Rich At Our Expense

Purrrrrrrr

By a strange coincidence, this year's Public Sector Rich List from the TaxPayers' Alliance is published just as the row over bankers' bonuses explodes once again.

The Rich List first. This year, the TPA has discovered 805 public employees earning more than £150,000 pa (and that excludes local authority employees, who are covered in the TPA's companion study, The Town Hall Rich List). Among the "highlights" (data relates to 2008-09):

• 8 people got more than £1m pa
• 333 earned more than the Prime Minister
• The group's average pay rise was 5.4%, compared to 2.7% for a nurse and 2.3% for a teacher
• The group's average total remuneration is £226k per annum; by comparison, according to the Institute of Directors, a managing director of a private organisation with a turnover of between £50 million and £500 million (about the size of a typical quango) could expect to earn £141k and an executive director £87k.

And for the first time, the Rich List includes executives from our nationalised banks (but note it's only board members - ie it doesn't including all those high rolling traders and investment bankers who remain anonymous because they are not on the boards). There are 30 of them, including the List's top earner, Mark Fisher of the Royal Bank of Scotland, on £1.4m.

Which brings us back to those banker bonuses, with over 5000 of the varmints apparently in line for over £1m apiece - ie a total bill in excess of £5bn just for the top guys.

Should we care?

You bet we should. As my Lord Myners was explaining all day yesterday, these bankers have been bailed out with squillions of taxpayer dosh. Apart from the effectively nationalised banks (ie RBS and Lloyds), all the other UK banks are being propped up with open-ended taxpayer guarantees on their liabilities. WTF should we allow them to walk off with barrowloads of our cash?

So what of their threats to resign and go off to work for Goldmans?

Call their bluff, we say.

Look, the key reason we're still in this mess is because Brown has not grasped the nettle we've blogged about so often (eg here). However it's dressed up, we need to split high street retail banking away from investment banking (aka a new Glass-Steagall).

High street banking should go back to being a low risk utility type operation, fully guaranteed by taxpayers but heavily regulated and subject to a hefty annual insurance charge to pay for the guarantee. Pay packets would soon return to the the more modest levels that always used to exist in our high street banks.

In contrast, investment banking should be much less regulated, a thousand flowers should continue to bloom, but there should be absolutely no taxpayer guarantee, either explicit or implicit. Investment bankers should pay themselves whatever they like, but if their bets go wrong, they should be left to incinerate.

We desperately need to get on with this. The existing arrangements are not only grossly unfair to taxpayers, but over time they will hobble our nationalised banks into oblivion. Whatever they decide to do, they will not be able to match their competitors bonuswise, because we won't let them. They will inevitably go the way of all nationalised industries before them - second-rate and a drain on national prosperity.

So what would we do right now?

Irrespective of international agreement, we'd announce our own Glass-Steagall. From say, end-2011, any bank wishing to offer UK high street accounts guaranteed by the taxpayer would have to comply with new regulatory requirements. And those requirements would include complete separation from any entity offering investment banking services (there would be other restrictions as well, covering such matters as asset and liability liquidity).

Meanwhile, we'd say to our nationalised banks yes, you can continue to pay bonuses, but they have to be in the form of deferred equity in your new post-2011 offspring. Cash? Forget it.

Throughout history, so-called "rent seekers" have sought to capture government so as to extract unwarranted financial gain at the expense of taxpayers. But whether in the public sector or the private, taxpayers should not be expected to underwrite the riches of others.

PS And talking of rent seekers, the furore over Climategate is gathering pace. The conflicted tax-funded global warming industry has now woken up to the threat, and is trying to argue that lies and distortions from East Anglia aren't that important to the case - loads of other "respected" scientists have come up with the same results independently. Except of course, it isn't like that. As the splendid Prof Philip Stott pointed out on R4 Today this morning, the whole global warming biz is an inverted pyramid, resting on the work of about 40 scientists. And 39 of them work at East Anglia. Well, no, I made that last bit up, but it is only around 40, forming a very tight groupthink mutual support network. But like the man said, you can't fool all of the taxpayers all of the time.

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Ken Puts His Finger On It

The man who sorted us last time*

Ken Clarke holds a number of views we don't share, but all things considered, he was a pretty reasonable Chancellor. Indeed, from the vantage point of today's blackened economic crater, his famous Golden Legacy looks a little more golden with every passing day. If only he could have stayed at the controls. If oooonly.

