My prediction for 100/200 year's time: google/facebook search will combine with already patented genetic matching techniques (example); AI will take over, with each ruling its own fiefdom based on some existing corporate entity; each will steer different social/genetic matching systems to breed us like crufts animals. At least one of those AIs will just have fun trying to make REALLY weird-shaped people. (We do the same with dogs, after all.)
Another P3 comment and an unformed braindump. This is confusing stuff and I'm a long way from spotting a path through it.
There's some digging to be done into the recent resurgence of DDT + GM related stories. I got myself tangled in the GM stuff (defending the tech in the face of what I and others considered a badly misinformed protest) but pull that thread and a whole lot of baggage comes with it. e.g. old Monbiot stories about marxists-turned neoliberals starting science lobby groups (also active during the recent Rothamsted protests) or the GM Watch stuff. Climate scientist Simon Lewis was wondering on twitter: "perhaps it's important to ask of scientific experiments: is this the science of the 1%. Or the 99%", suggesting that any attempt to separate science from the issue of control or money was not possible. (Ironically plenty of climate deniers would completely agree.)
Via Andy Evans: "Think this says everything you need to know about the Tory party in one handy nugget":
Upon trying to access the internet at the ICC [during the Tory party conference], we were informed that while Conservative party members could surf for free, other attendees would have to pay. One bemused ICC staffer quietly informed us that the conference venue offers universal free web access for the other 51 weeks of the year but was ordered to restrict it especially for the Tory summit." (Research Professional, 17.10.12)
So they demanded an otherwise free resource be denied to others so they could attempt to squeeze some rent from it? Yup, Andy's right, that's an absolutely perfect example of the real meaning of privatisation in Toryland.
(with the caveat that of course it may be too perfect a parable to actually be true but, hell, I'm just gonna go ahead and propagate it anyway...)
Head of NHS Brand-Offer to the Public: £77,079 - £97,478.
"The post-holder will lead on the development and implementation of a brand strategy for the NHS as a publicly-funded, free at the point of delivery service and on the development and delivery of the NHS Commissioning Board brand and offer to the public. This includes the development of a strategy to encompass corporate, staff and consumer brand offers and associated visualisations and leading on all related brand communications and campaign activity. The post-holder is responsible for ensuring that the NHS brand values are at the heart of the work of the NHS Commissioning Board and the new clinical commissioning system."
I don't even know what kind of person would go for this job. Is it marketing? Is it management? What?
At any rate: congratulations to the ConDems for taking New Labour's bizarre butchery of public and private to new levels of absurdity. Both public and private should play vital roles in the economy. What we've created instead looks suspiciously like all the worst bits of both worlds.
So is the NHS now nothing more than a logo?
If they were to make all replacement parts and add-ons downloadable and 3-D printable, they might not need to even manufacture the parts themselves; they can simply release the file and the synthesizer owners can 3-D print at home, or with a 3-D printing service like Shapeways. In this way they do not need to mass-produce, hold inventory or distribute their products; they only need to design and release.
I saw this just after a conversation about whether it's possible to plan for reducing transport costs by changing where production takes place. (This actually happens in some sectors - I'll come back to that in another post.) Here's another example of much the same enthusiasm.
Just assume for a moment 3D printers and fully equipped fablabs (let's call it fab tech for short) were capable of making more or less anything. (There's a nice little fictional account here.) The design process happens entirely in software and can be torrented like any other file (with all of the IP implications that would have). This isn't a realistic picture: material input into something like an iphone is very specific, and you'd have difficulty printing a nuclear bomb without enriched uranium (though it appears guns are less of a problem). As with any industrial revolution, fab tech would be more likely to change the commodity landscape, not product-for-product replace our current one.
Even if that world of a perfect split between software design and hardware printing were possible, what does it look like? It's a beguiling question, and I can imagine two opposing forces: an increase in Jacobs-like innovation dynamics and a rather more mundane 'weight of stuff' and production cost problem. As a first guess, I think the latter is probably by far the most important, but it'll be fun to think through more.
Our new grant. Intro write-up also up at the Talisman blog. There's a link in there to this interactive viz of the UK's trade flows - a starting point for working on how best to make the spatial economy visible.
