Bureaucracy triumphs over health outcomes

Dr Malcolm Kendrick describes the Quality and Outcomes Framework (QOF) of the UK's National Health Service. It's the usual array of poorly-thought out, meaningless micro-targets that doctors are paid to achieve, but that have nothing to do with health. As Dr Kendrick points out, such (perhaps) well-intentioned, but futile bureaucratic processes impose a formidable opportunity cost on the NHS, to the detriment of doctors and patients. My suggested solution is to apply the Social Policy Bond principle to health; a short description of this application of the bonds is given here; a much longer version here.

We see the same proliferation of Mickey Mouse micro-targets in other policy realms, notably education, and in diversity guidelines or regulations. They spring from the same presumably benign impulse, but they suffer from a similar lack of vision and strategy. They assume that processes that might have served society well in the past will continue to do so into the indefinite future. They do not allow for diverse, adaptive approaches. Yet it takes courage to criticise them, as Dr Kendrick is doing. My experience is that many people grumble about such top-down initiatives but are understandably reluctant to say anything openly. Though Social Policy Bonds aim to inject the market's incentives and efficiences into the solution of our social problems, perhaps their more important contribution - if they ever take off - will be to focus policymakers' attention on outcomes that are meaningful to the people they are supposed to represent.

Greenhouse gas emissions: we're not actually doing anything to reduce them

Here, as reported in the current Economist, are some grounds for optimism about curbing global emissions:

• 'China understands the need to decarbonise and is investing massively in solar and wind.'
• 'The second-biggest emitter, America, has taken a green turn under Mr Biden.'
• 'Brazil has sacked a rainforest-slashing president;'
• 'Australia has ditched a coal-coddling prime minister.'
• 'Nearly a quarter of emissions are now subject to carbon pricing.'
  
• 'In polls of 12 rich countries...the share of respondents who said [climate change] was a "major threat" rose in every country except South Korea, where it was already high.'

I'm in the happy intellectual position of not having to advocate for or against greenhouse gas emissions, because I think the priority is to decide on those climate-related outcomes we want to see, then rewarding people for achieving them, however they do so. But since emissions are the bandwagon onto which everyone has climbed, what's happening to them is an indicator of how serious we are about the climate. It sounds good so far doesn't it? All those positive trends. But we shall get a better picture if I just repost (I first posted these on 7 September) this graph and caption from John Michael Greer's blog: 

'Climate activism became a big public cause about halfway along this graph. Notice any effect?'

It's the outcomes that are important and it's clear that, despite the singular focus on greenhouse gases, we're not actually achieving any reductions in the rate at which they're emitted. It's a familiar story: we target surrogate indicators; things that current science tells us will influence a target variable, rtaher than the variable itself. In this instance, greenhouse gas emissions, rather than climate change (or the negative impacts of climate change), and we're not even succeeding at that.

Here's a better idea: let's not assume the questions about the causes of climate change have been definitively answered. Let's also decide on what combination of goals we wish to achieve. And then reward the sustained achievement of these goals. I have written innumerable papers and blog posts about applying the Social Policy Bond principle to climate change. Links to papers can be found here, and this blog can be searched for relevant posts.

Paying people not to kill each other: why not?

Some of the people I speak to disdain applications of the Social Policy Bond idea because it's transactional. 'They shouldn't be doing it for the money: people should not have to be paid to reduce their pollution, or to look after their own bodies, or not to commit burglaries.' Or, indeed, to refrain from killing each other. So neither Middle East Peace Bonds nor World Peace Bonds, nor any variant has ever been issued; nor, let's be frank, is likely to be issued in the foreseeable future. I will admit that paying people to achieve peace sounds, at first, a long way short of ideal. We should be at peace because we respect and even love each other, even people of a different tribe, race, religion and all the rest. That would be lovely, but it's plainly not working.

So, for those who are squeamish about aiming for a noble ideal (peace) using sordid means (money), here are my reasons: 

• Paying people who achieve peace is similar to paying nurses and teachers who also work, at least partly, for idealistic reasons. Money pays their bills and allows them to raise families. It is not all about enriching already wealthy plutocrats or corporations but even if, under a bond regime, that were to occur, it would have been a result of channeling people's self-interest into socially beneficial outcomes. 
• There are plenty of people who benefit financially from fomenting conflict. A World Peace Bond regime would help to offset the incentives on offer to those people. 
• A bond regime aiming for a decades-long sustained period of peace would set in place incentives for people to explore, research, investigate and refine many different ways of achieving peace. Many bodies already work to this end but...
• ...a bond regime would give them more resources to work with. This includes people: rewarding peace would allow these bodies to attract more, and better-qualified, people to work for them. We need to divert talented, hard-working people away from less socially beneficial activities (trading currencies, say) or socially destructive (creating ever more sophisticated weapons of mass destruction), and towards such worthwhile goals as the ending of war which, I believe, in spite of all the evidence, is achievable - provided we have it as a long-term goal, and reward it in accordance with its value. 

As I say, the current methods of trying to end war aren't working. Perhaps it's because the rewards and incentives are dwarfed by those reaped by those who depend on conflict for their living. A bond regime may be our best hope of bringing about the sustained period of world peace that all of humanity craves and deserves. Or maybe somebody out there has a better idea?