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Inequality is dividing England. Is more devolution the answer for its disadvantaged regions?

Years of political turbulence, economic shocks and the failure to ‘level up’ as pledged have turned English devolution into a key political and constitutional…



Twenty-five years ago, when new institutions of national government were created in Scotland and Wales, they reflected the widely held view that the Welsh and Scots should have more control over their economies, aspects of welfare provision and key public services. Yet at that time, hardly anyone thought devolution might be applied to England – despite it being the largest, wealthiest and most populated part of the UK.

Today, things look rather different. The notion of English devolution has morphed from being of interest only to constitutional experts to being a preoccupation of Britain’s politicians as we approach the next general election – many of whom have lost confidence in the capacity of central government to tackle the country’s most deeply-rooted problems.

A historic £4.2bn devolution deal, which will bring together seven councils under an elected mayor of the North East in May 2024, is the latest attempt to address some of the deep geographical inequalities that disfigure and disenfranchise large areas of England.

Meanwhile, much of English local government is experiencing immense financial pressures, with large councils such as Birmingham and Nottingham declaring themselves at risk of bankruptcy while others teeter on the edge of a financial cliff. In many parts of England, it is increasingly unclear who local residents should hold accountable for public service provision – in part due to the amount of outsourcing to the private sector that has become routine.

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The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.

“Take Back Control” was the slogan of the Vote Leave campaign leading up to the Brexit referendum of September 2016. It may not be a coincidence that the country which played the key arithmetical role in determining its outcome – England – was the only one where devolution had not been introduced, and where many non-metropolitan residents felt their views and interests counted for little in the citadels of democratic government.

Since then, more years of political turbulence, economic shocks intensified by the COVID pandemic, and the government’s failure to “level up” as pledged, have combined to erode the allegiance and goodwill of many of its citizens. What this means for the future of a UK union-state model that has rested, to a considerable degree, upon English assent is likely to become one of the key political – and constitutional – issues of our time.

What is English devolution for?

In fact, the idea of establishing a new layer of government between Whitehall and England’s complicated network of local councils has engaged the attention of successive governments since the 1960s. But questions about the form, scope and functions of this “middle” layer gradually turned into a party-political football, with governments of different colours inclined to reverse the arrangements put in place by their predecessor. And the wider democratic ambition hinted at by the term “devolution” was largely absent from these reforms.

Whereas in Scotland and Wales, devolution was long ago couched in terms of democratic advance and national self-determination, in England it was largely regarded as a mere extension of central government’s approach to regional policy-making – and even the advent of elected “metro mayors” did little to change this view. But now, politicians from both main political parties have come to believe in a new, sub-national model that can be badged as England’s own version of devolution.

A spate of deals involving the voluntary combining of different councils were announced in 2022, including for North Yorkshire, the East Midlands and the North East, and again in Chancellor Jeremy Hunt’s 2023 autumn statement for Lancashire, Greater Lincolnshire and East Yorkshire. And a report by Labour’s Commission on the UK’s Future, chaired by former prime minister Gordon Brown, signalled that the party should extend the current government’s programme of English devolution.

This idea lay at the heart of Boris Johnson’s ambitious programme while he was prime minister for addressing the deep disparities in productivity and social outcomes that exist in England, to which he gave the grand but elusive title “levelling up”. This plan – set out in a lengthy white paper in February 2022 – seems, for the most part, to have fallen by the wayside now that Johnson has left the political stage. But it still marked an important staging post in the journey of the once-niche idea of English devolution. Both main political parties have signed up to this principle and have indicated they will create more devolved authorities should they win the next general election.

Advocates sometimes point to an extensive – though hotly contested – body of research on the positive consequences for local economies of taking policy decisions at levels closer to the people they affect. One influential theoretical support for this idea highlights what economists call the “tacit knowledge” about a place, which is often vital to understanding the particular policies and initiatives that are likely to yield most benefit there.

What can be said with more confidence is that a lot hinges on the quality of the institutions that are created, and how well funded they are.

Others argue that a more decentralised system of political authority is more likely to win the allegiance of, and secure more engagement from, people throughout England – in a context where trust in the UK’s political class has plummeted, where MPs are less popular than local councillors, and where there is widespread disenchantment with the perceived bias of central government towards London and the south-east.

However, to what extent does the record of England’s existing “metro mayors” support this case?