Alison Heppenstall, Gordon Mitchell, Malcolm Sawyer (LUBS) and I have been awarded an 18 month grant by the ESRC through their secondary data analysis initiative. Titled 'Geospatial Restructuring of Industrial Trade' (GRIT), the motivation for the grant came from a deceptively simple question: what happens to the spatial economy when the costs of moving goods and people change?
That's a good old fashioned location theory question, but 21st century challenges are breathing new life into it. During the next few decades an energy revolution must take place if we're to stand any chance of avoiding the worst effects of climate change. What price must carbon be to keep within a given global temperature? How long will any switch to new infrastructure take? (Kramer and Haigh 2009; Jefferson 2008) In fact, will peak oil get us before climate change does? (Wilkinson 2008; Bridge 2010) In a time when we're discovering costs may go up as well as down, do we have a good handle on the spatial impact this may have? Can we use new data sources and techniques to answer that, in a way relevant to people and organisations being asked to rapidly adapt?
GRIT will focus on two jobs. First, creating a higher-resolution picture of the current spatial structure of the UK economy. Second, thinking about how possible fuel costs changes could affect it. We'll examine the web of connections between businesses in the UK, looking to identify what sectors and locations may be put under particular pressure if costs change. There is a direct connection with climate change policy: the most carbon-intensive industries (also very water intensive) are also those with the lowest value density, and so most vulnerable to spatial cost changes.
Most economics still works in what Isard called a "wonderland of no dimension" (Isard 1956, 26) where distance plays no role except as another basic input, in principle substitutable for any other. Some economic geographers believe that because energy and fuel are such a small part of total production costs, "it is better to assume that moving goods is essentially costless than to assume [it] is an important component of the production process" (Glaeser and Kohlhase 2004, 199). At the other extreme, social movements like the transition network privilege the cost of distance above all else. They make the intuitive assumption that if the cost of moving goods goes up, they can't be moved as far – so localisation is the only possible outcome. They are making a virtue of what they see as economic necessity imposed by climate change and peak oil. At the extreme, some even argue that "to avoid famine and food conflicts‚ we need to plan to re-localise our food economy".
Reality lies somewhere between those two extremes of ignoring spatial costs altogether or assuming a future of radical relocalisation. GRIT is taking a two-pronged approach to finding out: producing a data-driven model and talking to businesses and others interested in the problem. Our two main data sources both use the 'standard industrial classification' code system, breaking the UK into 110 sectors. First, the national Supply and Use tables contain an input-output matrix of money flows between all of those sectors. (I've created a visualisation of this matrix as a network: click sectors to view the top 5% of its trade links and follow them. Warning: more pretty than useful, but gives a sense of the scale of flows between sectors.) It contains no spatial information, however – we plan to get this from our second source, the 'Business Structure Database' (BSD). As well as location information for individual businesses, each is SIC-coded and also provides fields for turnover and staff number. It also has information on firms' structure: "such as a factory, shop, branch, etc". (There's a PDF presentation here outlining how we're linking them, though I'll write more about that in a later post.)
By linking these two (and adding a dollop of spatial economic theory) we have a chance to create a quite fine-grained picture of the UK's spatial economy. From that base, questions of cost change and restructuring can then be asked. The 'dollop of theory' is obviously central to that; we've tested a synthetic version that produces plausible outputs (see that presentation for more info) but 'plausible' doesn't equal 'genuinely useful or accurate'. I'll save those problems for another post also. This sub-regional picture of the UK economy is a central output from the project in its own right and it is hoped it can be used in other ways – for instance, for thinking about how industrial water demand may change over time.
Even before that, two big challenges come with those datasets. First, BSD data is highly sensitive. It is managed by the Secure Data Service (SDS) and can only be accessed under strict conditions (PDF). Work has to take place on their remote server, and anything produced needs to get through their disclosure vetting before they’ll release it, to make sure no firm’s privacy is threatened. These conditions include things like: "SDS data and unauthorised outputs must not be printed or be seen on the user’s computer screen by unauthorised individuals." So, no-one without authorisation is actually allowed to look at the screen being worked on. Crikey. The main challenge from the BSD, however, is getting any of the geographical information we want through their vetting procedure. The process of working this out is going to be interesting. To their credit, the SDS have so far been very patient and helpful. While genuinely keen to help researchers, they also have to keep to draconian conditions – it can't be an easy tension to manage.
