You get what you deserve

It appears doctors are increasingly of the view that certain treatments should be denied to the obese and to smokers. This was a relatively small, self-selecting survey, and certainly doesn't reflect the position of professional bodies, so it's wise to be cautious, but it does seem to indicate a trend towards the concept of the deserving and the undeserving sick.

It's easy to mock this on a number of pragmatic grounds. Obesity and smoking can both be symptoms of more profound disorders, rather than just self-indulgent lifestyles choices, while an obese employed 50 year old who has paid tax for 30 years arguably has a greater call on resources than a skinny teen who has never worked. There is also the issue of where you draw the line. Should skiers be denied treatment for broken bones on the grounds that they put themselves at risk?

The best answer is that health care in the UK is still (just) a public good and is made available as a universal right. To be deserving of health care requires simply that you be sick. This doesn't mean that treatments aren't rationed, or that clinical judgements aren't made on the basis of the individual patient, but it does mean that your non-medical circumstances and behaviour have no bearing on your access to health care.

Unfortunately, the concept of a right is one that has been under attack for some years, witness the regularity with which we are told that rights always entail responsibilities. A fundamental right is by definition unconditional. For example, human rights are so called because the only qualification is that you be human. That is why Abu Qatada has human rights. If Theresa May can prove that he is actually a fish, then she can pop him on a plane to Jordan tomorrow (she might have to ensure he had a clean tank of water for the journey, but that's about it rights-wise).

Philosophers distinguish between claim rights and liberty rights. In essence, the former entail responsibilities or duties while the latter don't. A worker has a claim right to be paid, so long as he has fulfilled his responsibility to work. A worker has a liberty right to withdraw her labour, unconditionally. Much of politics concerns attempts to recategorise between the two.

A more subtle interpretation of the survey is that GP commissioning, a centrepiece of the Lansley reforms, is beginning to worry doctors as it puts them in the firing line in respect of the inevitable decisions over rationing. Where once they could blame the local health trust, or even a specific hospital, they will shortly be the ones responsible for the postcode lottery. Shifting responsibility onto the patient is one way of avoiding that burden.

This requires patients to be increasingly assessed as worthy or unworthy, which harks back to the days before the NHS when doctors were often a powerful arbiter of social norms, and usually conservative to boot. The fat and smokers are easy targets, but how long will it be before other "undeserving" groups come into focus? How long before a religious doctor starts to cavil over birth control or abortion? If my assumption that drugs will sooner or later be reframed as a public health issue is sound, then we can expect some interesting debates about the worthiness of drug users when it comes to prioritising limited resources.

A day trip to Mordor

I've been keeping a low profile of late in terms of the footy, largely because the entire universe pivots on my every move and I don't want to put the mockers on our tortoise-like crawl to the safety of a third place finish. The ability of Newcastle, Spurs and Chelsea to intermittently blow up, or at least run out of puff, should see us safe, but it's been a season of turns and twists so keeping schtum on playing matters is probably wise for now.

I think it safe to comment on events off the pitch though, and yesterday's vist to the Britannia Stadium, to battle Sauron and his Orcs, did produce what Gary Lineker would term a "talking point". This was not the apeing of Arsene Wenger's rightly famous arms in the air gesture (more Basil Fawlty than Monsieur Hulot). Manager-baiting is perfectly legitimate when it focuses on the individual's foibles and record, though the well-known paedo-abuse that Wenger has received in the past, notably at Old Trafford and WHL, is well over the line. However, Arsenal fans are hardly saints in this regard and many would consider the mass outbreak of twitching that occurs in the seats behind the dugout when Harry Redknapp visits to be pushing it.

But those examples aside, the point is that managers are generally fair game and most are thick-skinned enough to cope. In the case of Sam Allardyce, you suspect that all he is is thick skin, like a real leather rhino suit. Not being understood, and not being liked (often by your own fans), goes with the job. As Pep Guardiola has found out, even near-universal adulation is no defence against the occasional abusive idiot, or Jose Mourinho as he is known.

