Remarkable essay on openDemocracy by Anthony Barnett, who is recovering from major heart surgery. Here’s just one excerpt:

The determining issue may be Brexit. But Brexit has never been about Europe. Which is why its key advocate, who unbelievably is Prime Minister, is pitching his campaign on getting it “done” so we can focus on the “really important issues” that we face as a country. It’s a paradox Lewis Goodall tweeted neatly. After Brexit, way above all the other issues voters care about is the NHS. Once scorned by Johnson as a religion he now presents himself as its most zealous believer, while Jeremy Corbyn commits the last days of his campaign on the need to save it from Trump and privatisation.

Well, I’ve just experienced the very best of the NHS. I’ve also seen at first hand a culture which could open the way to undermining it. There is no doubting its fundamental magnificence. The heart of this is that it is driven by human need, not the profit motive or concern over costs. You know this the moment a hospital gets to work. I had an angiogram a few weeks before my operation. It’s a procedure where a nurse inserts a tiny catheter into your wrist and up through your arm’s artery until it gets near your heart. A dye is then injected which can be X-rayed so that specialists can assess the state of the blood vessels around the heart in advance of surgery. You are conscious throughout. Two people worked on my other wrist injecting blood thinners to ensure that the procedure itself does not trigger a heart attack or a stroke, and an emergency team is on hand in case it does. Along with radiographers, it meant there were eight people in scrubs in a gleaming operating theatre with a huge X-Ray machine and multiple screens, for this simple check-up. The ‘market’ cost of just this 20 minute procedure not to speak of the administrative outgoings of billing the charges would have been unspeakable. But it was needed, so it was done.

You don’t experience its cost-effectiveness in this. But others were coming in after me with conditions that were perhaps more complicated. With good management it is a very efficient use of the team that was in place. In the US, because of all the insurance, billing, and the disputes over charges, just the administrative costs of health care alone came to an estimated $496 billion in 2019. This is considerably more than the total expenditure on the NHS this year which was £143 billion.

The costs would have been far-greater for the surgery itself. But in my heart unit there were fellow patients from every class and walk of life, sharing a battlefield equality in our farting and groaning, as we were all treated equally with state-of-the-art operations, free from financial fear. The extraordinary human return means so much to our families we forget that elsewhere such a medical emergency could have bankrupted us. In the United States, between 2000 and 2012, over 40% of the nearly 10 million people diagnosed with cancer “depleted their entire life’s assets” to cover its treatment, according to the American Journal of Medicine. It’s not flippant to suggest that fear of such an outcome is itself enough to make you ill.

Well worth reading in full. I’ve never thought that Brexit is the key issue. In a way, it’s a kind of attempted coup d’etat by powerful political and economic interests (many of them foreign) to reshape the UK into a private-equity sandbox.

Interesting interview of Michael Lewis by Tim Adams in today’s Observer, talking about Lewis’s marvellous book, The Fifth Risk: Undoing Democracy about how the Trump Administration is dismantling or enfeebling vital bits of the administrative state. I particularly liked this segment:

Adams: Part of your story examines the consequences of the ideological cull of climate scientists from government. You have lived in close proximity to wildfires in California, there have been unprecedented hurricanes. Do you think there will come a point when people demand leaders who understand the importance of scientific knowledge?

Lewis: You would think so. It hasn’t happened yet. For people to suddenly start to value what good government does, I think there will have to be something that threatens a lot of people at once. The problem with a wildfire in California, or a hurricane in Florida, is that for most people it is happening to someone else. I think a pandemic might do it, something that could affect millions of people indiscriminately and from which you could not insulate yourself even if you were rich. I think that might do it.

Adams: That is quite an apocalyptic thought. You have always seemed by nature an optimist, are you feeling more nihilistic about what you call the drift of things?

Lewis: I’m a little more wary than I have been. What we are seeing is an attack on the idea of progress and the idea of science. In the Trump administration there seems to be a total lack of respect for expertise. It sounds like you have something of the same with Boris Johnson. For this kind of attack to work you need to have characters who don’t care at all about consequences.