So when he speaks about matters fiscal, we always listen. And he's just put his finger on something that's been troubling us for months.

In some classic off-the-cuff Ken remarks, he's let slip some of the fiscal advice he's been giving to young George. He's apparently warned George against “getting too adventurous” in plans for public spending cuts before the next general election. He points out that some voters could be scared away from the Tory party if it was too specific about tax and spending plans:

“You could then wind up with a very messy outcome... I think it is very difficult to have a sensible argument. You are running enormous risks — we have not had an election like this before.”


Although emphasising that most people knew that the level of public debt was “disgraceful and unsustainable”, he said: “The population is only keen on tough measures so long as they don’t affect them and their families.”


Predicting that Labour would portray the Tories as wanting “to do the nasty stuff — you know, take away unnecessarily”, Mr Clarke said: “We will find some voters are seduced away by that if we are not careful, so there is a problem in the run-up to the election if we start getting too adventurous.”

Spot on. The veritable nub.

You see, we're back to the old problem with democratic politics and taxpayers' money. Backsliding self-serving animals that we are, we are quite happy to cut spending, but only so long as it doesn't impact on us.

Take Tyler. Although he doesn't look a day over 30, in reality he'll turn 60 next year. At which point he'll cop a free bus pass. And free prescriptions. And probably a sackful of additional goodies he hasn't yet discovered.

Now, he shouldn't get any of that. He is well able to afford it for himself, and he knows it**. But what if the Tories threaten to take it away along with a whole stack of other middle class welfare benefits? Will he get miffed? Well he might. Especially when he finds out the Tories will close his local hospital, and withdraw policing from boozed-up Guildford on Saturday nights.

Experienced politicos like Ken understand this only too well. They are principally in the business of getting elected, and there is simply no electoral upside in promising to cut spending. All cuts will hurt someone, and they are very likely to take against you.

Yes. Yes, indeed. An iron law of democratic politics.

Except where does that leave us vis-à-vis the jolly old fiscal crater? Is the plan that Cam gets in on an Obama-style promise to make everything better, and then once he's in, he... well, what exactly? Rip off the mask within days and implement savage and untrailed spending cuts? Or dither and dally Obama-style as reality gets ever uglier around him?

Which do you reckon sounds more likely?

Yes, quite.

Hmmm.... mmmm.... ohhhhh...

The ghastly truth is that we won't vote for spending cuts because we aren't yet ready. As we've noted before, we haven't yet suffered the Götterdämmerung crisis that we need to concentrate minds. We haven't yet had the outright collapse in sterling. We haven't yet had the terrifying spike up in borrowing costs and inflation. We haven't even had the real end of our property ladder fantasies.

So we're not ready. We won't yet vote for politicos who promise serious cuts because we haven't yet suffered the pain of not cutting. And even if our politicos understand the grim realities, there's no way they'll promise cuts if it means we won't vote for them.

Ggggggggggg.... guuuu.... glug....

Look, I do apologise for a week of terminal depression.

I really will try to find something upbeat to blog.

There has to be something.

*PS Yes, it's true that Ken's fiscal consolidation did involve increasing taxes as a percentage of GDP, from 32% to 35% of GDP. But the main work was done by a reduction in spending, from 43% to 38% of GDP (TME).

**Footnote Tyler's small stater sense of identity is telling him not to accept the "free" anythings. But his sense of tax victim outrage is telling him to grab whatever's going.

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Hubble Bubble

Bubbling: Bank of England Monetary Policy Committee in session

A frightening article in today's FT (HTP JW):

"Some of the most controversial financing practices of the credit-bubble years – from cov lite loans to Pik toggle notes and dividend recap exercises – have returned to Wall Street, stoking fears that debt markets are growing overheated. The techniques fell into disrepute during the financial crisis because they were based to varying degrees on the same rosy expectations that encouraged companies and consumers to assume what proved to be crippling levels of debt."

Don't understand the lingo?

"In a cov light – short for covenant light – loan, borrowers are granted credit with few, if any, conditions. Pik toggle transactions make it possible for debt to be repaid with more debt – payment-in-kind notes. In a dividend recap, companies take on additional debt to pay dividends to their owners."