‘King of the north’

When the mayor of Greater Manchester, Andy Burnham, staged an impromptu press conference in the street outside Manchester town hall to protest against the local lockdown that the UK government wanted to introduce in the north-west of England in October 2020, his stance received considerable local support – to the extent that he briefly acquired the nickname “king of the north”. Since his election as mayor in May 2017, Burnham has led a number of high-profile initiatives on issues such as homelessness, and overseen the integration of health and local social care services.

Andy Burnham’s impromptu press conference outside Manchester town hall.

Similarly, it is unlikely that a backbench MP would have been able to wrest concessions from a prime minister as did the Conservative mayor of the West Midlands, Andy Street, after he made public his opposition to Rishi Sunak’s decision to cancel the HS2 rail project in September 2023.

While the responsibilities held by England’s metro mayors are, by international standards, pretty limited, they are at times able to deploy what political scientists term the “soft power” that comes from being the acknowledged leader of, and voice for, a locality. They also tend to be more independent of their own party machines than MPs are, going out of their way, when it suits them, to dissent from their parties’ London-based leaderships.

But it would be unwise to get too starry-eyed about a system that relies so heavily on soft power rather than the allocation of formal responsibilities. The absence of an elected legislature tasked with scrutinising and legitimating the work of these leaders – who are typically, and often not very effectively, held to account by local council leaders – is a significant further constraint on their ability to act as democratically legitimate changemakers.

This is very different to the model established in London, which had its own government restored by the first government of Tony Blair in 1999 following a city-wide referendum. The Greater London Authority is made up of elected representatives whose job it is to scrutinise the elected mayor, currently Sadiq Khan, and his administration.

In contrast, metro mayors elsewhere in England – tasked with delivering policies and overseeing funding allocations in areas of priority set by central government – are typically frustrated by the limits imposed on their own agency. Nor do they have the fiscal tools, both in terms of raising revenue and borrowing against financial assets, that are typical of many city and regional governments outside the UK.

The idea of having mini-parliaments across England’s regions, on a par with the legislatures established in Scotland and Wales, was dealt a fatal blow in 2004. During the course of the Blair governments, his long-time deputy prime minister, John Prescott, had pressed for the gradual conversion of the English regional development agencies Labour had created into a form of elected regional administration. But this died a very public death when voters in the north-east overwhelmingly rejected the idea – despite having been selected as the region most likely to support it.

Twenty years on, the suite of new city-regional authorities being created risks deepening the existing cleavage between England’s major cities and those parts of the country without a large urban metropole. Indeed, some of the devolution agreements recently announced had been stalled for years by the unwillingness of particular authorities to participate in these initiatives. The deal encompassing the cities of the north-east, for example, was held up for years by the refusal of Durham County Council to join its larger urban neighbours.

Read more: Inspiring the ‘devolution generation’ in Greater Manchester

The idea that establishing leadership at the level of a large city and its surrounding hinterland can improve the quality of democratic life, and create a more responsive layer of government, remains appealing for many, despite the unsteady emergence of this model in England.

However, amid attempts by UK politicians and administrators to present this as equivalent to the clearer and more robust forms of governance introduced in Scotland, Wales and Northern Ireland, another important question has emerged. Namely, whether the English have come to feel some jealousy and suspicion about these new forms of government established outside England – and less enthusiasm for the union as a whole.

A national grievance?

The idea that England and the English need to be recognised as a distinct national entities within a multi-national union has more popular resonance in an era when debates over sovereignty, national identity and self-determination have become integral to political life

For some, this imperative arises from the belief that changes associated with devolution elsewhere have served to put the English majority at a disadvantage. Some express this in financial terms, arguing that England’s taxpayers have been funding the more generous per-capita settlements awarded to Northern Ireland and Scotland. Others see it as a reflection of the revealed preference of the British political establishment to appease those living in these areas, by awarding their inhabitants additional political rights while neglecting the inhabitants of England’s non-metropolitan areas.

Following the establishment of new parliaments in Belfast, Edinburgh and Cardiff, and the absence of any such model for England, the idea that these reforms have created an imbalance which puts the largest part of the UK at a disadvantage has become a familiar political sentiment. This was particularly salient when the ability of MPs sitting in Scottish and Welsh seats to vote on contentious legislative proposals that applied only to England became a controversial political issue – as in 2004, when the Blair government introduced controversial legislation requiring students at English universities to pay some of their tuition costs.

