Britain: A Cautionary Tale for America
noahpinion.blog
noahpinion.blog
>France has roughly the same population as the U.K., but almost 50 percent more homes.
France also has four times the land area compared to the UK.
>The Economist ties Britain’s energy scarcity to its overly rapid and haphazard push for decarbonization; having banned coal, and with natural gas now extremely expensive due to the Ukraine war, the UK has been forced to rely on hideously expensive offshore wind power.
The dash for gas came about well before decarbonisation was on the agenda. It was instituted by Thatcher after the coal miners strike and because we had an abundance of it in the North Sea.
https://en.wikipedia.org/wiki/Dash_for_Gas
The NHS is struggling because we have an unhealthy population. A lot of that can be put down to behaviours we have adopted from the US (poor diet, car centric lifestyles and lack of exercise).
I think we should stop pretending the NHS doesn't have quality and availability issues, which are validly pointed out in the OP article. I was shocked to discover that the NHS is paying out £60bn in compensation: https://www.bmj.com/content/391/bmj.r2211
Some of that seems to be claims inflation, but it also has to indicate a very real problem. The NHS runs an extremely "lean" system where people are triaged and it errs on the side of under-treatment. That saves money on treatment, but has other costs that don't immediately appear.
There are whole areas which are systematically under-funded to the point of nonexistance. If you're going to try for an adult ADHD or autism assessment, you're going to wait a very long time.
I don't have any answers myself, but I do wonder if going for the sacred cow of "free at the point of use" might work. But NHS dentistry isn't free and still experiences massive funding problems.
And that means that introducing per-appointment charges would likely have only a very minor effect on reducing waste & improving availability. Healthy people of working age would see it as imposing extra charges for no tangible improvement.
Either that, or you'd need to be looking at introducing a two-tier NHS, which I don't think many people would be happy with - "it might work in Europe, but what if it ends up being more like America?" would be the worry.
I think your point about the importance of triage to being able to running "lean" is a better place to look for improvements. The Single Patient Record ought to make automated triage a lot more reliable, for instance. And taking a broader view of ongoing health & economic impacts would help with your ADHD/autism assessment use case, as well as similar issues affecting people of working age (maternity care, being another obvious example).
That said, I do hear people sometimes complaining that the administrators were fired to save money, and this just put all that administrative burden onto the doctors and nurses who weren't trained in it and didn't go into medicine to perform; if that's true, tech may be able to assist with reducing that burden?
But, actually, some of the tech programmes from the past decade have been effective - NHS Digital & NHSX, the NHS Spine, the work that's led to the Single Patient Record. All much smaller, simpler, and more agile than the gigantic, nightmarish NPfIT money pit of the 2000s. The post-Covid reorg, putting everything under NHS England, inevitably killed some of the momentum but there was real value created and people are doing their best to learn from the experience.
As you say, labour is the real cost driver - but a lot of that labour ought to be done under the banner of Social Care rather than the NHS. Of course, fixing Social Care isn't exactly simple, and will become almost impossible should the nativist right succeed in slashing the supply of care workers.
The disabled were scapegoated for much of my teens, I wouldn't be surprised if that continues; the elderly… I won't be surprised if someone realises an old person who needs treatment to live, doesn't get it, dies, isn't going to vote against the party responsible for that in the next election the way a pensioner whose income doesn't rise with the cost of living will be able to.
Mothers and children are still going to be important to look after. But with ever-decreasing fertility rates, I wonder if this has become much cheaper per capita already, and the "true" (steady-state) cost for this part of the NHS is therefore hidden, just as old-age care costs were hidden when the population pyramid was the old shape?
I don't think anybody is pretending it doesn't. We just need to ask why it has got so bad since Covid and why we seem to be struggling more than similar European countries.
This is not by itself of great importance.
There's several different meanings of "built on", but even with the most expansive definition for this purpose, the UK could double how much is "built on" at a cost of around a tenth of what isn't: https://fullfact.org/economy/has-92-country-not-been-built/
There's other reasons to say "perhaps not a good idea" to a higher population (food security, energy security), but the land is there for more (or simply bigger) housing.
(1) agriculture is both the biggest user and not done in a way that comes even close to maximising land efficiency; nor is there any reason it should, given there's not much pressure on agricultural land and the UK has easy access to cheap food imports.
(Even if there was pressure on farmland due to a loss of trade, it would be access to fertiliser that would cause more long-term issues than the land itself; phosphorus shortages would reduce carrying capacity in the range of 9-39 million depending who I ask).
(2) even with the UK's right to roam legislation, leisure use of most land is close to a rounding error. I mean, think about it for a moment: unless you live somewhere like Cambridge where the cows roam in the middle of the city, how often do you go to the middle of a cow pasture for a picnic? Ever tried taking a shortcut through a field of sunflowers (I did as a teenager, I don't recommend it)?