The second challenge is really getting under the skin of the input-output data. On the surface, it appears to very neatly describe trade networks within the UK, but its money flows can't all be translated simply to spatial flows. For a start, as the visualisation clearly shows, the largest UK sector, 'financial services', gets the UK's biggest single money flow from 'imputed rent' – which doesn't actually exist as exchanged goods or services. This comes down to the purpose of the Supply and Use table – a way to measure GDP. Imputed rent is a derived quantity used to account for the value to GDP of owned property. That's only one small example, but it illustrates a point: care is needed when trying to repurpose a dataset to something it wasn't intended for – in this case, to help investigate the structure of the UK's spatial economy. It is hoped that less problems exist for more physical sectors, but that can't be assumed.
The second 'prong' is to talk to businesses and other interested parties to find out how they deal with changing costs and to see if the work of the project makes sense from their point of view. We plan to hold two seminars to dig into the affect of changing spatial costs on businesses. Anecdotal evidence suggests suppliers have been citing fuel costs as a reason for price increases for a while now.
A whole range of other groups are keenly interested in spatial economics, though it might not always be labelled thus. An example already mentioned, the 'transition movement' is taking action at the local level. It has, in recent years, developed strong links with academic researchers. A vibrant knowledge exchange has developed between locally acting groups and researchers, with the aim of making sure that "transition and research form a symbiotic relationship" (Brangwyn 2012). It isn't just about spatial economics: it's imbued with a sense that people can play a part in shaping their own economic destiny. It's hoped that GRIT will be of interest here also.
So that's GRIT in a nutshell. There are clear gaps in the project's current remit. Trade doesn't stop at the UK's borders and any change in costs will have international effects (an issue I've been pestering Anne Owen from Leeds School of Environment about). Many of the costs most essential to business decisions are either hard to quantify or to do with people, not goods. (Think about how much it costs a hairdresser to get a person’s head under the scissors from some distance away, e.g. in the rent they pay; this hints at the reason data appears to show the service sector may be the most vulnerable to fuel cost changes.)
Aside from the technical aspects of the project, there are two other things to write about I'll save for later: the nature of distance costs and the place of modelling in research and society. And on that last point, just a bit of brainfood to finish on from Stan Openshaw (1978). In theory, GRIT wants to tread both of these lines, but that's something far easier said than done. (Hat-tip Andy Turner for lending me the book.)
Without any formal guidance many planners who use models have developed a view of modelling which is the most convenient to their purpose. When judged against academic standards, the results are often misleading, sometimes fraudulent, and occasionally criminal. However, many academic models and perspectives of modelling when assessed against planning realities are often irrelevant. Many of these problems result from widespread, fundamental misunderstandings as to how models are used and should be used in planning. (Openshaw 1978 p.14)
Brangwyn, Ben. 2012. “Researching Transition: Making Sure It Benefits Transitioners.” Transition Network. http://www.transitionnetwork.org/news/2012-03-29/researching-transition-....
Bridge, Gavin. 2010. “Geographies of peak oil: The other carbon problem.” Geoforum 41 (4) (July): 523–530. doi:10.1016/j.geoforum.2010.06.002
Glaeser, EL, and JE Kohlhase. 2004. “Cities, Regions and the Decline of Transport Costs.” Papers in Regional Science 83 (1) (January): 197–228. doi:10.1007/s10110-003-0183-x.
Isard, Walter. 1956. Location and Space-economy: General Theory Relating to Industrial Location, Market Areas, Land Use, Trade and Urban Structure. MIT Press.
Jefferson, M. 2008. “Accelerating the Transition to Sustainable Energy Systems.” Energy Policy 36 (11): 4116–4125.
Kramer, Gert Jan, and Martin Haigh. 2009. “No Quick Switch to Low-carbon Energy.” Nature 462 (7273) (December 3): 568–569. doi:10.1038/462568a.
Openshaw, Stan. 1978. Using Models in Planning: A Practical Guide.
Webber, Michael J. 1984. Explanation, Prediction and Planning. Research in Planning and Design. London: Pion.