The constitutional problem created by this imbalance had been aired in parliament by a number of MPs and members of the House of Lords when devolution was first introduced in the late 1990s. Some argued that one of the unintended effects of these changes might be to engender a feeling of national grievance – perhaps even a reactive nationalism – among the English. But for the most part, this prospect was ignored or scoffed at by politicians from both main political parties.

Soon after the new parliaments were established, however, the question of how reforms elsewhere would affect England – and whether it too needed a mechanism to signal the consent of its MPs to legislation that only affected England – moved into the political mainstream. Some campaigners and MPs suggested that only the establishment of an equivalent English parliament could address the profound imbalance created by the devolution granted to the other UK countries.

In 2015, the David Cameron-led Conservative government introduced a new set of rules for dealing with those parts of legislation that related to England only. Known by the acronym EVEL (short for “English vote for English laws”), these reforms proved immensely complicated to operate and elicited little enthusiasm among MPs, while being almost unknown to the wider public. They were quietly abolished by Johnson’s Tory government in 2020.

Read more: Tory votes for Tory Laws? Cameron's EVEL plan to cut out the opposition

While the idea of remaking the UK along federal lines, with each part of the state having its own parliament for domestic legislation, enjoys some support and may grow in appeal, Britain’s politicians and the vast majority of its constitutional experts remain decidedly cool towards this idea. They believe that pushing in this direction could lead to the dissolution of the UK given the preponderant size and wealth of England – meaning it would have a disproportionate amount of influence within a federated UK.

Such a reform is unwarranted on this view, because England is already the most powerful and important part of the UK governing system, with an overwhelming majority of MPs sitting in English seats. But once the question of how and where England sits within the UK’s increasingly discordant union was raised, it would never be easy to put it back into obscurity.

‘When will we get a vote?’

According to some survey evidence, the people in England most likely to believe their country is losing out in the UK’s current devolution settlement are those most inclined to feel that central government is too distant from – and neglectful of – their lives. They were also the most likely to vote to get the UK out of the EU in 2016.

This sentiment was already a sensitive political topic by the mid-2000s, when Conservative MPs became concerned about the implications of devolution elsewhere for the English, while their Labour counterparts typically preferred to hymn the virtues of regional devolution, particularly in northern England. But how the English and their political representatives felt about these issues took on new relevance during the Scottish independence referendum of 2014.

Towards the end of this contest, an announcement of further devolution to Scotland was made in the form of a much-trumpeted “vow” endorsed by the leaders of the Conservative, Labour and Lib Dem parties. Whether this promise of new powers for the Scottish government made any difference to the outcome of this historic poll is highly debatable. But what was notable was the hostile reaction it elicited in different parts of England – including on the part of many Tory MPs towards their prime minister. Such was the level of annoyance it stirred, Cameron was compelled to hold a gathering at his country retreat, Chequers, to assuage the mutinous mood of these backbenchers.

Surveys have suggested that a sizeable minority of the English held strong views about the outcome of the Scottish referendum – with about 20% of respondents happy for the Scots to go, and around the same number worried about the impact of Scotland leaving the UK. But another sentiment was palpable at this time. “When will we get a vote?” was a question I recall being put to me again and again by English audience members at various panel discussions over the summer of 2014. Behind it lay a sense of frustration that, in comparison with the Scots, the English were being left disenfranchised as their allegiance to the governing order was taken for granted.

The contrast between the narrow terms in which the “English question” was framed at Westminster and the growing appeal of powerful ideas about sovereignty, democratic control and national self-determination in this period is striking. And it formed an important prelude to the rebellion of the English majority in the Brexit referendum of 2016 when, finally, they were given a vote on an issue of constitutional importance, with profound economic and societal results.

Despite all that’s since been said about that Brexit vote and its impacts, the question of what happens when a national majority becomes more restive about the multinational arrangements in which it sits demands further consideration in this context. As I argue in my new book, Fractured Union, the future prospects of the UK’s union may even depend on it.

A lesson from history?

One – perhaps slightly unexpected – international example worth considering here is Czechoslovakia, which split into the separate states of the Czech Republic and Slovakia on January 1 1993. Despite many differences in context – not least its long history of rule by the Communist party, and the centrifugal dynamics let loose by the party’s disintegration in 1989 – aspects of this story are highly relevant to the current situation facing the Anglo-Scottish Union in particular.

