
Google is an effective monopoly, be in no doubt: in the supply of the most advanced form of android and in search but it compensates for that by facilitating choice. So then one might choose it even with instinctive reservations about monopoly.
The NHS is an effective monopoly but it needs to be like the modular smartphone. It has no business in un-facilitating choice.
So one could swap the cholesterol/blood pressure authoritarianism for the diagnostic tests the patient needs or asks for. One could take many of the decisions out of the doctor's hands and leave them with patients, as on the Continent where the poor are at least as healthy, especially in old age, and appreciate the choice and autonomy.
Then the society can make proper decisions about funding. If the society wants another 1% of GDP spent on health and financed through taxation then an informed debate and consensus could bring it about.
The NHS is good at devising solutions that are good for populations but not good for individuals and then insisting on its solutions.
This leaves it full of bloatware and undesired programmes. It annoys patients and doctors.
It also precludes consensus which is not about a majority but more like the absence of sustained objection from any quarter.
All service industry monopolies are undesirable but a state monopoly runs at a disadvantage to a private one: it does not have a true market discipline.
The import of technology can elude it more easily as there are less external pressures to change its ways.
Even that once admired relic of the state's interface with the public, the Post Office counters, cannot shake off its authoritarian demeanour.
So facilitate choice and ride the wave of technology and other societal forces if you want less inequality; change shakes things up and you are at least not on the side of the status quo.