Thursday, 28 April 2016

A Matter of Opinion

Lola has a lump on her hind leg. We first noticed it a couple of weeks ago. It didn't seem to be causing her any concern but after a day or so of agonising Jo and I decided that she needed to go to the vet. We went to our local practice and she was examined. The vet told us that she was in otherwise good health but that the lump was cause for concern, so he took her away and took samples from the lump using a syringe to create slides of the fluid inside it and the more solid areas. This visit cost us £125. We would get results in a couple of days. We phoned a couple of days later to find out what was going on. The vet told us that the results were inconclusive and the next step would be to go for a surgical removal. I was reluctant to pursue this as she was still unconcerned with it, so he told us to try a course of antibiotics and anti inflammatories, which we could pick up from the surgery. We did so. This cost us a further £53. He wanted to see her again in 7-10 days.

Over the following week I wrestled to get the antibiotics into Lola. She wouldn't take them in pate, preferring to lick it off and spit the pill out, so I had to push the pills into her throat and hold her mouth shut, stroking her neck until she swallowed. I did this twice each day. After the course we returned to the vet and he examined her once more. The lump seemed a little more solid inside but was otherwise unchanged. He told us that we would need to go for surgery and to send the lump off for analysis to find out if it was malignant or not. He prepared a quote for us. This was £1096.33. This is a sum that we can't really afford without hardship. It would hit our savings hard and damage what little emergency fund we have. He told us that our other option would be to go for a smaller biopsy that would cost a bit less, but after which we would need to have it removed anyway, at the same price. My head was reeling at this point because the surgery might not be the end of the treatment, especially if we found out that she had a malignant cancer. I had multiple concerns. I worried about whether we could continue treating if need be and even if we would have the funds to afford to have her put to sleep should the lump continue to develop or other ones grow, causing worse problems. The vet understood that we needed time to think, so left us with the written quotation and a bill for this follow up consultation of £28.

So far we had spend over £200 to find out nothing useful. Lola was insured until last year when the premium increased significantly once she reached ten years old. The excess increased as well, and the sum insured reduced to £1000. Not only that, but, once the excess was taken off, the insurance would only cover 75% of the remaining cost of any treatment, up to the ceiling of £1000 for total treatment, not for the total paid out. In other words, the quote we had would have maxed out the insurance anyway and we would have only recovered around half the cost and any further treatment would be down to us to pay. As it is I'd let the insurance lapse because it seemed such poor value. This is typical for older dogs.

So as things stood last week we had an otherwise healthy animal with a lump on her leg facing urgent surgery that would cost us more than we could comfortably afford. I was deeply upset because I genuinely thought that we would have to face putting her to sleep within the next few months if her quality of life began to suffer. The vet had not been prepared to speculate how the lump might or might not develop and I felt we were unable to explore the possibility of palliative care. I felt that we had been edged into a corner by this vet, so I contacted three other nearby practices, asking for quotations or second opinions. Two got back to me and yesterday we took Lola to see the first vet that had replied. He told us that the second opinion would cost £35 and that he would be happy to talk through all courses available to us.

Once more Lola was examined. Like many dogs she hates being in a vet surgery and she trembles. Despite this, the vet told us that we have a healthy dog who is apparently completely unaware that she has a lump. It causes her no pain or discomfort. It isn't attached to a muscle. It hasn't affected the lymphatic system and is nowhere near any major blood vessels. It would cause her no harm to leave it at this stage. Of course it may grow and then become a problem, but it isn't a problem for her right now. We could opt to have it surgically removed if we want to, but that option is neither urgent nor is it necessary at this stage. If we decide to take that option he prepared a like for like quote. This was £470. We could reduce this cost further if we opted to not have the lump analysed after removal. He told us that at the moment it looks like we have time to think about what we'd like to do, as the lump is causing no problems. There is certainly no pressure to treat it in any way at this stage.

What's notable is that the facts of the case are unchanged. Lola has a lump. It may or may not be malignant. The only way to know for sure is removal and analysis. But one vet was pressurising us to commit to surgery, one told us that it wasn't necessary at this stage. One quoted nearly £1100 on top of £200 already spent, the other charged £35 for a consultation and a range of options. For now I've decided to measure the lump on a daily basis to get some idea of whether it is actually growing and if so at what kind of rate. If it seems to be stable and continues to give her no trouble, I think Lola can live with a lump on her leg. If she shows signs of pain or it seems to be growing and therefore might become more of a problem, I'll opt to have it removed. No prizes for guessing which vet I'll go with if that's the case.