Or as market insider JW puts it:

"COV-LITE, THE FINANCING YOU COULDN'T DEFAULT ON UNLESS YOU WERE CAUGHT STABBING THE CEO'S PET LABRADOR - AND THEN ONLY IF THE LABRADOR HAD BEEN A PET FOR A VERY LONG TIME."

Yes, junk financing is back, underlining a point we've blogged before - the bubble is reinflating. From equity markets to property to junk bonds to banker bonuses, the hubbling bubbling balloon of insanity is once again looming over us.

And you don't need to be a professor of finance to understand why: yesterday's junk debt has been shuffled off onto the taxpayer, interest rates are more or less zero, and sitting on your banking hands never earned a megabonus.

Well, that's not so bad you say, at least we've got the economy growing again, and stopped unemployment spiralling.

Except of course, we haven't. When last sighted (Q3), our economy was still contracting, and unemployment was still rising.

And then there's the horrible head-splitting issue of government debt. As we blogged here, our real national debt (including public sector pensions, PFI, and various other Enron items) is already £2.2 trillion - about 150% of GDP. Adding in the contingent liabilities we've taken on by nationalising RBS and Lloyds takes the total  to £4.6 trillion - well over 300% of GDP. And to put that in context, the normal rule of thumb based on historic experience says that 60% is the maximum safe limit.

You see, the thing is - and pay attention because you may have missed this - by nationalising all those bad bank debts, we've not only let off the bankers from the full consequences of their previous actions, we've also exposed ourselves (ie we the taxpayers) to the major risk that our credit will be cut off. Sure, we are not Dubai (quite), but a 300% debt/GDP ratio is flashing red, red, RED.

We're reinflating those dangerous asset bubbles on the back of our collective sovereign credit. Credit that is already stretched way beyond normal bounds.

So what happens? On the basis of what we've heard so far, here's what we think.

The next government will fail to deliver the spending cuts required to get our public finances back on track. Tax increases will undermine enterprise and effort. Economic growth will be very sluggish over the next few years - much less than the preposterous 3.25% pa envisaged in the last budget. At some stage the markets will take fright. Sterling will plunge (further) and interest rates will surge - long-term rates will be jacked up by the markets, and the Bank of England will jack up short-term rates in an attempt the stabilise sterling. House prices will slump. The bubble will collapse.

At which point, the only way out will be inflation. Lots of it. All that money printed by the Bank to support the bubble will finally come home to roost. And trust me, roosting bank notes are not a pretty sight, especially if you're a pensioner or a saver.

Hopefully, I'm wrong. Hopefully, Cam gets a working majority, screws up his courage, and comes up with a credible programme for sorting the public finances (ie spending cuts combined with bankable fiscal rules).

But most people we've spoken to reckon Cam is SuperMac Mk II. As you will recall, SuperMac Mk I was a so-called one nation Tory patrician who throrougly disapproved of the tough fiscal policies pursued under Thatcher. And as you will also recall, he was the PM who had his entire Treasury team resign because he would not back their plan for restraining public expenditure.

You know what? I've depressed myself again.

Think I'll stop there and maybe treat myself to a shot of morphine.

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Don't Just Focus On The Big Idea?

Last week, Faris (a big thinker) asked me "What's the Big idea?" We were in a pub - where such questions often get asked - and it was the day of the UK ad industry's Battle of Big Thinking where a number of mutual friends (including Amelia and Katy) had, no doubt, spoken eloquently and brilliantly about a variety of ideas.

But were they big ideas? Is social media a big idea? Is branding? Faris and I agreed that fire and alcohol might both be classified as big ideas, but we weren't sure about the rest.

Big idea are big because they are so rare and yet businesses are obsessed with having them, be that in their product range or their marketing. That seems like a futile effort to me. The only important big idea for business is their underlying strategy which should underpin everything they do - though, of course, the search for the big idea often causes them to ignore that fact.

That aside, it's much better to focus on having a lot of arguably smaller ideas: small ideas that can have immediate impact, small ideas that can generate further small ideas and small ideas that might just turn out to be slightly bigger than you first thought.

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In Their Heads But Not Their Souls

The fire last time

Yesterday Tyler had a chat with one of Britain's few sound MPs. We naturally touched on our fiscal crisis, and the risks of a 70s style market meltdown. Tyler wondered if MPs understand the need for urgent and painful action?

"Well, on one level, yes... but it's in their heads, not their souls."

