in which I consider the NHS as an airline

Perhaps chair of the Mid-Staffs Public Inquiry Sir Robert Francis had something like this in mind when he asserted in an interview that,

“If we ran our airline industry on the same basis, planes would be falling out of the sky all the time.”

It’s an alarming depiction or an alarmist one, selected from the conversation and published to fit The Telegraph’s narrative of the NHS as wholly unsafe and unsound. However, it does put focus back on quality.

If the NHS were to match the safety safety record of the airline industry  (accepting for the moment Francis’ statement that it doesn’t), then both the decades of command-and-control management and the perpetual disorganisation of the Health and Social Care Act 2012 would have to be be abandoned.

It is strongly indicative of the distaste and distrust of public services which  permeated New Labour that it implemented Soviet style direction over them. Patients and pupils were made subject to failed methods of tractor production.

“English healthcare managers, (whose life was perceived to be nasty, brutish, and short even before the advent of targets) were exposed to increased risk of being sacked as a result of poor performance on measured indices”

The NHS – and every patient – was subjected to an experiment in management techniques already well-known to have failed.

A year before Bevan and Hood published that discussion paper, senior Conservatives were already promising an end to the NHS if restored to government. (Nick Clegg made public his antipathy toward the NHS and his support for the Tory view in 2005.) It should have surprised no-one that in Coalition, Lansley’s Act to turn the NHS in England from a healthcare service to a procurer of private providers became law, and perpetual fear, fragmentationand disorganisation established.

Lansley’s experiment was enacted while Francis was still writing his report, which was not published until nearly a year after the NHS it was describing had been swept away, and a new experiment begun. “Competition” is the new Lysenkoism.

Both these approaches, then, have to be swept away for the NHS to address safety, because at least the following would have to be the case:

  • It wouldn’t take nearly three years and several million pounds to prepare and publish a safety report. That looks like complacency and waste on an epic scale.
  • Such a report would not then be largely ignored by the organisation which commissioned it
  • Such a public Inquiry would not even be necessary, because there would be the equivalent of an AAIB 
  • Operators would be tightly regulated – and operators known to be unsafe – including those which were foreign-owned – would be prohibited
  • Unsafe parts of the organisation would cease operation until remediated
  • The organisation would be process-driven, not target driven.
  • The organisation would be quality driven, not inspection driven.
  • The organisation  would be safety driven, not profit driven.
  • Operational data would be transparent, not obscured by commercial-in-confidence contracts
  • The right measures would be used correctly to monitor and improve the processes used
  • Every single person in the organisation would hold themselves responsible for patient safety. Every single manager and leader would hold themselves and their teams accountable for patient safety
  • There would be continuous improvement instead of constant reorganisation
  • Absence of safety incident would never be interpreted as safety.
  • Prevention of accidents and errors would be highest priority. Do no (avoidable) harm.
  • No changes would be performed without thorough Root Cause Analysis or implemented without effective risk management and comprehensive – and of course, successful – testing
  • No change would be considered without a sound justification, including risks and impacts to patient safety
  • The organisation would have quality improvement experts supporting staff at all management levels
  • There would be sufficient project investment and operational budget to deliver the availability of the services required
  • All buildings and tools would be built with adequate systems redundancy and utilise redundant levels of accurate instrumentation

On that last point and aligned with this aviation theme, there is a succinct and brilliant illustration of the difference between targets and measures here.

The list is incomplete. What has to be understood are the differences between a passenger taking an airline flight and a patient being treated by the NHS. I leave that to the clinicians, but my sense is that delivering a person from airport A to airport B roughly on time and without incident may be relatively simple compared to diagnosis and treatment. The passenger flight is a repeatable and repeated task, which makes reducing variation – enemy of quality – much easier.

Finally, It should not be presumed that the passenger airline flight is always a pleasant or even safe experience. Not only are airline passengers subjected to absurd, wasteful, and even demeaning treatment pretending to be necessary for their security (another form of safety), but not all airlines are equal.

But then, maybe a barrister or a health editor doesn’t travel economy, let alone budget or low-cost.