Wilkinson, P. 2008. “Peak Oil: Threat, Opportunity or Phantom?” Public Health 122 (7) (July): 664–666; discussion 669–670. doi:10.1016/j.puhe.2008.04.007.
"I have trouble with the fundamental premise of “we need to manage the planet”. That seems to be exactly where we have lost our way..."
“We need to thread a path between anarchy and fascism, maintaining an unstable balance between two devastating equilibria.”
These could be read as saying the same thing. Elinor Ostrom addressed the same issue in her final article. It's the subject of J.C Scott's Seeing like a State, which does better at identifying the problems than any solutions. Stafford Beer tried addressing it but just designed a different kind of centralised system.
There are already global networks and systems. Transnational companies are so effective because they can reduce transaction costs internally and do away with many uncertainties. They are doing many things politicians tell us are impossible or dangerously socialist/technocratic. It's just they're doing it for their own aims, which is apparently fine.
Fundamentally, no - we can't 'manage the planet', can we? But are there any other routes to take other than to throw our hands in the air, concurring with Agent Smith that we're no better than a virus - or:
So far, we’re not doing any better than cyanobacteria. We consume resources and reproduce until everything is filled up and used up. Okay, we have a few successes, for example in controlling acid rain and CFCs. But on balance, we don’t do much better than the bacteria.
That's result of the extreme freedom end of the spectrum - that we can all act according to our own wills and somehow the best of all worlds will result. This treats our social structures like mystical gods - "as if correctly sensing the importance of sunlight for life on earth, we were to merely worship the sun rather than study astronomy or photosynthesis" (Desai 1994, p.47, talking about Hayek's take on the price system).
J.C Scott's point is all about the logical conclusion of the 'gaze' of top-down state planning, which is the other end of the spectrum.
I have no idea how we get from all this theory to new systems that can help. The problem with successful systems (like successful cognitive algorithms) is that they generally have to evolve through trial and error in a high-cost environment. I suppose we are increasingly going to face such an environment.
Human nature has a good trick though - this is a key Jane Jacobs point when she talks about the 'logic' of productivity in dense networks: "the process is full of surprises and is hard to predict - possibly it is unpredictable - before it has happened." She likens it to art: an attentive feedback by those creating. "At any rate, messages - that is, suggestions - afforded by the parent work seem to be vital to the process." [p.59, Economy of Cities 1969]
So there's this process of deliberative creation, fumbling, mistakes, recombination - as humans, we get to benefit not only from the power of evolution but of our own ability to be discerning as we feel our way forward. We then need to build platforms on platforms on platforms as we find what works [got a bit of a thing about platforms after reading Steven Johnson]
That's my take on the middle way anyhoo.
planet3.org jeremiad of mine bouncing off Stephen Emmott's 'Ten Billion'.
Jeremiad: liking that word! h/t MT for providing my first sighting of it.
Robert Wilson and Mark Lynas picked up on a Pod Delusion interview with the new leader of the Green Party, Natalie Bennett. James O'Malley spoke to her about GM and the Rothamsted trial (that me and Sue responded to at the time with this open letter). Natalie’s response is troubling, for reasons I’ll discuss below – and not just her position on GM. Many of the usual tropes appear (some of which me and Sue targetted in the open letter), especially regarding corporate control. I’ve transcribed the key bits here with the time location for the mp3. Discussion after the transciption. She notes to start with that:
The Green Party doesn't whip. We allow divergent views and if something does come up I don't agree on, I just need to say, my personal view is that but the party line is that and the party has no problem with it.
But of course, she’s the leader of the party now and so her views on this stuff do matter – not least for my own choice at the ballot box. I’ve voted for the Greens in the past, but with recent events over Rothamsted? This interview as it stands, I think, rules me out of voting for them again – though there’s `dialogue’ mentioned, perhaps that could change. Somehow I doubt that, but we’ll see.
Anyway – James gets straight into the Take the Flour Back protest. Natalie’s first thoughts (14'):
My first degree is agricultural science, so that's where I come to from this. I think that GM crops and the release of GM crops into the environment is the wrong way to go because the fact is GM crops as currently instituted represent a further expansion of industrial agriculture, enormous scale corporate agriculture that's just utterly the wrong direction to be going in, in terms of the future of farming that we need.