I think this demonstrates what life would be like for human health in the UK if we didn't have the NHS. It's under sustained attack from the Tory government and the whole doctors' strike is over the principal of stretching resources and people further than they can really be stretched in the hope that the system fails and we can be forced down the route of private medicine. But if I can get two so very different interpretations of the same data, one of which appears to be motivated by maximising profit, then how can we really trust a private system? The expensive vet was part of a chain, having been bought up by a company that acquires vet surgeries and then imposes its policies upon them. It seems to me that this is very much what big private companies would do with GP surgeries if they could. At the moment, even though many NHS services are now delivered by private contractors, you can be reasonably sure that your GP won't refer you for unnecessary treatment just to bump up the bill, because there is no bill right now. Once that particular Rubicon has been crossed though, who knows what cost your health will be? And just like Lola's insurance, personal health insurance will drop out just as soon as it runs any risk of having to pay out. Once the profit motive really takes hold in the health service how can we be sure that what we're told is correct? Would we really be able to trust our GPs if they are always having to think about how to be profitable?

Sunday, 10 April 2016

It's about the money, just not the money we're talking about

I was surprised that the protest calling for Cameron's resignation actually got some coverage in the news. More surprising is that traditionally Tory supporting papers have splashed on their front pages criticism of Cameron's tax affairs. Despite his publication of a spreadsheet showing his income (but not his extensive assets) and quite proper tax arrangements, it would seem, the papers have found out that Dave inherited £300k from his dad and then got a £200k gift from his mum, neatly avoiding around £80k in inheritance tax. That assumes that his mum will live for seven years after the date of the gift, but it basically looks like Dave was set to inherit half a million, only some of that would be subject to tax, so his mum, who isn't subject to the same tax, inherited the balance instead and then passed it on. Hmm.

As dodgy deals go, it's not in the top league. It's understandable, even though it looks like a clear cut case of legal tax avoidance. Compared to Cameron's overall wealth it's a relatively small sum, but it's still enough to buy a reasonable house in a poorer part of the country. Money is relative and it's those kind of comparisons that Dave is keen to avoid. Compared to many of the people his government defends, Dave has relatively modest wealth, but compared to the people he routinely squeezes and belittles, he's fabulously rich. This is where the anger comes from, not because of his personal accounting, even if that's where the papers have found some mud that might stick.

The main reason for yesterday's protest has got somewhat lost amongst all of this. It was called because Cameron had personally intervened only a couple of years ago to prevent tighter Europe wide laws on off shore tax avoidance when he'd been talking tough on tax. It was the evidence that he was saying one thing but doing something far different that spurred Abi Wilkinson and others into action. My own anger stems from his dogged pursuit of damaging austerity policies that harm the majority of people and enrich those who already have money. It's unfair and immoral. And I suspect that more and more people are waking up to this.

However, the papers attacking him for his personal tax affairs stink of rank hypocrisy. Most are owned by non doms who benefit from a wide range of tax avoidance schemes. They also continue to champion austerity as necessary and fair. Until recently they were huge cheerleaders for Cameron. So what changed? The EU referendum did.

While many in business are for remaining in the EU, most of the media owning barons aren't. They stand to gain from laxer regulation and looser employment laws if Britain were to leave the EU. They can more easily lean on the British government to get what laws they want than they could on the wider EU, who wouldn't be affected by headlines in the UK. Cameron is the champion of the Remain campaign and so he has set himself against the powerful UK tabloid press. They know that if he goes then the Leave campaign would get a boost and Remain would be tainted by association with Dave. Hence, as soon as they find a piece of mud that might stick to him, they sling it.

So it's about the money in the hands of the media empire owning, tax avoiding non domiciles who want to control the UK government, not about the cash the Dave rightly or wrongly inherited from his dad, nor how his dad came into that wonga in the first place. The problem is that the press is still above the law in this country, despite Leveson, but how it has managed to maintain that position is for another post. Predictably, it's just as tawdry a story as this one.

Saturday, 9 April 2016

A Man, A Plan, A Canal... Panama!

I couldn't resist the temptation to misappropriate this palindrome. No doubt loads of people have done the same, as I can't claim to be the most original thinker on the planet. Yet Panama has become the focus of the world over the last week, thanks to the leak of papers that revealed just some of the global elite's off shore tax avoiding activities, including that of UK Prime Minister "Dodgy" Dave Cameron's father, the late Ian Cameron.

After much media pressure Dave admitted piece meal and grudgingly that he might have possibly benefited from his father's activities. As I write, a protest is mustering around Downing Street to demand his resignation and, more importantly, to demand action on global tax avoidance. Thanks to a useful story about the parentage of the Archbishop of Canterbury, the protest probably won't get much, if any media attention. Dave's job is safe for now. He's probably more worried about the result of the EU referendum in a couple of months. Yet things are coming to a head for him, and his flavour of governance. The problem is that he and George Osborne have focussed on the cost of everything and the value of nothing which rather concentrates the public's minds on totting things up, like the cost of tax avoidance and the whole issue of taxation for the moneyed classes.

The problem is that tax avoidance is legal. And the more money you have, the more opportunities there are to avoid tax. The answer is of course to legislate to prevent people from avoiding taxation. George and Dave have done their bit, but it's a little inconvenient for them that it appears that Dave recently lobbied against closing some of the off shore loop holes in European law.

