Prescribing work (Rantish)

By Matt Nolan 22/08/2013


FYI:  Rant – although I’ll try to make sure I write slowly and clearly, as it is an issue I want to be considered on but have to intrinsically include my moral views to such a degree it is a rant :)

Now I am relying on a news story, so potentially the actual pressure on doctors will not be such that they are “encouraged to question unemployed patients on their career goals”.  Furthermore we may not see incentive schemes that involve “rewarding doctors who get their patients off the benefit” (Note:  My impression is that this is the old “sickness beneficiary” patients that are being discussed here).  If we are not going to see these things occurring then that is good – and my post doesn’t need to be seen as an attack on the current government.

But if this is in fact in the pipeline, then either the current government is not utilitarian (whereby I’m taking that as maximising some form of social welfare function), or as a society “we” have a much more bitter and twisted view about beneficiaries than I had previously realised.  This is reinforced by the strange comments towards the end of the article such as:

“It is currently an inhibitor – a source of contention that gives the GP a perverse incentive to advocate for the client,” they said.

And:

International research has shown consequences from being out of work include poorer mental and physical health, increased rates of mortality, and risk of cardiovascular disease, lung cancer and respiratory infections.

While the first quote is relevant, you may wonder why I picked the second.  It is true that a lack of employment is often related to these things, and it is true that giving people opportunity could improve their lives!  But just as with the constant confusion around externalities when they are actually internal to an individual there is something funny here.  Employment links “through” other things to outcomes for the individual, and by pinning it to this one outcome in such a way we are completely removing individual choice (as they could *choose* to join the labour force), the actual drivers of outcomes, and the true responsibilities of society.

Stop for a second here and ask a simple question, why?  Why does being out of work lead to these negative outcomes?  Why do people find it hard in a mental health sense to get into work, or integrate in a workplace?

Is it really because they aren’t being pressured enough by their GP?

I ask as this is the suggestion being put forward – but a cursory thought about what is going on suggests that this doesn’t make sense as a solution.  Why would increasing the cost for the individual of their current state of the world make them better off?

If we actually cared about the worst off in society, if we cared about those who are having problems integrating themselves into their community or workplace we would try actually dealing with those issues head on – rather than imposing a cost on them and saying “it is for their own good AND its cheaper than actually doing anything”!  Not being employed hits people because they don’t get that social interaction, it hits people because they feel isolated and alone, it hits people because they feel like they don’t have a purpose.

And hell, this would only get worse if manufacturing scarcity keeps falling, making society wealthier but ensuring we all have to become service providers or bust!  In such a case, it is social pressure from our perverse obsession with valuing people based on work that seems wrong – not the fact that people respond to this by feeling isolated!  But I digress.

Digression – but wait, isn’t it economists that only value people as a “labour input”?

The misidentification of economists as people who only value individuals based on their capacity to produce is disappointing – no economists think that way.  In fact, it is people who are extremely “outputs” based as in this that are closer to this view – in the current example employment is being treated as as the “output” of interest.  As we noted here, it is actual an inherent view of value which matters when setting policy, and visible outputs only give us a loose (and often not policy invariant) view on this.

The only way to really figure out how to make policy that improves outcomes is to step back from making conclusions about what we should do and to ask what is the relationship between things eg to find the ‘structural’ reasons why these matters are related, in ways that could correspond to value.  If we can get people to reveal value (prices are a useful mechanism for this often) this is great, but often we can’t – implying that for advising with regards to policy we are trying to understand relationships with regards to an unobservable target.  This implies that we must be very clear, and very descriptive, in giving said advice.

As a result of all this, economists happily recognise individuals have a role as a labour input, they provide labour and things are produced.  They then describe this.  Doing this in no way presupposes that we subjectively value individuals like machines, and that we think their only purpose comes from their ability to make things.  I remember trying to make clear during the discussion on the minimum wage (with associated rant) that as a society we shouldn’t be viewing the wage as a description of the value of someone, instead we should be separate the view of work and the value of the individual more clearly – remove the minimum wage, but ensure there is income adequacy through a minimum income.  Note:  This policy suggestion is normative, and many economists would disagree, I have used it as an “example” only.  However, this doesn’t rule out the first point – that when it comes to doing economics they are trying to be descriptive of action and choice, not prescriptive with regards to value, when they look at “people in their labour input hat”.

In this way we can comment descriptively on the way society values individuals.  Let me explain.

The use of labour, capital, land, and technology provides outputs with a series of claims on these outputs among the right holders for the different types of inputs.  The inherent value we place on each others lives can be inferred from the way people are willing to surrender some of this claim in order to do something like save someones life, provide a minimum safety net for the worst off, or spend on healthcare to improve their quality of life.  These measures suggest value that all of you are placing on each other – not the value economists place on you – and if it appears “too low”, your anger should be directed at yourselves instead of shooting the messenger ;)

Back to the point

Suggesting the that large scale welfare reforms during a major upheaval in the domestic economic was not sensible is the sort of thing that has led people to be called childish – something that in turn implies that, as an individual, I must be childish.

However, I’m willing to be a lot more “naive” or whatever and state that the entire framework for this is something I am uncomfortable with.

If we are honest about it, none of this is really about helping those in need.  It is because people are annoyed that they work all day, checking Facebook and looking and videos of cats, in order to produce something!  How dare these other people not work – not produce anything – and then scrounge resources off the tax payer!  It is this preference among a large section of New Zealand that National is pandering too with these sorts of policies.

If National introduces policies that increase stress for those in mental duress, or financially incentivise doctors to put people through this duress in an already hard time in their life, I will be unable to vote for them [if the GCSB business hadn’t already done enough].  I’ve already ruled out Labour and the Greens for their seeming unwillingness to leave the RBNZ independent and their push for schemes like NZ power and business subsidies (exchange rate intervention and picking winners).  I cant’ vote for NZ First, well because they are racist and don’t care about their policies making any sense.  But it isn’t that I can’t seem to vote for anyone, I want to anti-vote away from all of them – this isn’t the society I thought I was part of.  These are a series of views about how we treat people New Zealander’s were supposed to abhor.

Getting the wrong end of the stick

Now don’t get me wrong!  I could have the wrong end of the stick.  If when saying this:

“Work-focused conversations need to start in primary care,” they wrote.

They mean that they will spend time with the individual, and help them integrate into society and find their own way forward, this is golden.  I would expect this involves people who are trained to do that sort of work, so it would require spending.  And investing funds into those who are suffering a hard time in order to help increase their opportunities and quality of life is what our social contract is all about!  This does deal with my complaint earlier, and goes to the core of the problem – perfecto!

But there is a world of difference between increasing opportunity by opening doors to those who are in a bad place, and placing a cost on their shoulders.  And the focus on “work” instead of “social contact and integration” betrays this.

I hope to find out that I have the wrong end of the stick, I have ranted about nothing, and in truth the government is just interested in improving funding for counseling services and other forms of social assistance that help our most vulnerable.  I also hope to find that many in society shared my concerns when they read some of these quotes, and are happy to see that the government is not being punitive.

Update:  Brennan McDonald chats here.