The biggest surrogate indicator of them all

A headline from the current Economist: 

Do vaccine mandates actually work? The Canadian and European experiences suggest they do

How does the Economist define 'work'? In its view, the mandates work in that more people are or 'nudged' or coerced into being jabbed. It's unfortunate, then, that the link between proportion of the population jabbed and health of that population is tenuous. (See for instance here, here and here.)

My approach is different. I think that, for a health intervention to 'work', it must improve people's health, as shown by measurable, meaningful, objectively verifiable health improvements. Definitely not surrogate indicators, such as cholesterol levels or numbers of people receiving jabs. 

My starting point would be to define and reward the achievement of society's health goal, so that the structures and activities of the sectors that support that goal would be entirely subordinated to that goal rather than, as now, the other way round. On a national level, physical health could be defined as a range of long-term targets, all of which would have to be reached and sustained before we can say we have achieved our goal, at which point Social Policy Bonds targeting health could be redeemed. My suggestion is that our goal would include such targets as: longevity, Quality Adjusted Life Years, and infant mortality. There would be others, to be decided by experts in consultation with ordinary citizens.

That would be the first step. The second would be to put in place a system whereby people are rewarded for bringing about such improvements in health. Not for  jabbing, screening, or curing or treating disease, nor for selling drugs or health insurance. Those are indirect means to an end, rather than ends in themselves and the results are lamentable: pills that are no better than placebo (see here and here). Or incentives to over-diagnose and over-treat. Or to falsify or otherwise manipulate the results of drug trials.

Applying the Social Policy Bond concept to health would change all that. All the activity they stimulate and reward would be entirely subordinate to society's long-term health goal. There would be a market for the bonds, but it would be society's servant, not its master. The Social Policy Bond principle uses the market as a means to society's goals. It doesn't view the market as an end in itself. Under a Health Bond regime, the the end that the market serves under a bond regime will be society's health, as defined and targeted by society itself. The goals of those working in any field impinging on society's health would be exactly congruent with those of ordinary citizens: to improve society's health as quickly and efficiently as possible. I have described how applying the Social Policy Bond idea to health would work here, or in a lot more detail here.

Cutting out the middlepersons

Charles Hugh Smith writes: 

Maybe it's time to eliminate the politicians who soak up hundreds of millions of dollars in campaign contributions from corporations and the super-wealthy and just elect Pfizer, Merck, Amazon, General Dynamics, etc. directly. Since corporate lobbyists write most of the legislation anyway, why not cut out the intermediaries in the process?

The super-wealthy buy political power via Political Action Committees (PACs and Super-PACs), think tanks and philanthro-capitalist foundations (Gates Foundation, et al.). Now that it takes tens of millions of dollars to buy the conventional "winning campaign," the political class spends much of its time fund-raising, i.e. lavishing kisses on the derrieres of corporations and the super-wealthy, implicitly promising to do their bidding better than the alternative candidates that the corporations and super-wealthy could buy. 

There are several plausible explanations for why this has happened. Mostly, I think, it's because society does not have clear, verifiable broad goals on which our politicians and public servants are judged. Society has become so complex that the relationships between government activity and outcomes are difficult to identify, and it would actually be unfair to judge an administration according to whether broad, long-term social and environmental goals have been achieved. But what governments can do, and should be doing, is articulating society's goals, and raising the revenue for their achievement. Democratic governments can do these quite well, while actually achieving complex, long-term goals is often beyond them.

As this summary of At What Cost by Nicholas Freudenberg has described:

[G]lobalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith. As corporations manipulate demand through skillful marketing and veto the choices that undermine their bottom line, free consumer choice has all but disappeared, and with it, the personal protections guarding our collective health. At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from climate change to opioid addiction.

 So much for the diagnosis. What can be done? My suggestion is two-fold: 

• Articulate society's broad goals, and
• Supply market incentives into the achievement of these goals. 

Explicit, verifiable goals that are meaningful to ordinary people rarely feature in today's politics, but they should. Rather than let the activities of large organisations be dictated by those organisations, we ought to embed these bodies in a system that rewards the achievement of society's goals. In a Social Policy Bond regime, such goals need not be achievable within the time horizons of governments, political parties or even the lifespan of any individual. So, for instance, we could target long-term improvements in the health of a country's population in a way that rewards every initiative that helps achieve that goal. 

The other essential element of a bond regime is the injection of market incentives into the achievement of social goals. In economic theory, and in actual practice, all the evidence shows that markets are the most efficient way of allocating society's scarce resources. For obvious reasons markets have a sullied reputation currently; too often they've been invoked to justify behaviour that has, in fact, undermined free, competitive markets, leading to the extreme industry concentration that Mr Freudenberg and others have described. That would not happen in a Social Policy Bond regime, unless such concentration were the most efficient way of achieving our goals. More likely, we should see a protean coalition of bodies, all co-operating with the aim of achieving our social and environmental goals as cost-effectively as possible: this would represent a new type of organsation, one whose every activity would be subordinated to society's wishes.