Which seemed a pretty good summary of the entire problem, from the top down.

Brown/Darling have acknowledged the need for some kind of fiscal tightening, but not until way off in the medium-term, well beyond the next election. And even then, they've kept the details hidden, and their numbers only add up on the basis of wildly optimistic assumptions about future economic growth (eg see this blog).

Cam/Os have talked much more of the tightening talk, but their announced measures deliver less than £10bn of the £50-100bn cuts required (eg see this blog). St Vince ditto (see this blog).

The hope seems to be that once again, we can somehow muddle through. Unfortunately, our fiscal hole is now so big, that is most unlikely.

Last week, Tyler attended a session to launch of Politeia's latest paper Booms, Busts & Fiscal Policy - Public finances in the future? (unfortunately not online). It was written by one of BOM's heroes - Ludger Schuknecht, a senior economist at the European Central Bank and co-author of a seminal study on the inefficiency of Big Government (Public Spending in the 20th Century).

Disappointingly, Mr Schuknecht himself wasn't actually in attendance - that's because ECB rules apparently require him to clear anything he ever says in advance with his bosses (Soviet institutions didn't trust their senior staff to go out alone without minders either).

Anyway, Schuknecht reviews the deterioration of public finances across the major economies, and says our fiscal situation is the worst:

"The worsening in fiscal balances [is] staggering... within only three years, public debt is projected to increase by 40 per cent of GDP in the UK [against 30% in the US, and 20% in Japan and the Euro area]...

The first challenge must be the ambitious correction of fiscal deficits so that the debt dynamics do not explode... Given the higher deficits in the UK... their dynamics could be even less favourable..."

So debt dynamicwise, our position is even less favourable than an explosion. Does it get any worse than that?

[Debt dynamics? We've blogged about this before under its everyday label - the Doomsday Machine - and it's the simple idea that once debt gets beyond a certain point, the interest on that debt starts to cumulate faster than the borrower can pay down the debt... leading to all of us having to turn off the central heating and live on baked beans for the next 30 years]

HTF did we get here? Schuknecht highlights something we've blogged many many times on BOM - Brown spent far too much. Either deliberately or recklessly, Brown assumed a temporary boom in tax revenues from the finance and property bubbles was permanent income for him to spend as he wished. Which, coupled with the increase in welfare spending from this recession, means that in 2010 public spending will exceed 50% of GDP. And over the decade of the noughties, public spending will have increased by a pant-wetting 16% of GDP, far more than any other major economy (Germany's increase is 1.4%).

So what to do?

Mr S has a familiar prescription - spending must be cut substantially.

As he points out, deficit reductions based on tax increases are not only damaging to economic growth, they are unlikely to be sustainable from a political perspective - ie people won't tolerate them for long. And as he further points out, there is now considerable evidence (including that gathered by he himself) that government spending much above 35% of GDP is increasingly inefficient - ie it does little to achieve its objectives:

"A ratio below 40% of GDP and ideally 30-35% should be sufficient and allow good outcomes in areas judged to matter in western economies: functioning markets, equal opportunity for market participants, essential public goods and services, infrastructure, economic stability, and income distribution.

The evidence is that ambitious reforms that reduce government spending on public employment and other public consumption and on transfers and subsidies, is the best and most successful way to bring down public spending at little cost to economic cost and wellbeing."

So we need an axe, but the axe needs to be combined with a serious programme of public sector reform... something like school vouchers and competing social health insurers, say.

Oh, and one other thing - the state pension age needs to be increased much further and faster than we currently plan. The truth is we cannot afford it any more, and people are going to have to support themselves for much more of their lives (thereby of course, boosting economic growth and improving the fiscal arithmetic still further).

All very sensible stuff, fully supported here on BOM.

But as it happens, there were a couple of very senior MPs at this Politeia event, and while one of them seemed to get it, the other observed that cuts are all very well but we must not push them so far as to foment social unrest.

Presumably, he was thinking of the riots in Toxteth, Brixton, etc back in the early 80s (pic). And you have to say, you could imagine it happening again - especially given the tensions over mass immigration and British jobs for British workers.

But on the other side, TINA is heading back towards us. And this time she looks mad as hell.

