Towards a Liberal Utopia?
Gabb, Sean, Independent Review
* Towards a Liberal Utopia? Edited by Philip Booth London: Institute of Economic Affairs, 2005. Pp. 300. £15.00 paperback.
Towards a Liberal Utopia? may be described as a set of variations on a theme stated by F. A. Hayek in 1949. Writing at a time when liberalism in the classical sense appeared to be a superseded if not a discredited ideology, Hayek called on liberals "to offer a new liberal programme which appeals to the imagination. We must make the building of a free society once more an intellectual adventure, a deed of courage. What we lack is a liberal Utopia, a programme which seems neither a mere defence of things as they are nor a diluted kind of socialism, but a truly liberal radicalism which does not spare the susceptibilities of the mighty" ("The Intellectuals and Socialism," University of Chicago Law Review 16 [spring 1949], 433). The theme being stated for Booth's collection, the variations are composed by twenty liberals who examine the whole area of public policy. They find it sadly wanting as arranged at present, and they suggest a set of reforms that would restore the framework of a liberal society during the next half century.
It is difficult to single out any one or two analyses and prescriptions in the book for special praise, but it would be a lazy reviewer who contented himself with a short summary of every contribution. Perhaps the two most significant contributions are Tim Evans and Helen Evans' on health care in 2055 and Tim Congdon's on the present weight and limits of the tax burden.
What makes Evans and Evans's essay so significant is that health care is an area of public policy that will inevitably affect every member of a society. The scheme of education, though important, is something that affects most people hardly at all and from which escape into the voluntary sector is fairly easy for anyone who really wishes to escape. Much the same can be said for policing and social security. Europe, the environment, and the Constitution are undeniably important, but they have little perceptible impact on the lives of ordinary people. Health care, though, is something that we all require at some point in our lives, and most of us will require health care that is too expensive for us because we do not have the high income to buy easily in the voluntary sector-especially so once we have paid taxes to support the established scheme.
Evans and Evans describe briefly but powerfully how the British National Health Service (NHS) has failed to deliver on the promise of comprehensive health care made by its projectors. By every measurable standard, the NHS delivers results that are at best mediocre compared with those in other wealthy nations that have greater reliance on the voluntary sector. To these failings must be added the peculiarly British feature of long waiting lists for virtually every kind of treatment not immediately required for the saving of life. Health care in Britain may be in financial terms "free at the point of use," but it is certainly costly-and heavily so-in terms of how long patients must wait for treatment.
There is an apparent escape from the NHS in the rebirth of a voluntary sector within which people may choose their own manner and times of treatment, and this sector is increasingly available to persons of ordinary income, but the escape is so far only apparent. Although people may try to escape from the structures of the British state, that state has not thereby given up its claim to manage their health. It is instead pursuing them into the private sector, where a growing burden of regulation prevents them and their physicians from agreeing on the most effective schemes of treatment.
Moreover, increasing surveillance seriously threatens individual privacy. …