I have a particular obsession with soils, and we're utterly trashing the planet's soils. Soils are absolutely critical and essential and we barely understand what's going on with them. We can't replace them easily, and huge industrial scale agriculture that's just ploughing across the landscape in huge fields that relies on a very small handful of seed companies who don't allow farmers to save their own seeds - it's entirely the wrong model of agriculture. So GM for me is tied up with an entirely wrong model of agriculture and is entirely the wrong way to go. // And there are safety concerns in terms of the risk factors - what you could be releasing without really understanding what you're doing.
Asked about the Rothamsted trial in specific (15'30''), James points out that you can oppose corporate control of the food system and support GM. Natalie skipped straight past that:
The nature of that experiment was, you were letting loose something into the environment. There'd been experiments in greenhouses that no-one had a problem with, but it's a genie that once you let it out of the bottle, it's out there. I know the scientists were claiming there was a very very tiny chance of cross-contamination, but actually there were some other figures produced from different peer-reviewed papers published in journals that said the figures were a considerable order of magnitude higher than they were saying. And there simply wasn't the evidence that this was necessary or pointing us in a direction that was useful.
Asked the specific question (16'15''): "would you align yourself with Take the Flour Back? If they had succeeded in smashing the experiment up, do you think they were doing the right thing?"
Nice and clear. James also read out an email question from ‘a Rothamsted scientist’ specifically for her (16'25''):
Agriculture uses land, energy and other natural resources. With increasing demand for food and other agricultural products, its environmental impact will increase. To avoid this, improved crops that give better yield using fewer resources like pesticides, fertiliser and water can help. How can the Greens and GM science folks find a way to dialogue so that a case-by-case applications of GM could be evaluated for environmental benefits?
I'd certainly be very happy to talk to them and I think I've got the foundation so that we can talk the same language, and I'm always happy to talk to scientists and people of good will who are coming from a place where they want to solve the sort of problems he's talking about. What I'd say is, plant breeding is terribly important, but there's also issues of the way you manage the land, the way you ensure you haven't got soil erosion - huge numbers of issues that simply aren't being tackled. And that focus simply on plant breeding comes from a very strong commercial focus.
So. The first thing that leapt out at me was her getting straight in there with her scientific credentials: coming at from an agri science background, she claims to be not just your average crop-trashing reactionary. It also gives her, she says, a common scientific language to talk to Rothamsted with. On Rothamsted’s arguments about contamination (e.g. in their Q&A), she references “some other figures produced from different peer-reviewed papers published in journals that said the figures were a considerable order of magnitude higher than they were saying". That’s something to follow up: no-one expects actual references in an interview, but I wonder what she’s talking about? At any rate, again, she’s keen to present herself as an agricultural scientist who accepts the validity of peer review. I wonder where these papers will turn out to be directly relevant to the Rothamsted trial, or the same contamination arguments you can see on Take the Flour Back’s own website? (Also, I wonder how many orders of magnitude she has in mind?)
Specific question for Natalie then: what peer-reviewed papers are you referring to when you claim Rothamsted are wrong about the contamination risk by `orders of magnitude?’
This illustrates a point that climate 'skepticism' also shows very clearly: you'll rarely hear people say, "I think x, but there's absolutely no scientific basis for it. I just happen to think that." Science is like motherhood and apple pie in that respect. But doing as Natalie has done here - say "I am scientifically literate" - doesn't make you scientifically literate. She clearly thinks its important, getting straight in there with "I have a science background, so..." But how does she do on her substantive science knowledge? And, actually, can we prise the science from the politics on this one? I'd argue yes, but...
There’s also a murky confusion here that was present in a reply I got from Caroline Lucas too (haven’t checked if I can use any of that publicly yet): there are x, y problems with GM or the corporate food system ; therefore I support trashing the experiment. It’s weak and unreasonable. I’ve said before, I fully support the need for direct action, but – as with James Hansen (and notice that wasn’t even destructive of property) – you need to be putting a helluva lot more work into your reasoning than any of the Rothamsted attackers or attack-supporters have mustered. It’s perhaps what I find most annoying about Green Party members supporting the destruction of the crop: you’re making arguments about problems with the global food system. How did you get from there to “let’s trash their experiment?" (This was roughly Caroline Lucas’ take as well: here are x,y arguments about the food system. Also, direct action has a valid place in a democratic society. None of which I disagree with.)