As we've blogged many times, we are standing on the fiscal edge. Buoyed by the Bank of England's massive gilt purchases, and the belief hope that Cam/Os will get a post-Election grip, the markets have so far given us the benefit of the doubt. But if that slips, we are in real trouble. As spelled out in yesterday's report from investment bank Morgan Stanley:

“Growing fears over a hung parliament would likely weigh on both the currency and gilt yields as it would represent something of a leap into the unknown, and would increase the probability that some of the rating agencies remove the UK's AAA status...

In an extreme situation a fiscal crisis could lead to some domestic capital flight, severe pound weakness and a sell-off in UK government bonds. The Bank of England may feel forced to hike rates to shore up confidence in monetary policy and stabilize the currency, threatening the fragile economic recovery.”

Hung parliaments... MPs with weak souls... Cam/Os faffing around... TINA looking mad... a long hot summer...

Sounds like it's time to follow the Major and lay in some fire extinguishers. And a shotgun.

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The Sex Industry Industry Just Got Bigger

The Major was so enraged he nearly did himself a serious mischief. "WTF should I pay for some bearded sociologist to spend a year visiting lap dancing clubs?!" he foamed. "When I go along with my chum Gomulka, we damned well have to pay for ourselves!"

As you will have seen by now, Leeds University is advertising for a sociologist to spend a year researching "the rise and regulation of lap dancing and the place of sexual labour and consumption in the night time economy." For which he will be paid £31 grand.

He?

Well, actually, it won't be a He, will it? Definitely not. This job is part of a major new tax-funded industry which seeks to prove men are sex beasts who like nothing more than to commodify women and grind them into the dirt:

"The purpose of this research is to explore the rise, tolerance and integration of sexual consumption and sexual labour displayed through the erotic dance industry which symbolises the commodification of the female body in late capitalism. Examining how female sexuality has been commercialised and now merges easily with traditional forms of leisure in the city, provides a window into further understanding larger social issues such as the feminisation of poverty; the consequences of student debt and the impact of changes in Higher Education; the diversification of feminised employment patterns that rely on ‘body work’..."

Just get that language - "commodification of the female body", "late capitalism" (it's only a matter of time, sisters), "feminisation of poverty" (men don't get poor any more?), and student loans as a instrument of sexual oppression.

What's the point of it?

And more specifically, why should we have to pay for it?

Ah, well, think Commissar Harperson, think Fiona McTaggart, and think that huge police crackdown on sex-traffickers - Operation Pentameter 2.

Yes, you remember that one. Hundreds - maybe thousands - of police took part in coordinated raids on massage parlours and brothels throughout Britain. And the strange thing was, loitering on the pavements outside many of those establishments they found TV crews, handily placed to record the police leading the trafficked women to safety and the ugly male traffickers off to jail.

It was judged a great media success, thoroughly exploited by then Home Secretary Jacqui on that evening's TV bulletins (obviously this was before her own unfortunate entanglement with a commodifier came to light).

But needless to say, the reality has turned out to be somewhat different. In fact, of the 528 supposed sex traffickers picked up that day, not one - NOT A SINGLE ONE - was subsequently convicted of trafficking (OK, five were later convicted, but that was nothing to do with Pentameter).

So why did the raids take place?

It seems Jacqs and the others had convinced themselves there were 25,000 trafficked prostitutes working here (the figure quoted by notorious humbug Mr Bugs Bunny in 2007) - a massive problem that needed urgent action.

It subsequently turned out that figure had been made up by the Daily Mirror, but it might equally have come from a tax-funded organisation by the name of the Poppy Project. They have had around £6m of public money, and in 2008, they produced an alarming report on brothels in London saying they were employing thousands of women, many very young, from all round the world. The report was seized on by Harperson to justify further crackdowns - until it was pointed out that the report was so shot through with flaws and inaccuracies as to be useless.

Look, we all agree people traffickers have to be caught and locked away. Of course. And we probably all agree that prostitution would have no place in a perfect world. Sure.

But given where we are - ie stuck here in the real world - we shouldn't conflate prostitution and people trafficking. We could and should stop the traffickers. But there's no way we'll stop the sex industry, which we've previously estimated at $500bn pa worldwide (see here). And we don't want our militant feminist politicos getting us to make an attempt on the back of horror stories about traffickers.

There's one other thing we really really don't want. And that's yet another tax-funded industry devoted to convincing us we should spend yet another pile of money on something which is almost certainly impossible (cf the climate change industry).