That said, on (2), UK land dedicated specifically to golf courses is close to (a little smaller than) UK land dedicated to housing: https://www.bbc.co.uk/news/uk-41901297
But the wind is cheaper than gas. Yes you could argue that if we had stuck with coal that would have been cheaper than gas or wind, but the long term threat and the long term most expensive option is clear. Wind and solar gives energy independence, so we aren't reliant on a market that could be turned upside down by one country invading another.
The aim of Nordstream (however misguided that turned out) was low prices.
Minor point: companies get the VAT back or don't pay it in the first place.
Again, saying it is politically suicide so they don't (mostly, Greens are open about it) but actions speak louder than words.
By all indications, "5-6 cents high" was politically desired, "10-14 cents high" isn't.
> Whether you think the UK has been falling behind America economically for a decade or for two decades depends on which set of prices you use to measure living standards. If you use the two countries’ national price indices, the UK has been growing slower than the U.S. since the financial crisis of 2008; if you use PPP prices, as Paul Krugman prefers, the UK’s relative stagnation has come only since Brexit in 2016:
it was still on the uptrend until 2020 when switching off the economy squashed all growth and not just in Britain but other major continental economies too, Germany has actually been in and out of recession multiple times since.
2016 added some turbulence to domestic politics and econ but until then our recovery from the GFC had been fast, occasionally faster than the rest of the G7.
The exception here is the US, again. And what did they do differently? Massive QE and "helicopter money". Anti-austerity worked extremely well for growth, even if the debt went up.
Then again although not comparable to America's it's possible that the British economy was/is large enough to sustain even more liberal fiscal policy but given the dependence on import and that it's primarily a service economy I doubt it.
America is truly exceptional.
HK under JJ Cowperthwaite (1961 to 1971), but more generally since then and especially pre '97.
I can afford to not work at all here. With health insurance, property taxes, and general outgoings per month being so much higher in the US (California, at least), there was no way I could retire early over there.
And whereas it's easy to hand-wave away "Trump, the healthcare, guns, ... " in a dismissive sentence, those things have real impact on a society and on the individuals living in that society. There's a reason [1] I moved away from the US, and will never return. Money-über-alles has its downside.
It's also worth noting (since the author brings it up) that the Mississippi comparison is pretty bogus. According to data from the Office for National Statistics and the US Census Bureau, median household wealth in Great Britain is substantially higher (around £300,000, or $403,000)[2] compared to the US ($175,000) [3] and Mississippi ($59,000). GDP and personal wealth are not the same thing.
1: https://news.ycombinator.com/item?id=44217106
2: https://www.ons.gov.uk/peoplepopulationandcommunity/personal...
3: https://www2.census.gov/library/publications/2024/demo/p70br...
It seems that the UK is becoming the new Portugal (warm retiree destination with stagnant non-retiree economy)
FWIW, I retired to the coast in the NW, I have a beach on one side of the house and a park on the other. It's pretty nice :)
Even up here in the NW though, it's been too damn hot recently...
Don't mean to be blunt, but when did that happen? How has a country where you can finance your burrito [1] "learned the perils of excessive financialization"?
Also, a lot of this (especially the slower recovery after 2008) reads more as the perils of being the periphery of an empire vs being the core.
[1] https://finance.yahoo.com/markets/stocks/articles/uber-techn...
.. no, that's Monaco. OK, so clearly we should exclude "microstates which are tax havens for billionaires" from the list. Does raise question about whether "excessive financialization of the economy" is actually bad: Monaco is entirely finance and tourism.
We then have to decide whether "finance microstate doesn't count" applies to Ireland and Switzerland. Let's give ourselves the benefit of the doubt and say yes; we're trying to get to a table where USA #1 and UK #2 appears.
So then we get to .. Norway? Not often held up as an economics model, more of a social model. It turns out that being a low population petro-state is also great for GDP. Let's rule those out as well, which takes care of Qatar. Finally we get to the US.
We're then left with only Denmark, Netherlands, Australia, Sweden, Israel (!), Austria, Germany, and Belgium above the UK in the table.
So I would say the lesson is not necessarily US exceptionalism or expensive European gas (which affects half that list, and note Israel is famously almost the only non petrostate in the Middle East), but that the UK is actually doing a lot worse than we realize for idiosyncratic reasons (probably including, but not limited to, Brexit).
Should we look at this table and copy whatever Ireland is doing to have twice our GDP? Would the average Brit recognize that Ireland is twice as rich as the UK? I'm not sure.
(The list of problems in the article is fairly valid, but they're unable to synthetize between "everything is underfunded" + "debt is bad" => the only arithmetically possible solution, "raise taxes")
What did you mean by that (!)?
(On the US side the aid sent is $10 per capita per year).
From what I found there was a one-off increase in 2024 due to the war, and a special payment in 2022 for the Iron Dome.
Averaging over the past 5 years, and including those special payments, it’s still $574 per Israeli per year. (And about $17 per American).
Compared to respective GDPs per capita of $70k and $95k.