There are a plenty of reasons for jeering or booing an opposition player, from his being an ex after the love died (Pennant), a thug who crippled one of our players (Shawcross), a figure of fun across the land (Crouch), a former Spurs player (Crouch and Etherington), or just plain annoying (Delap). But it's hard to see any justification for Stoke's fans booing Aaron Ramsey.

Some of them have claimed it's a reaction to Ramsey's refusal to accept Shawcross's apology after the career-threatening tackle in 2010, but their malevolence hardly supports a "more in sorrow than in anger" response. Apparently, echoing the Arsenal fans' regular chant of "Robin van Persie, he scores when he wants", which was varied on the day to "Ryan Shawcross, you know what you are", the Stoke fans took to singing "Ryan Shawcross, he'll break what he wants". Classy.

Even the normally confrontational Tony Pulis ducked the issue, claiming "I was more concerned about the Arsenal supporters booing Shawcross so I didn't hear the ones on Ramsey". I'm not sure what he was "concerned" about. Perhaps Shawcross is so mentally fragile the merest hint of displeasure is enough to tip him into profound depression. Probably not. This continued suggestion that Shawcross is as much a victim as Ramsey sticks in the craw, which is probably why the needle between the two clubs has continued to such a degree.

The Stoke fans attitude strikes me more as an example of how, in the safety of a crowd (or online), some people revel in the freedom to be gratuitously offensive, like the Chelsea knuckleheads who marred the period of silence in memory of Hillsborough at the recent semi-final with Spurs. What is perhaps more concerning is that neither Pulis nor his club were prepared to formally condemn it. To cap matters, while MOTD included a terse admonition by messrs Lineker and Hansen, this was clearly intended to provide sufficient balance to justify extensive footage of the crowd mimicking Wenger, something that Lineker himself went on to do.

It is this petty bullying, and the mealy-mouthed justification of it, that ultimately creates a climate in which serious violence on the pitch can be excused as "robustness" or just "unintentional".

Update (Sunday): The BBC's craven attitude on Saturday is now explained by the appearance of Tony Pulis as a guest pundit on MOTD2. The Wenger wave got another airing (or three) and Pulis was allowed to extol the spirit of the club and fans, not to mention the love of the underdog "in this country" (Pulis being an expert on abroad). Nobody suggested he might like to take the oportunity to distance himself from the booing of Ramsey, which was not mentioned at all.

Meanwhile, the campaign to have Crouch given the goal of the season award (which is not the ironic joke you think it is) continues apace. Suarez's distance lob this weekend is considered "not technically as difficult". RvP's volley against Everton has been airbrushed from history.

The legacy of Shirley Porter

When Shirley Porter, the former leader of Westminster City council, appeared on Desert Island Discs in 1991, one of her choices was Maybe It's Because I'm A Londoner. Given that she emigrated to Israel in 1993, to avoid the charges of gerrymandering that were eventually laid against her in 1996, she may have been indulging in sentimentality, but I like to think the feisty Tesco heiress was just taking the piss.

The news that London boroughs are seeking to export housing benefit claimants to Stoke and elsewhere has resulted in accusations of "social cleansing". This term is considered offensive not because it hints at discrimination by class and ethnicity, which is an objective fact, but because "cleansing" is associated with the communal violence that scarred the former Yugoslavia in the 90s. It was Boris Johnson who coined this emotive phrase in 2010, referring to his opposition to the government's plans for a housing benefit cap. He insisted that he would not allow London to go the way of Paris, with the poor moved to the outer suburbs, a process he disparagingly called "Kosovo-style social cleansing". Most Boris-watchers interpreted this as a coded message to the outer London Tory-voting boroughs that they would not be dumped on. His opposition to the benefit cap itself soon evaporated.

