The Great Escape: Health, Wealth, and the Origins of Inequality

"There are two strands to this book. Funnily enough, it has some overlap with the Hans Rosling book Factfulness because The Great Escape is actually the escape from poverty. The title comes from the movie of the same name , where some people escape from a German prisoner of war camp. His question is: is that good? They are now better off than the poor buggers left behind. So, with the inequality that they’ve created between them and the people who are still in the prisoner of war camp, is that good or is that bad? He’s saying that it’s good, basically, because they’ve escaped, and that’s much better than everyone still being in jail. And maybe that can lead to other people escaping. So, it’s really about how human progress works. He’s saying that we have to accept and tolerate and expect a certain amount of inequality because that’s just how societies progress and escape the past. However – and it’s a big however – we need to explore underneath that inequality. There comes a point when inequality becomes very detrimental. He would argue quite strongly that that point has been reached in many of our advanced economies. He has an anecdote from another economist, Albert Hirschman , which goes as follows: you have two lanes in the Lincoln tunnel and you are driving to an important engagement, let’s say you have opera tickets in New York. Suddenly both lanes stop for twenty minutes. You’re panicking, you think “what on earth is going on? I’m going to miss the opera”. Then, if the lane next door to you starts moving – this is the great escape – then you think, “oh great, that’s moving, soon I’ll be moving”. Twenty minutes later, you’re not moving. You think “well, hang on, the system is rigged against me. Why are they moving and I’m not moving? What’s so good about them?”. In which case, you become enraged and maybe you start cutting into that lane even if that’s illegal. So, here we have crime and frustration. You can see this as a metaphor for bad inequality. It was Deaton and his wife Anne Case who dug around in official American statistics to show us, on average, a country getting richer and richer and richer. But averages don’t tell you very much. They can be highly misleading. They found that, from the start of this century, white males who had not gone to college were dying younger. It took real sleuthing by the two of them to discover what you would have thought should be leaping out of any decent set of national statistics. And yet their paper was a revelation. The American economy has grown for the last nine years but, in the last two, the overall life expectancy has shrunk. We just don’t focus on that. We are happy that the economy is doing well, disproportionately, I would argue, to our concern that life expectancy has shrunk. It’s true that there is a focus on opioid addiction which is some of the explanation. There is also an increasing focus on inequality and on the kind of community despair in places that have been hollowed out. You could argue that this is precisely what has led to Donald Trump. But the fact that it took two very gifted sleuths – one of whom won a Nobel Prize for economics – to dig all of this information out of our statistics shows me there’s something wrong with our statistics. That’s why I found this a very useful and interesting book. He’s very moderately left-of-centre, I would argue. He probably would talk about more tax and redistribution but in quite a mild way. He talks about more training for people who are left out. He absolutely talks about revamping the American health system, which in GDP terms looks excellent because it contributes 17% to the economy, whereas in Japan it only contributes 9%. But health outcomes are better in Japan than they are in America. A lot of that money in America is just wasted money on lawyers, unnecessary interventions, drugs that are too expensive, and on unnecessary drugs. He’s saying that kind of scheme is wasteful and inefficient, and that a lot of people drop through it. So, I think he would definitely argue that we need something that looks more like what some Americans would call a “socialist” health system, or what we would call a national single-payer health system."