 

 

in which there is no consolation to be got from these philosophies

That reclusive and pessimistic cleric, Thomas Malthus, created a mathematical law to support his contention that population would inevitably outgrow the food supply. The increase in the food supply, it stated, is arithmetic; whereas the increase in population is geometric: thus the population is kept to the level of subsistence by “misery and vice”.

Malthus’ law was bunkum, and it has been argued that he only added it in to give his essay on human population a scientific gloss. The same might be said of the “unsustainable NHS law” repeated by the media and politicians, and set out nicely in a recent Guardian post by Ian Birrell.  The increase in the number of old people and their complex demands will always outstrip the taxpayers’ ability to fund the NHS; and just as Malthus argued that providing relief to the poor only added to their misery by allowing them to breed, medical science only increases the demand from the unwell to access new reliefs and cures: indeed, it actually increases the number of unwell by offering treatments for conditions previously untreatable.

Genuinely horrified by the poverty in his parish, Malthus concluded that population should be managed by reducing births among the impoverished: either by ending the Elizabethan Poor Law or by encouraging abstinence to delay and thus reduce procreation. Genuinely offended by a health service built on the principles of shared risk and access based on need, not ability to pay, the Healthcare Malthusians call for “competition”, “choice”, “efficiency savings”, private providers, and charges for GP visits.

What they do not set out – entirely absent from Ian Birrell’s piece – is where they put health as a priority amongst the totality of government expenditure and the intricacies of taxation. Leaving the total government budget unchanged, which should be a priority: tax concessions for higher-tax-rate mortgage payers, subsidising private pensions, or finding more to pay for healthcare? Every penny of government expenditure is a result of political choice. Why do the Healthcare Malthusians never offer other government expenditure to be sacrificed to fund the NHS, given any upper limit to government spending? Why do they never call for avoided, evaded, or delayed taxes to be collected?

Where Malthus essayed a struggle between man and implacable nature, Herbert Spencer described a struggle for survival within society and between societies; and while the Anglican cleric may have prayed for souls of the poor, Spencer’s apostle JD Rockefeller preached the thriving of the robber barons as the consequence of a law of nature and of god, while no-one should mourn the devastation caused by their success.

The term ‘Social Darwinism’ can be misleading, given it was Darwin who interpreted the natural world through Spencerian social views. The struggle for survival derived from Malthusianism, the survival of the fittest from Spencer, who provided a narrative for Empire and for the English middle- and upper- classes, still horrified by the rising numbers of the breeding poor.

“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”

It is not coincidence that Scrooge is a miser. In a struggle for survival, hoarding an unfair share of the wherewithal to live (food for Malthus, money for Rockefeller) would seem a wise strategy. Similarly wise, in a world in which it is deemed that the government has no government money left, hoarding access to healthcare (or education, or jobs, or law, or property)…

Neoliberalism did not spring anew and afresh in the 1950s. Criminalisation of the poor, rejection of social security, belief that governments must not interfere with ‘natural’ laws,  forced labour: neoliberalism is a revival of social darwinism. Neither has  Malthusianism disappeared: you only have to listen to UKIP sympathisers speak of the UK being ‘full’.

Or you could ask those who say the NHS is ‘unsustainable’ why they wouldn’t find the money for it, or what should happen to those who could no longer access it. Spencer, or Malthus?

 

in which I seek for a narrative

From about half-three yesterday morning I was listening to the joint effort between BBC Radio 4 and 5Live to report the local election results. I can’t remember exactly when – it seems to have been from the moment I turned the radio on –  they declared they had a narrative. That narrative was of a surge of support for UKIP.

For some of the programme, Claire Perry MP also had a narrative: repeating metronomically that the long term plan was working, that there were one and half million new jobs, that the economy was recovering. She replaced James Brokenshire MP, and his narrative about a bad night for Labour.

At another point, a reporter who had been hanging around a count in London interviewed a Labour representative on what had actually been a very good result for Labour. That BBC reporter had a narrative, too: that Ed Miliband had “a habit” of forgetting Labour council leaders’ names.