This week's news shows that the process of Paris-style relocation is well underway, but with ripples extending beyond the Greater London area. The benefit cap has inevitably bitten hardest in the centre of town, with many families gravitating to the outer boroughs. Newham's Stoke initiative is partly a reflection of the localised property boom caused by the Olympics, but it's also a consequence of increased demand caused by this intra-London migration. The speed with which this has happened also reflects the fact that the housing system was already under stress. This stems from the reduction in social housing stock, and the accompanying decanting of the poor from Central London, which has been going on since the Westminster homes for votes scandal in the late 80s.

The continuing robustness of the London property market, and the need of buy-to-let landlords to generate enough rent to cover their mortgage repayments, means that private rents in most of the capital will outstrip the benefit cap. The cap will not, as claimed by the government, force rents down in London, though it may achieve this at the margins elsewhere. So long as councils are unable or unwilling to build additional homes to meet demand, this will inevitably result in a continuation of the current process whereby the poor (both unemployed and working) are forced out of London. This is not an unfortunate and unintended consequence. It is quite clear from the combination of policies (e.g. pushing council rents up to 80% of the market rate) that this is deliberate. However, because this is being engineered through central government, the policy is not vulnerable to the charge of crude gerrymandering, though the electoral impact in London will undoubtedly benefit the Tories.

Residence in Central London will be dependent on a property/wealth qualification. It will be "a privilege, not a right", according to Westminster Council, where the spirit of Shirley Porter lives on. This will lead to exactly the sort of "doughnut" that Johnson claimed he would resist, though perhaps what he meant was that it would look more like the discarded flakes of a Cornish pasty (click '2016' for the full effect).

House raus

It seems frankly surreal to think that in the early years of the 21st century we are still debating the reform of the House of Lords. We should be colonising the Moon or mining asteroids, not deciding precisely which species of political hack should be entitled to wear ermine.

What probably saved the Lords from earlier extinction was that it conceded the bulk of its power, specifically the ability to reject or unilaterally amend legislation, in 1911, before the arrival of universal adult suffrage in 1918 (men) and 1928 (women). Had it held out till after WW1, it's hard to see how it could have survived as a hereditary body in any form. By collapsing like an England cricket team before tea-time, it perversely found itself in a political dead zone that allowed it to live on, zombie-like, for an another 100 years.

The House of Lords should not be reformed. It should be abolished outright because it is a standing affront to democracy. It is not quaint, nor even particularly traditional: life peers were only introduced in 1958. It is a two-fingered salute to the people of Britain; an arrogant and unashamed symbol of the institutional corruption at the heart of politics. The UK's bicameral system developed to reflect and entrench different class interests. The perpetuation of the Lords is therefore an acceptance of the continuing privilege of the old aristocracy and the new oligarchy.

It does not need replacing with a directly-elected second chamber, let alone one with a residuum of appointed political loyalists and bishops. Bicameral systems are only appropriate where the second chamber reflects an alternate pole of power, such as the federal states in the US. Unicameral systems are more than adequate where no such power balance is necessary, and there is no evidence they are any less democratic (cf. Norway, Sweden, New Zealand, Portugal etc).

Most bicameral systems reflect strong regional or ethnic divisions. The argument for a second UK chamber on federal lines is weak, as there are already devolved assemblies in Scotland, Wales and Northern Ireland. These aren't going to be abolished, which would mean either restricting a federal second chamber (weaker than the devolved assemblies) to just the English regions or adding another, competing layer of government. Both ideas are nonsensical. Multiple devolved assemblies for the larger English regions (i.e. the North, Midlands and South West), with powers equivalent to Scotland and Wales, might constitute a progressive alternative to the Lords, but this isn't on offer.

A well-worn argument for a second chamber is the need for a separate body to the Commons to revise, or "improve", legislation. The not-so-subtle implication is that the Commons is either incompetent in its drafting or too cowed by the whips to get it right first time. This is really an argument for better scrutiny of legislation by the Commons, and more authority for standing committees. It isn't an argument for intervention by the "grown-ups". The Lords is no defence against an elected dictatorship, and providing a second chamber with sufficient powers to function in that role will inevitably result in conflict and a constitutional crisis.