The break-up of Czechoslovakia did not emanate directly from nationalist demands among the populace, but was significantly determined by decisions made at the political level. Just six months prior to the vote, support for the option of splitting Czechoslovakia into two wholly independent states was as low as 16% in both parts of the country. And there is every chance that a referendum on this issue (which came close to happening) would have produced a majority for the continuation of the status quo.

Two decades earlier, in 1968, new legislation established to protect the Slovaks from being dominated by the Czech majority held that constitutional and other important laws had to be passed on the basis of “special majorities”. These provisions were the source of constant grumbling and some resentment on the Czech side, being perceived as anti-democratic checks upon the will of the majority.

Under the political control of the Communist party, these differences were overridden by the party’s interest in the preservation of the wider state. But once Communism ended and a democratic model was introduced, friction between ideas of Slovakian sovereignty and the imperatives of a federal state model accentuated the underlying tensions between these nations and the parliaments where they were represented. In some echo of the Anglo-Scottish situation, many Czechs resented a perceived imbalance at the scale of representation of the Slovaks within the federal government, and questioned the disproportionate transfer of resources to the poorer Slovakian territory.

Despite extended and fraught negotiations over the constitutional framework, the gulf in the constitutional outlooks of politicians from these territories was considerable, with both sets espousing entirely different constitutional perspectives. Agreement was finally reached on a new federal framework in November 1991, but this deal was voted down by the Slovak parliament. Its Czech equivalent thereafter declared that further negotiation with the Slovak side would be pointless.

At the parliamentary elections of June 1992, the main winners in both territories were the political parties least inclined to compromise with the other side. Having given up on negotiations, and with the prospect of a referendum in Slovakia on its future within the state having been abandoned too, the Czech government moved towards the idea of a speedy and complete division.

Could it happen in the UK?

Czechoslovakia’s split throws into relief the key role politicians can play in moments of constitutional crisis, as well as the corrosive effect of feelings of neglect and unfairness among a national majority that can build up over time. It highlights, too, the challenge of sustaining a union when politicians at central and sub-state levels hold irreconcilable constitutional worldviews, and are fishing for votes in different territorial ponds.

Is it conceivable that some British politicians could, at some point, seek advantage by mobilising an appeal to the English majority against the claims and complaints of the smaller nations in the UK? And might the emergence of public scepticism within parts of the Tory party towards the models of devolved government in Cardiff and Edinburgh be understood as the first signs of such a dynamic?

There have already been moments in the recent political past when the appeal to the defence of neglected English interests has been politically powerful – for instance, during the 2015 general election campaign when the Conservatives deployed images of Labour’s leader, Ed Miliband, sitting in the pocket of the SNP’s leader, Nicola Sturgeon. And this may well recur as a theme in future Westminster elections, particularly if the SNP is able to recover from its current downturn.

However, in the longer run, what will do most to determine how the disaffected inhabitants of “provincial” England feel about devolution – and the lure of greater recognition and protection for English interests – is the quality of governance, service provision and economic opportunity they experience.

In recent years, despite the introduction of metro mayors, there has been little success in closing the regional gaps which “levelling up” was designed to address, and there is a real prospect of yet more local authorities going bankrupt. It would be little wonder, then, if the calls for greater priority to be paid to the concerns of the English heartland grow louder in years to come.

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Michael Kenny receives funding from the British Academy and (previously) the Economic and Social Research Council. His latest book is Fractured Union: Politics, Sovereignty and the Fight to Save the UK (Hurst, January 2024).

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Copper Soars, Iron Ore Tumbles As Goldman Says “Copper’s Time Is Now”

Copper Soars, Iron Ore Tumbles As Goldman Says "Copper’s Time Is Now"

After languishing for the past two years in a tight range despite recurring…



Copper Soars, Iron Ore Tumbles As Goldman Says "Copper's Time Is Now"

After languishing for the past two years in a tight range despite recurring speculation about declining global supply, copper has finally broken out, surging to the highest price in the past year, just shy of $9,000 a ton as supply cuts hit the market; At the same time the price of the world's "other" most important mined commodity has diverged, as iron ore has tumbled amid growing demand headwinds out of China's comatose housing sector where not even ghost cities are being built any more.

Copper surged almost 5% this week, ending a months-long spell of inertia, as investors focused on risks to supply at various global mines and smelters. As Bloomberg adds, traders also warmed to the idea that the worst of a global downturn is in the past, particularly for metals like copper that are increasingly used in electric vehicles and renewables.