There was also a psephologist, who declared that Labour looked unlikely to reach what he argued was a very timid target of 150 seats.

All based on the results of a tiny fraction of the seats to be declared: and typically small seats.

At just after 5am the election coverage ended; just as Cambridge and large, important London boroughs were announcing results. Naughtie was swept away, muttering about narratives. That narrative of UKIP surge, earthquake, and destruction of major parties – set up so early and on such minimal evidence – persisted throughout yesterday across the BBC and beyond it; and into this morning.

News organisations are very poor at narrative, and the reason is in the name: “news” is just that – latest information, something just happened. Perhaps aggravated by 24 hour news and the competition from the Internet, “news” organisations have become disseminators of narratives based on single incidents, without any context. Any intent to provide information – accurate information – has been set aside in the obsession with using narratives which can be re-used to create “news” as people react to them.

Such narratives inevitably lack originality: it’s much easier to take an existing narrative and re-use it; and not get out of line with competing media. Thus, “news” is necessarily framed in familiarity, not clarification.

And of course everyone knows – or thinks they do – that narratives need a viewpoint.  Lazily, the perspective of the UKIP voter; the disaffected, politician-hating voter (real or imagined) has been churned since.

Created from shreds of evidence, mediated through the inexperience of interns and the haste to communicate, fabulated by think tanks and the self-interested: these careless narratives should more properly be referred to as fictions.

And poor ones at that. If the measure of information is surprise – the amount of new information conveyed – then these news narratives are largely worthless. Worse, they become zombies, reanimated when needed by the next person in the media with no time, inclination, or even desire to actually do their job and investigate.

 

in which I wonder what a party stands for

Prompted by his report on the non-collection of taxes (see my previous post), Richard Murphy is inviting ideas for a ‘tax pledge’ by the 2015 intake of UK MPs. I proposed that such a pledge begin with a brief preamble setting out what tax is for. My justification is as follows.

What we need to be assured of is not that the people we elect will follow particular policies, but that they will measure all plans, policy and legislation against the principles we wish people in public office to have. Specific policy ideas are easy to set aside once elected: in fact it’s highly probable they will be, given that policy, legislation is created and enacted through debate and amendment.

What we need to know is that the people we vote for will not set aside principles once elected.

The answer to the question, “What do you stand for?” is insufficient if it is something like “ending the cost-of-living crisis”, or “repealing the Health and Social Care Act”. As electors (and citizens) we should expect assurance that the person we elect will oppose anything that makes employment less secure or subverts a publicly funded, publicly delivered NHS: because we know they (and their party if they are not Independent) share with us convictions about the value of people, of human rights, and of what a state and an economy are for.

in which something doesn’t add up

I was excited to have a piece published in Discover Society, in which I tried to disentangle some of the gordian knot of neoliberal policy and point to where I think the sword should strike.

My starting point was Thatcher’s declaration that there is no such thing as public money, but only ‘taxpayers’ money’; and that the nation-state was totally dependent on taking or borrowing money from every citizen (subject, in our case) to pay for whatever politicians wanted to do.

If we accept for the moment that this is the case (it most certainly isn’t) and that Thatcher’s heirs actually believe it, then you would expect such governments to be obsessive not just about controlling spending, but about collecting every penny of tax due: especially as they were (and are) determined to cut taxation.

Imagine my bemusement then, to read a report published by Richard J Murphy and others this week which catalogues the horrendous volume of taxes due but uncollected, the complete inadequacy of the HMRC in gathering taxes, and the parlous state of company records in the UK.  Just look through the 10 minute summary of the findings: they are a national scandal, an absolute outrage.

What clearly doesn’t add up is that a government which is – to phrase it very generously – parsimonious with government spending (except, it seems, where private corporations are the direct recipients) simultaneously permits wholesale tax avoidance and, by implication, evasion. Why is it not chasing down every last penny with even a fraction of the resource it is putting into the relatively trivial level of benefit fraud?