The broader argument that you need wise and experienced cross-benchers, independent of party, is just naked elitism. It is also not proven that appointing the "great and good" provides anything other than a very narrow range of life experience, no matter how expert the individual may be in their chosen field. What democracy needs is more representatives of the working class and the regions, not more TV-friendly academics and self-satisfied businessmen.

In a reformed Lords, most appointees and elected members would be time-serving party hacks, professional lobbyists or members of the usual metropolitan elites of finance, the law, media and PR. In other words, pretty much like MPs have become, and pretty much the same as the Lords has been for the last 50 years.

The widespread assumption that we need a second chamber, with no attempt to justify this need, is indicative of the degree to which the continuing presence of the Lords has corrupted political debate in this country. An example of this is the YouGov poll being quoted in support of Nick Clegg's Lords reform plan this week. The poll was commissioned by Unlock Democracy (nee Charter 88), who are explicitly committed to a second chamber. The respondents were not offered the choice of abolition.

This same lobby group has taken to regurgitating a poll carried out in January, well before the announcement of the joint committee's reform proposals on Monday. This one was commissioned by The Sun following the Lords amendment to exclude child benefit from the £26k benefit cap (the amendment was later overturned by the Commons). The poll was clearly intended to question the Lords legitimacy in blocking a policy favoured by the newspaper. Again, it did not ask if the respondents were in favour of abolition, merely whether they were in favour of the Lords being elected and (pinko) bishops excluded.

The debate over the next few weeks may well centre on the issue of a referendum, however the one thing we can be sure of is that this will be as much an abuse of democracy as the farce over electoral reform and the haggling over Scottish devolution. We will be faced with a binary choice: do you agree with the government's proposal for a new second chamber or not? What we really need is the opportunity to express support for straight abolition. Clear the house, and take all that ermine crap with you.

The great wen UFO

As we commence the festival of London-centric self-congratulation that runs from the marathon to the Olympics, the question of whether the capital is too big for its boots, or just too big for Britain, has once more raised its head. In the Spectator recently, Neil O'Brien (of the Tory think tank Policy Exchange) reiterated the myth that London took leave of the rest of the UK as a result of the coming of Thatcher and the mid-80s Big Bang.

It was a shabby, defeated city, brilliantly captured in The Long Good Friday, in which the rat-like gangster Harold Shand picks over the ruined wilderness of London’s abandoned docklands. We all know about what happened next. Mrs T and the Big Bang. Yuppies then hipsters. Russian oligarchs and Polish builders alike have moved to London.

This ignores the fact that the "Bigger Bang" of the Eurobond markets began in the 1960s, as the City's traditional Sterling area went into decline, that gentrification began then too (a point made in Dominic Sandbrook's current TV series on the 1970s), and that the "wilderness of London's abandoned docklands" was in reality a relatively short hiatus between the closure of the docks due to the containerisation revolution in the 70s and the formation of the LDDC in 1981. The very notion of the "hipster" is a London in-joke, the international super-rich have based themselves here since 1789, and there's been a big Polish community since WW2. It's also worth pointing out that Bob Hoskins does not look like a rat. A well-fed penguin, maybe.

London, and specifically the City, has always been out of tune with the rest of the UK. This didn't start in 1979 or 1986. O'Brien wishes to make the point that London is categorically different to the rest of the UK, so extreme contrasts and abrupt divisions are used to illustrate this: "Economically, culturally and socially, London has now left Britain behind, blasting off from the rest of the nation like some vast UFO. Its inhabitants need to remember those who have been left behind." That last sentence sounds half-hearted, while the preceding one is brimming with glee. The departing UFO metaphor is also a bit awry, as to most of Britain "that there London" is more like a huge alien spaceship that has come to hover over the island, like something out of Independence Day or District 9 (it's well known that Cockerneys will happily perform degrading sex acts in return for dog food).