Yet the commodity crash of recent years is hardly over, as signs of the headwinds in traditional industrial sectors are still all too obvious in the iron ore market, where futures fell below $100 a ton for the first time in seven months on Friday as investors bet that China’s years-long property crisis will run through 2024, keeping a lid on demand.

Indeed, while the mood surrounding copper has turned almost euphoric, sentiment on iron ore has soured since the conclusion of the latest National People’s Congress in Beijing, where the CCP set a 5% goal for economic growth, but offered few new measures that would boost infrastructure or other construction-intensive sectors.

As a result, the main steelmaking ingredient has shed more than 30% since early January as hopes of a meaningful revival in construction activity faded. Loss-making steel mills are buying less ore, and stockpiles are piling up at Chinese ports. The latest drop will embolden those who believe that the effects of President Xi Jinping’s property crackdown still have significant room to run, and that last year’s rally in iron ore may have been a false dawn.

Meanwhile, as Bloomberg notes, on Friday there were fresh signs that weakness in China’s industrial economy is hitting the copper market too, with stockpiles tracked by the Shanghai Futures Exchange surging to the highest level since the early days of the pandemic. The hope is that headwinds in traditional industrial areas will be offset by an ongoing surge in usage in electric vehicles and renewables.

And while industrial conditions in Europe and the US also look soft, there’s growing optimism about copper usage in India, where rising investment has helped fuel blowout growth rates of more than 8% — making it the fastest-growing major economy.

In any case, with the demand side of the equation still questionable, the main catalyst behind copper’s powerful rally is an unexpected tightening in global mine supplies, driven mainly by last year’s closure of a giant mine in Panama (discussed here), but there are also growing worries about output in Zambia, which is facing an El Niño-induced power crisis.

On Wednesday, copper prices jumped on huge volumes after smelters in China held a crisis meeting on how to cope with a sharp drop in processing fees following disruptions to supplies of mined ore. The group stopped short of coordinated production cuts, but pledged to re-arrange maintenance work, reduce runs and delay the startup of new projects. In the coming weeks investors will be watching Shanghai exchange inventories closely to gauge both the strength of demand and the extent of any capacity curtailments.

“The increase in SHFE stockpiles has been bigger than we’d anticipated, but we expect to see them coming down over the next few weeks,” Colin Hamilton, managing director for commodities research at BMO Capital Markets, said by phone. “If the pace of the inventory builds doesn’t start to slow, investors will start to question whether smelters are actually cutting and whether the impact of weak construction activity is starting to weigh more heavily on the market.”

* * *

Few have been as happy with the recent surge in copper prices as Goldman's commodity team, where copper has long been a preferred trade (even if it may have cost the former team head Jeff Currie his job due to his unbridled enthusiasm for copper in the past two years which saw many hedge fund clients suffer major losses).

As Goldman's Nicholas Snowdon writes in a note titled "Copper's time is now" (available to pro subscribers in the usual place)...

... there has been a "turn in the industrial cycle." Specifically according to the Goldman analyst, after a prolonged downturn, "incremental evidence now points to a bottoming out in the industrial cycle, with the global manufacturing PMI in expansion for the first time since September 2022." As a result, Goldman now expects copper to rise to $10,000/t by year-end and then $12,000/t by end of Q1-25.’

Here are the details:

Previous inflexions in global manufacturing cycles have been associated with subsequent sustained industrial metals upside, with copper and aluminium rising on average 25% and 9% over the next 12 months. Whilst seasonal surpluses have so far limited a tightening alignment at a micro level, we expect deficit inflexions to play out from quarter end, particularly for metals with severe supply binds. Supplemented by the influence of anticipated Fed easing ahead in a non-recessionary growth setting, another historically positive performance factor for metals, this should support further upside ahead with copper the headline act in this regard.

Goldman then turns to what it calls China's "green policy put":

Much of the recent focus on the “Two Sessions” event centred on the lack of significant broad stimulus, and in particular the limited property support. In our view it would be wrong – just as in 2022 and 2023 – to assume that this will result in weak onshore metals demand. Beijing’s emphasis on rapid growth in the metals intensive green economy, as an offset to property declines, continues to act as a policy put for green metals demand. After last year’s strong trends, evidence year-to-date is again supportive with aluminium and copper apparent demand rising 17% and 12% y/y respectively. Moreover, the potential for a ‘cash for clunkers’ initiative could provide meaningful right tail risk to that healthy demand base case. Yet there are also clear metal losers in this divergent policy setting, with ongoing pressure on property related steel demand generating recent sharp iron ore downside.