The focus of the Coalition in particular, as per my Discover Society article, is on cutting expenditure: while maximising what is supposed to be the government’s income, the equivalent of business invoices out, is being neglected. No business could run like that, for long.

So is this simply inattention, or is it incompetence, or is it actually something even worse? Could it possibly be that the same politicians who echo Thatcher’s ‘taxpayers money” dictum are not ignorant about what money is, and how it works in a modern economy in a nation-state with its own sovereign currency, but that they know perfectly well that such a state does not have to collect taxes – or borrow – in order to spend?

By publicly pretending that there is such a thing as “taxpayers’ money”, is the Coalition perpetrating on the subjects of her majesty a massive lie, a multi-trillion £ fraud?

in which I consider the greatest “economic benefit” principle

The question and answer about the mining industry in this brief exchange (at about 54 mins) between Nick Robinson and Jonathan Portes prompted me to tweet to the latter that he had just demonstrated why economists should be allowed to inform, but never to make, policy. Jonathan gracefully replied in general agreement - then went on to explain his comments in that interview in more detail on his NIESR blog. It’s worth reading, particularly this, the heart of the argument (the latter part of which , unkindly, was not clarified in the BBC interview) :

“This is what I was trying to get across: the standard utilitarian Adam Smith case for a liberal, market-oriented approach: that (accompanied by appropriate redistribution) it will maximise welfare. It does not imply, as one or two people suggested, that I don’t care about the human consequences of economic decisions, nor that I think people are a commodity like coal.”

Before I continue I should declare a possible source of bias. My father was a coal miner for the first part of his working life. His father was a coal miner for all of his working life, and his father was an iron-ore miner and then labourer in the collieries.  None of them were around to see the mining industry closed down in the 1980s (with the other heavy industries). I would not possibly presume to represent what their views would have been.

I agree that the utilitarian Adam Smith case is the standard premise of current political orthodoxy in the UK.  It was first translated from theory into practice by the Thatcher Conservative government; adopted by  Labour  as its “Third Way” as its leadership become New Labour; and then by an “Orange Book” leadership coup in the Liberal Democrats.

Since the 1950s, the Adam Smith case has been developed, supported and propagated by an ever-expanding and closely linked network of well-funded thinktanks.  These organisations provide what is now a flood of aligned policies, together with a constant media presence. It is a mode of thought virtually unchallenged by mainstream media, with the BBC notably in thrall to it. Many of the current government – most notably, many of our most senior Ministers – have done nothing (or hardly anything) except work for thinktanks or their party. With the UK’s unwritten constitution, it is not at all clear where the boundary is between government and thinktank, or indeed if there is one.

Following this model, to maximise welfare the role of government must first and foremost be to protect and further the liberal, market-oriented approach. This prevents the state from providing public services. Energy supplies, water, sanitation, communications, roads, railways, waterways, the environment, the National Health Service, ambulances and fire engines, education at all levels, prisons, probation, perhaps the legal system itself, even policing and the armed forces: everything must be divorced from public management and converted to private supply through markets. The state is transformed into a commissioner of private provisions. This is indeed what the UK government (run by all major political parties) has been doing since 1979. Instead of governing a state, government is not even managing an economy: it is setting aside whatever controls it can. Politicians might claim the titles of government office, but economists are in charge.

Politicians are thus  limited to specifying what amount of redistribution is appropriate, and the means of that redistribution. However, given that the government has rejected the principle of shared risk and abandoned public ownership to be replaced by markets, what means remain with government to redistribute any wealth? And why would government do that anyway?

A serious problem for Portes’ case is that the two necessary conditions - a liberal, market-oriented approach and appropriate redistribution - are in conflict: strong adherents of the former assert that they are incompatible. Markets are believed by the adherents of Smith to be the most efficient means of distributing goods and wealth: redistribution thus disrupts markets and undoes what markets do so well. Governments are consequently pressurised (or already convinced) to trust entirely to the liberal, market-oriented approach and to ignore the redistribution. Even if welfare may be maximised,  it is certainly not shared. The signal feature of the US, then the UK, since the 1970s has been the accumulation of wealth by a tiny elite and the accumulation of personal debt by the rest of us. In the UK we now have a government so fundamentalist in its adherence  that it is not just divesting itself of the responsibility for protecting the population at all from the market-oriented approach, but lauding the unfair consequences as not just inevitable, but moral. The standard case has long since been moved from liberal to neoliberal (probably prior to Thatcher), and government is removing the vestiges of the postwar state as provider of social security.