It was well known that Ian Cameron dealt in off shore investments. The area of his specialism wasn't a secret but the detail and the proof of exactly how he operated wasn't in the public domain. We knew that David Cameron came from a wealthy background and that his dad dabbled with wealth management and tax efficiency. I'm somewhat surprised that it took his being named in the Panama papers for Dave to be questioned on this. He and George have, after all, been telling us for the best part of a decade that the country is broke and we can't afford proper social security or many public services like transport, libraries, schools and hospitals without private companies taking over, slashing staffing and reducing the service. The whole thrust of austerity is that the country is broke and therefore we must do without these essential services or at the very least swap them for crapper alternatives that just happen to make some moolah for their mates.

Most of us know that austerity is bollocks. It's been a convenient lie to ensure that the remains of the welfare state and publicly owned services can be scrapped to suit the ideology of wealthy individuals who neither need nor use them. There is a small but massively powerful group within the Tory party who saw this as an opportunity to quickly remodel the country according to neoliberal free market principles. We've been drifting in this direction for 35 years or so, but they were impatient to see the job finished and to ensure that their work couldn't easily be undone. That's why big jobs like the huge overhaul of the NHS into a properly marketised system that can easily become fully private was conveniently left out of the 2010 manifesto. Many of the reforms across the whole of society, like those on disability benefits have actually cost us a lot more than if they were left well alone. So much for there not being enough money. The problem for austerians was that money was going to the undeserving poor and we really can't have sick people living in comfort can we?

I digress, but the point is that austerity was always meant to be self defeating in the terms used to defend it to the British people. Osborne's last budget (and I sincerely hope it will turn out to be his last) laid this out so clearly that even the sympathetic media couldn't turn a blind eye. He took from the disabled and the poor to give away in tax concessions at a time when he was still bleating about the need to save public money. When IDS resigned last month he revealed that this was about taking from those "unlikely to vote Conservative anyway", rather than affecting the party's core support. It begins to look like what many of us have been saying for a long time, that George was looking after his mates and kicking everyone else, especially the poor and vulnerable.

Again, this is no great surprise. When Cameron and Osborne became the Tory Party's darlings in the mid 2000's the Bullingdon Club photo that included them and Boris Johnson did the rounds. The concern was that members of a club who openly mocked tramps and trashed restaurants, simply because they could afford to, might not be the best people to look after a varied society that includes many vulnerable groups. The spin was that the Bullingdon was in Boris, George and Dave's past. It was regrettable high spirits of youth and they've done a lot of growing up since then. However, their actions since gaining power over both London and the UK as a whole tell a very different story. London is now home of the global elite. Anyone on the median UK salary can't afford to live anywhere nearer to the heart of the city but the very fringes. The publication of a tube map showing affordable places to live for families with dual incomes was very sobering indeed. London is where the world's most wealthy come to invest in property, while the service staff (those who would have been squirrelled away downstairs in years gone by) are banished to its fringes. Britain has become a hugely unequal country under Bullingdon rule, but it's London that really showcases inequality.

But what's this got to do with Panama? Isn't that just what fabulously wealthy people do? They find investments to ensure that they and their families can keep as much of their money as possible to keep it away from the clutches of the tax man who'll only squander it on hopelessly inefficient public services. Well, yes, but that's exactly the point. While telling us that housebound people aren't entitled to help going to the loo, because we're broke, they've gone on keeping as much money as possible. It's not on. Dave knew many people would be upset about his privilege, which is why he tried to hide much of it as he could in a series of carefully crafted, inaccurate statements. His dad doesn't appear to have done anything illegal and nor has he, but he knows deep down that there's something immoral about protecting a huge inheritance while cutting public services.

And this is the nub. I would not be so angry at this wealthy elite if they hung onto most of their money, but let us continue to have public hospitals, libraries, and decent trains and buses. If social security was just that, a safety net that would catch people when they fall and help them up again, rather than acting as a punishment with degrading assessments and media shaming. If there were just enough redistribution to ensure than all citizens were comfortable and not scared about what next month might bring. If they actually bothered to take some care for the environment, too. I find ostentatious wealth distasteful but I'd look the other way if those at the bottom of the pile weren't being given an abject kicking. But because the Bullingdon boys couldn't resist continuing their tradition of finding new ways to hurt those less fortunate than themselves, they've thrown their own greed into sharp relief.

Of course Cameron will stay in post for the time being. If he should go soon, the chances are that another Bullingdon Bully like Boris or George will take his place and we'll be no better off. Despite our desperate need for political and media reform, those who hold power are likely to keep it. I would just appeal to those parts of the Conservative party who still have organs resembling hearts to stop and think. Austerity wasn't necessary. It's hurting more of your constituents than you probably realise. We don't have to sell off the land registry, Channel 4, the BBC, the remains of the NHS. We don't have to keep cutting taxes for business and the super rich. We can be a bit fairer. Please ensure that the lie of "Compassionate Conservatism" could actually hide a little truth. Reject the Bullingdon Bullies and try to be just a little kinder. Who knows? You might even enjoy it.