The key argument, though, is one that many of us have headbutted repeatedly: “GM for me is tied up with an entirely wrong model of agriculture and is entirely the wrong way to go." Her whole argument pivots on that – but is it true? The point me and Sue made says no – any more than computer code is tied up with entirely the wrong model of computing. Obviously, code is dominated by corporate players – we live in a largely capitalist world. Does that mean we should attack all coders, open source as well? The coding I’m doing at the moment is to help understand the economic impact of energy cost changes. Am I microsoft? Am I Apple? No. Obviously. This isn’t a difficult point, is it?
Equally, does the existence of Monsanto mean we should attack all GM? Right now, Natalie appears to say, unequivocally, “yes". She has, however, said she’ll talk to Rothamsted and other scientists, and that’s something I’d love to see happen. Take The Flour Back notoriously refused to openly debate the scientists. If the Green Party takes a different approach, perhaps something will come of it. We all have a network of ideas and unquestioned assumptions and they don’t change if they’re not challenged. Ben Goldacre nailed this one perfectly (and of course this applies to me as much as anyone else):
People make mistakes. What distinguishes you from the morons is what you do when the mistakes get pointed out.
She attacks the focus on plant breeding also: it ‘comes from a very strong commercial focus’ that, she believes, neglects other agricultural issues. My first thought on hearing that was: ‘as if good yields were only a capitalist concern’. There are, of course, complex issues of access to food and the way in which scale and profit-making may effect the structure of food production – but we need to remember how many mouths there are to feed, and that the need for scale isn’t going away. I think the approach people like Natalie want is what economic geographers would call `Jacobs externalities’ – a rather bland and mathematical description of the fact that certain kinds of localised production networks can produce more than the sum of their parts. That is true, they can. But they’re not the only way to be more productive, and Jane Jacobs fully recognised the vital role that standard, boring economies of scale can play. It’s an interesting abstract question whether those different kinds of scale outcomes must be at odds with each other – I would argue not. But at any rate, this ‘small is beautiful, big is evil’ heuristic is not going to help us understand how to progress.
The same applies to GM and many, many other things we need to try and keep our minds open about. So much has to change, and so rapidly, our body politic needs to be developing a much stronger ability to properly assess all options. We don’t seem to be showing much sign of doing that – possibly the reverse, in fact. Trite arguments about corporations and “GM is further expansion of enormous scale corporate agriculture that's just utterly the wrong direction to be going in" = major fail. We need to start by understanding GM as one technology among many, including (some links here) the history of mutagenesis and the way we’ve historically introduced plant species into different ecosystems. (Some more of my starting questions here, the first two being the most relevant; no closer to answering them, perhaps.)
Just to finish, Natalie does categorically say (following all the Jeremy Hunt kerfuffle) that homeopathy is 'a scientific nonsense' that only ever works because of the placebo effect. However, she then goes on to say that, actually, that effect gives it a place in publicly funded medicine, if all other approaches haven't worked and someone might actually benefit if that person "believes in it and trusts in it and, because of the placebo effect, it works... psychology is part of medicine".
Which is actually close to Jeremy Hunt's own take (see the link above): if you're focused on patient outcomes and - as she says, you've ruled out all other serious medical conditions with known effective treatments - a placebo might give you value for money. Interestingly, I'm having difficulty finding a flaw with that. Also, it implies that people saying “Jeremy Hunt believes in magic water" are wrong – at least going by his ‘patient centring is the point’ argument. To deny someone an approach that might help them because you want to wrestle their comforting illusions off them and cuff them round the ear might make you feel intellectually superior. But if that leaves them medically worse off, what's actually been achieved?
The answer might be - as James goes on to say in the podcast - that you've reinforced the message that evidence doesn't matter in health outcomes. But of course the evidence also shows this placebo approach can work for some, so it isn't quite as clear cut as that. It's annoyingly murky, not sure what to think.
However! To end on an emphatic note: dialogue between Green Party / anti-GM / scientists = yes, let’s see that happen please. And someone please record the outcome. It needs to be ongoing, not just debating-society point-scoring nonsense. The issues are hard, and changing one’s own assumptions is not always an easy or speedy process.
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.