This all makes immigration a problematical. Immigrants may indeed – as Portes demonstrates from the data – add to the general welfare, but the general welfare is not most people’s perception, it’s personal well-being and income. Were there a stronger personal sense of financial and job security, it would be much harder to press the immigration button as all major parties – plus, of course, UKIP – are doing.

The usual definition of the utilitarian case is Bentham’s axiom of  “the greatest happiness of the greatest number”.  You might pause to see whether your ethical views are consistently supportive of this by attempting this thought experiment.  My own ethical outlook came out as consistently opposed to it. What you get out of the axiom depends in part on the definition of  happiness which you plug in.  Portes uses the term “welfare” implying, perhaps, general well-being. But as in the case of the miners, does inflicting hardship on a few ever justify an increase in welfare for the many (assuming the redistribution which hasn’t happened)?

As Portes recognises, there was a failure of government to recognise and to mitigate the consequences of what he thought was an economic decision, based on the availability of cheap coal. Similarly, he put it to government that funding and action should be taken to contain the impact of immigration. To his credit, he sees that economic decisions have human consequences. But was this decision to close the mines, based on the market approach, justifiable as a political decision?

Market decisions are decisions based on price only. What about energy security? Surely the oil price shocks of the 1970s would have been enough to persuade us that dependency on foreign supplies and low prices was a risk.  And what about planning for energy production and use? Government has sloughed off its responsibility to the markets and to private providers, leaving us with an energy infrastructure 60 years old and creaking badly, and most importantly wholly unable to contain the impacts of climate change.

It turns out the popular perceptions of politicians – that all major parties are the same, that they look after wealthy corporations and the wealthiest individuals and not the electorate – are logical consequences of letting politicians believe in the standard utilitarian Adam Smith case. In the core of his blog, Portes offers thanks that no government is acting to protect its own people or business from the liberal, market-oriented approach. But as Ha-Joon Chang argues, was there ever a state which successfully nurtured its business and (social) infrastructure without protecting them from global markets? If we are to rebuild an industrial base and secure medium and large enterprises, and provide a future where we do more than sell houses to each other or seek rent, don’t we need a fundamental shift away from the current orthodoxy?

It’s not Brussels that we need to recapture our government (and country) from, it’s economists and corporate lobbyists.

To finish, a sidebar on the subject of migration. Had my grandmother not held an unassailable terror of the Atlantic crossing, my grandfather –  to be awarded a DSM in The Great War and recipient of a subsequent award from the colliery owners – would have moved his family to join his brother’s in Pennsylvania. Britain’s loss. But then, there were no immigration controls a century ago. Someone would have taken our places.

in which I consider “voter apathy”

At least three Guardian columnists (to my knowledge) have recently responded to comedian Russell Brand’s dismissal of the value of taking part in elections.  None, however, discussed the value of voting in the context of neoliberalism.

Across and around at least the leadership (past and present) of the three largest UK political parties (Conservative, Labour and Liberal Democrat) there has coalesced a neoliberal consensus, marked by obsession with low taxation, deregulation of the corporate sector, (re-) regulation of the public, conversion of welfare to workfare and penal-fare, and privatisation.  Since (at least) the 1970s, the political classes have become impelled by the inability – even immorality – of government as a means to improve the public welfare, or common wealth.

The public  has been conditioned to believe – by politicians themselves, by thinktanks that produce them and think for them, and by a media which (almost) never questions any of this state of affairs –  that politicians can only fail at best; or at worst, are in it “for themselves”. But then, in the neoliberal utopia, we are all “in it for ourselves”.