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Inspectors On The Non-Job

Labour's huge and incompetent government inspectorates are worse than a waste of money - they are downright dangerous. Take today's scandal:

"Poor standards of care at an accident and emergency unit in one of the country's flagship hospitals may have contributed to the unnecessary deaths of over 400 patients, an official NHS investigation has concluded. Dirty equipment and an absence of leadership contributed to a death rate almost 40 per cent above the national average among emergency admissions to the 770-bed Basildon and Thurrock University Hospitals NHS Foundation Trust, inspectors said.

The unit had blood stains on the floor, dirty curtains, stinking mattresses and soiled equipment; nurses who failed to monitor, feed and give drugs to patients correctly; and a rate of pressure sores almost twice the national average. Instead of the national four-hour maximum waiting time for A&E, the trust was operating a 10-hour waiting time."

That's scandalous enough of course (especially as the description sounds all too reminiscent of various other NHS hospitals we could mention).

But the real scandal of Basildon and Thurrock Hospital is that it's literally just been rated by government inspectors as "Good", with a 13/14 mark for "Safety and cleanliness" (see here). And those inspectors - the Care Quality Commission - are the very same inspectors who've now discovered the hospital is in fact unsafe and filthy.

So WTF is going on?

On BBC R4 Today this morning, Evan Davis attempted to find out from the Commission's head, serial quangocrat Baroness Young (Environment Agency, BBC, etc etc). She made virtually no sense.

First, she said the scores on the Commission's website were out of date, even though the scores relate to 2008-09, ie the recent past. She reckoned they'd only published them because the Secretary of State had a duty to so. Then she said the Commission's inspection methods had changed and that they now involve... er... inspections. Then she said the Commission is brand new and can't be held responsible for the rubbish produced by the previous inspectorate - even though it's been published by the Commission on the Commission's website.

Obvious questions arise. If the scores on the website are useless, why should we punters believe them? What's the point of them? What should we believe? How do we know any hospitals are safe?

But when Davis tried to ask those follow-ups, the Baroness slipped into a kind of gibberish that Tyler cannot report because he simply couldn't follow it (like virtually all members of the modern commissariat, Young is immensely articulate without actually making any sense).

So there we have it - another large government inspectorate churning out screeds of rubbish that is much worse than useless.

And what does the Quality Care Commission cost us?

The Commission is another of Labour's superquangos, established in March 2009 as the amalgamation of three existing quangos - the Healthcare Commission, the Mental Health Act Commission, and the Commission for Social Care Inspection. Summing the 2007-08 spend of those three gives us a total annual spend for the new Commission of £214m (see latest TaxPayers' Alliance quango book). Let's call it £230m for this year.

The combined staff is 2700, which you might consider more than enough. But the Commission clearly wants more, and is currently advertising the following attractive new posts:

• Head of Learning - £75k pa
• Head of Culture and Performance - £75k pa
• Head of Change Management - £75k pa

Amazingly, they are not advertising for a Head of Tying Up Your Own Shoe Laces, but we get the general idea.

We've blogged these hopeless government inspectors many times (eg see here). They have a long and shameful history of rating killer organisations as perfectly safe and fit for purpose - Oftsed rated Haringey Social Services as good at the very moment Baby P was dying under their watch (see here).

Things are so bad, even the chief inspectors no longer have confidence in the ratings. Baroness Young clearly thinks her organisation's ratings are useless, and earlier in the week the head of Ofsted said the same thing about their school ratings.

In Ofsted's case, it turns out that when they rate a school as "satisfactory", what they really mean is that it is failing to provide its pupils with a proper education. Which right now means that a shocking one-in-three state schools is failing.

Ofsted's Annual Report also illustrates another key weakness with these inspectors - they keep changing their minds. So nearly one-in-five schools judged to be good at their previous inspection are now rated as no longer good - ie merely "satisfactory" or inadequate. Who can place any faith in ratings that slide around like that?

So what to do?

First, abolish these massive inspectorates - they have expanded way beyond their original remit of making sure taxpayers' money was not being squandered, and they now do more harm than good (especially to the organisations they terrorise).

Second - yes it's that same old song - put power into the hands of the customers, and let the market decide who's doing a good job and who isn't. School vouchers and competing social health insurers are the only way we can seriously expect to achieve improvement.

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