John Harris offers a more romantic soft left perspective in the Guardian today, picking up on Andrew Lansley's announcement that the NHS will introduce regional pay and noting that exceptions will be made for (presumably) metropolitan high-flyers who will be sent beyond the M25 like latterday district commissioners (pith helmets optional). Harris welcomes the relative success of the SNP and UKIP as a sign of non-metropolitan frustration with the Great Wen, though his solution is a vague call for more top-down (i.e. directed from London) action: "the national state should shift anything and everything it can well beyond the capital". This even extends to welcoming Andrew Adonis's suggestion that the House of Lords should be shifted to Manchester.

This latter call is part of the fashion for eye-catching gestures towards regionalism that don't actually amount to much, such as moving some of the more tractable bits of the BBC to Salford, and insisting that what the larger English cities need are directly-elected mayors: a Boris in your backyard. This comes from the same people (Heseltine and Adonis appear to have formed a double-act recently) who abolished the powerful metropolitan counties (including the GLC) in 1986 and were surprised when the electorate rejected feeble regional assemblies in the North East referendum in 2004.

What O'Brien, Harris and Adonis fail to address is the economic basis for the dominance of London and the powerlessness of the regions. Local government was strong in Victorian Britain not because of the talents of Joe Chamberlain, but because Birmingham, Manchester, Newcastle and other cities were economically strong. The gradual conversion of the regions into bantustans, dependent on central government largesse and increasingly denied the right to fully manage their own affairs, is a consequence of economic weakness.

Equally, the dominance of London (and its South East hinterland) is a consequence of the capital's ability both to grab the lion's share of the UK's economic growth and exploit its international role as a tax haven gateway, service centre and luxury resort. Dubai with rain. There are also grounds to believe that the financial crisis of 2008, and the failure to reform the banking sector thereafter, are symptomatic of the evolution of London as a City state, pursuing goals independent of the rest of the UK. It was emblematic that David Cameron should choose to invoke the UK veto (or non-veto) at last year's Brussels summit to safeguard the interests of the City of London, while standing aside in respect of the Bombardier plant closure in Derby.

London is over-mighty and its gravitational pull is enervating to the rest of the country. The Labour party, unlike the Tories, has an obvious interest in rectifying this, however the Blair coup meant that it institutionally accepted that this was not possible within the neoliberal paradigm. Activist industrial policy is dead and we must not jeopardise the tax and trickle-down benefits that London brings.

There is solution to this. Traditional city states based their influence on being at the nexus of multiple trading routes.

London is now running an entrepôt trade in money at the intersection of the international time zones, just as Italian city states like Genoa or Venice had run an entrepôt trade in goods at the intersection of the trade routes from the East and the Mediterranean to the North and West of Europe. [pg 7].

If the political class will not reform the City's status as a tax haven gateway, then it should at least legislate to move the City to somewhere in the North so the benefit is distributed. What we call "the City" is a legal construct more than it is a physical place. The trading routes for money do not follow the natural routes of river valleys or trade winds, but are based on legislative fiat. Tax havens are such because we make them so, not because they are sitting on large, natural deposits of tax havenry.

The real geographical advantage of the square mile is the timezone, equidistant between Asia and the Americas, which means that anywhere in the UK would suffice just as well. There is an element of convenience in its proximity to mainland Europe, however this would not be significantly worse were it in Birmingham or Leeds, and this is more than offset by the advantages of being anglophone, particularly for US banks. It might be argued that such a shift would cause some foreign banks to prefer relocation to Frankfurt, but that ignores the fact that they are in London now precisely because it offers a more benign regulatory environment and thus more profit opportunities than Frankfurt, which would be preserved in Birmingham or Leeds.

Moving the House of Lords sounds radical, even cheeky, but the truly revolutionary option would be to move the Bank of England to somewhere in the heart of, well, England. It's time for the UFO to take off.