In a society where everything is to be mediated by money, it’s clearly absurd to expect politicians – indeed entire governments – to be motivated by public service which they sincerely believe to be wrong. It therefore makes little sense to retain old-fashioned notions of “the vote” as being something a citizen (subject, of course, in the UK) exercises in an act of civic responsibility or duty. The subject has no responsibility to the state, only to his/her selfish interests.

Our elites have in any case declared themselves (as did the Cynic so many of them studied in PPE) to be citizens of the world, sovereign like the global corporations they court, laundered together with their unpaid taxes). They are the elect, a higher state than the elected; above and out of reach of our state and its puny government.

The vote thus becomes, like the examinations certificate (see previous posts), a voucher,  to purchase policies which meet our individual selfish needs. Everyone will seek to cash-in their vote for the politician who offers the best return. We reach the moral limit of the marketisation of politics.

Of course, we all know that our votes – even combined – don’t have purchasing power equivalent to the global corporate behemoths (either directly or indirectly through the lobbyists and thinktanks). If the elections since 1979 have taught us anything – and the Coalition is the most egregious example until its successor – it’s that our elections have been turned into a sideshow. Not even bread and circuses. No damn bread, no damn circus.

What we also know – not least because Oliver Letwin helpfully spelt it out for us in his book – is that our votes are exchanged for lies and not even for promises. Our Parties compile election manifestos to hide from us what they will do.

Neoliberalism is wholly incompatible with democracy as we think we understand it. Democracy is based on social and collaborative values; on civic virtue and civic responsibility: neoliberalism is based on selfishness and individualism.

As Costas Lapavitsas wrote –  in the Guardian:

“Ultimately, financialisation will not be reversed without an ambitious programme to re-establish the superiority of the social over the private, and the collective over the individual in contemporary society.”

Substitute “neoliberalism” for “financialisation”, and say it again.

God, we’re crap

If there is one thing that our political classes want us never to forget, it’s that we’re rubbish.

Four decades ago, we came to the conclusion we couldn’t manufacture things. If we tried, we only ended up striking. If we actually made something, it was rubbish anyway. When we came up with ideas, they were rubbish. Don’t even try to make them. Some other country can do it better.

So we stopped trying to compete with Japan, or Germany. 

Gradually we learned that government was rubbish. Not the government, but government itself. It could never deliver anything. It just borrowed too much, and raised taxes. So we came to elect politicians who were absolutely convinced that government was rubbish, and had to stop any attempt to make our lives better, or safer, or healthier. Their job was to run the country down, and run government down. 

From that it was obvious that we couldn’t deliver or manage public services. So they had to go: railways, telecommunications, water, energy, and most recently the NHS and post services. All rubbish. We just can’t do any of this. We can’t run prisons, or probation, or police each other, or be trusted in public spaces. Stop trying.  

We’ve learnt that our old people are rubbish, just because they’re still here and we can’t afford them any more. 

We’ve learnt that our kids are rubbish, so stupid we’ve had to make up easier and easier exams for them to pass just so we can pretend they’re not.

We’ve learnt that we’re all rubbish; because we want too much pay, and time off work. Because everyone else part from ourselves is skiving on benefits, and not hard-working. We’re rubbish compared to the Chinese, or Singaporeans, because we don’t want to go back to Victorian working conditions and because (never forget) our kids are stupid and lazy, and we’re rubbish parents.

We’ve learnt we’re so rubbish that we have to be spied wherever we go and whatever we do. We can’t be trusted.

So here we are. Rubbish. Crap at everything.

Except for the very few of us who can extract rent, we are the fallen. 

And if we keep believing what the elite want us to believe, we deserve what we get from them.

the Tea Party and the new gnostics

There were many flavours of gnosticism, but they all – at least those derived from Judaism or Christianity – had some things in common.

A particular creation myth, and obsession with the first generations of people.

A conviction that redemption is found not through atonement or forgiveness, but through ignorance. Only through complete lack of knowledge and critical thinking could you make that sudden and complete  realisation of the gnosis, the vast and complex conspiracy which explained how the world really worked.

A conviction that this world is evil.

