Don’t look back or up; look inside yourself, where your own cunning, will and power - all the tools that life’s improvement may require - reside. (Zygmunt Bauman, Liquid Modernity p.30)

Krugman's piece on empowerment today bought that quote back to mind again from over ten years back. Events in the past couple of years have given it a new resonance, but it was Krugman's obvious point about medical care that leapt out:

If you’ve ever been in this situation you’ll understand what I mean by saying that empowering seniors to 'control their personal healthcare decisions' is very definitely not what you want right then.

I've had a related experience trying to organise home care for a family member. They were, in theory, 'empowered' with a budget to spend on that care. Of course, because they needed care, they weren't actually able to seek out their own care. You'd think that would be pretty obvious, wouldn't you? As it happened, I couldn't find any care providers with free availability. In the end, a separate process found a company I'd not come across. That happened once a professional social care worker who knew the system got involved.

Like so many things the current UK government are pushing further, that was all New Labour policy to begin with. There are such obviously sound economic reasons for having decent support structures rather than 'empowerment', mostly to do with boring information and transaction costs (which very drily sums up what's wrong with the situations above - there are costs that the idea of 'empowerment' ignores - a quite wilful ignorance, perhaps).

It would be a fine thing if those of us who want such support structures and were willing to contribute to them could separate from those who don't. I am happy to pay more tax to hand over a whole set of cost issues I would rather someone else organised. I would also rather that happened in a way that supported the obviously better-value options like state-led health (or some other non-state option that recognised the stupidity of purely insurance-based health care.) Perhaps there are good libertarian ideas that allow precisely this - after all, presumably, nothing would stop mutual societies being set up. But the difference between opt-in and opt-out rates for these kind of things makes the legislative route seem a helluva lot more straightforward.

One thought that occurred to me recently: in the US, large companies often provide health options as part of the job. As a whole, I think costs would be lower if healthcare was state-run, since in the US as elsewhere, most of the economy's activity comes from SMEs unable to offer such benefits, not the larger firms offering that kind of cover. It would thus make for a more stable workforce. But it's a picture of a very different political setup: fight your way into one of the corporate fiefdoms and healthcare will be provided for you and your family - but only if you remain loyal to the company. You can live inside those walls or, if you are not talented or hard-working enough (and thus it's entirely your own fault), you can scratch a living in the maquiladoras hunched up against them.

I'm sure that's a stoned vision of corporate sovereignty I grew out of 15 years ago, didn't I? But then, looking at what's happening here, in the US, in Europe, New Zealand, elsewhere, I'm not so sure.