Evolution is a fake, and creationism the truth; Obama is a fake president, and not the real one; the Founding Fathers were fakes, not the servants of God who really created the Constitution; there is a vast conspiracy of evil in the world which can be called communism: a Manichean battle being waged against the forces of public education,  public health and public debt, science, and gun-deniers and corrupted religions.

Gnosticism seems to have erupted again amongst the Tea Party and in the Republican parts of the USA.

on the rights and wrongs of workfare and internships

Why would you do something for someone else?

  1. Because you are in – or wish to establish or develop – a relationship.  By doing so, you wish to demonstrate your positive feelings and your worth.
  2. Because you wish to reciprocate, in order to continue a relationship.
  3. Because your morals or ethics demand that you do so, while not expecting any reciprocal act; you act out of goodness.
  4. Because you feel an obligation to do so; you feel indebted to someone.
  5. Because you feel impelled to do so from your understanding of your culture or society.
  6. Because you wish to take advantage, by doing something for selfish gain and with no intention to reciprocate.
  7. Because you are paid to do so.
  8. Because you are forced to do so through indebtedness: not a social obligation, but a form of peonage.
  9. Because you are forced to do so through threat of – or actual – violence.

You might try to classify these reasons into those where the obligation – the debt caused by your action – can be redeemed through payment of money. I would argue that for the first four it certainly can’t. You would be disappointed or insulted if money were offered in return, because accepting money  would change or devalue your original act and its purpose, and your self-image.

The use of money to settle social debts destroys social relationships, and damages esteem and virtue. The first four reasons can be called  ‘Human Debts’.

You could include reason five in the Human reasons, but as long as there is no punishment for failure other than guilt.

The neoliberal world-view admits only to reasons six and seven. All activity is to be mediated through payment ( usually referred to as “the market” or “markets”); although purely selfish acts are permissible provided they are a step to personal gain.  It can  admit reason five, but only if the prevailing cultural imperative is to act selfishly; not selflessly or to form a personal or social relationship. These, then, are the ‘Neoliberal Debts’.

Clearly – to anyone but a neoliberal – Human Debts not only exist but predominate in our social relationships. It is therefore inevitable that neoliberals use governments to create and exploit ‘Punishment Debts’ – (reasons eight and nine) as punishment for avoiding ‘the markets’.  This is why neoliberal states – although they praise deregulation and claim to protect against the evils of communism – will always massively increase surveillance and regulation of the individual and of public services, in a forlorn but increasingly violent attempt to end Human Debts.

(Of course Human Debts extend into private business as well, because we can’t help being human. Thus neoliberalism has generated managerialism, command-and-control management, management by arbitrary targets and ‘performance’: anything to deter us from interacting through Human Debts.)

Punishment Debts must have existed as long as Human Debts. The links between monetary indebtedness, debt peonage, and slavery are well established.  These are inevitably generated by inequality of power and of monetary wealth: the powerful and wealthy exact redemption of both honour and monetary debt through peonage and slavery.

So what of workfare, a compulsion by government to do something for someone in order to receive welfare; and unpaid internship?

Workfare presumes a debt is owed by the person who would receive it to the state. Someone in need of support is by definition assumed to be a burden, a moral bankrupt through their fecklessness, a failure. Workfare is Punishment Debt: as the Government exacts work for what it perceives as a debt owed to the government, or the state; usually misrepresented as a debt to people in work.

(Remember in neoliberal thinking there can be no debt to society, because society does not exist. The neoliberal state therefore has to create a fiction to replace society – like the mythical collection of “hard working people”).

The neoliberal justifies unpaid internship under reason six, as a purely selfish act. Yet this could only apply if the unpaid intern had sufficient income or wealth to act selfishly: anyone else (unless they are helping someone for reason 3) is only acting on a Punishment Debt. As with workfare, compulsion through the alternatives of poverty, penality, and public castigation are the violence threatened.

At this point, it is worth considering the complementary question to this: why would you pay anyone to work?

[The greatest influences on this post: David Graeber "Debt: The First 5000 Years" ;  Michael Sandel "What Money Can't buy"]