Meanwhile, Snowdon believes that the driver behind Goldman's long-running bullish view on copper - a global supply shock - continues:

Copper’s supply shock progresses. The metal with most significant upside potential is copper, in our view. The supply shock which began with aggressive concentrate destocking and then sharp mine supply downgrades last year, has now advanced to an increasing bind on metal production, as reflected in this week's China smelter supply rationing signal. With continued positive momentum in China's copper demand, a healthy refined import trend should generate a substantial ex-China refined deficit this year. With LME stocks having halved from Q4 peak, China’s imminent seasonal demand inflection should accelerate a path into extreme tightness by H2. Structural supply underinvestment, best reflected in peak mine supply we expect next year, implies that demand destruction will need to be the persistent solver on scarcity, an effect requiring substantially higher pricing than current, in our view. In this context, we maintain our view that the copper price will surge into next year (GSe 2025 $15,000/t average), expecting copper to rise to $10,000/t by year-end and then $12,000/t by end of Q1-25’

Another reason why Goldman is doubling down on its bullish copper outlook: gold.

The sharp rally in gold price since the beginning of March has ended the period of consolidation that had been present since late December. Whilst the initial catalyst for the break higher came from a (gold) supportive turn in US data and real rates, the move has been significantly amplified by short term systematic buying, which suggests less sticky upside. In this context, we expect gold to consolidate for now, with our economists near term view on rates and the dollar suggesting limited near-term catalysts for further upside momentum. Yet, a substantive retracement lower will also likely be limited by resilience in physical buying channels. Nonetheless, in the midterm we continue to hold a constructive view on gold underpinned by persistent strength in EM demand as well as eventual Fed easing, which should crucially reactivate the largely for now dormant ETF buying channel. In this context, we increase our average gold price forecast for 2024 from $2,090/toz to $2,180/toz, targeting a move to $2,300/toz by year-end.

Much more in the full Goldman note available to pro subs.

Tyler Durden Fri, 03/15/2024 - 14:25

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The millions of people not looking for work in the UK may be prioritising education, health and freedom

Economic inactivity is not always the worst option.




Taking time out. pathdoc/Shutterstock

Around one in five British people of working age (16-64) are now outside the labour market. Neither in work nor looking for work, they are officially labelled as “economically inactive”.

Some of those 9.2 million people are in education, with many students not active in the labour market because they are studying full-time. Others are older workers who have chosen to take early retirement.

But that still leaves a large number who are not part of the labour market because they are unable to work. And one key driver of economic inactivity in recent years has been illness.

This increase in economic inactivity – which has grown since before the pandemic – is not just harming the economy, but also indicative of a deeper health crisis.

For those suffering ill health, there are real constraints on access to work. People with health-limiting conditions cannot just slot into jobs that are available. They need help to address the illnesses they have, and to re-engage with work through organisations offering supportive and healthy work environments.

And for other groups, such as stay-at-home parents, businesses need to offer flexible work arrangements and subsidised childcare to support the transition from economic inactivity into work.

The government has a role to play too. Most obviously, it could increase investment in the NHS. Rising levels of poor health are linked to years of under-investment in the health sector and economic inactivity will not be tackled without more funding.

Carrots and sticks

For the time being though, the UK government appears to prefer an approach which mixes carrots and sticks. In the March 2024 budget, for example, the chancellor cut national insurance by 2p as a way of “making work pay”.

But it is unclear whether small tax changes like this will have any effect on attracting the economically inactive back into work.

Jeremy Hunt also extended free childcare. But again, questions remain over whether this is sufficient to remove barriers to work for those with parental responsibilities. The high cost and lack of availability of childcare remain key weaknesses in the UK economy.

The benefit system meanwhile has been designed to push people into work. Benefits in the UK remain relatively ungenerous and hard to access compared with other rich countries. But labour shortages won’t be solved by simply forcing the economically inactive into work, because not all of them are ready or able to comply.

It is also worth noting that work itself may be a cause of bad health. The notion of “bad work” – work that does not pay enough and is unrewarding in other ways – can lead to economic inactivity.

There is also evidence that as work has become more intensive over recent decades, for some people, work itself has become a health risk.

The pandemic showed us how certain groups of workers (including so-called “essential workers”) suffered more ill health due to their greater exposure to COVID. But there are broader trends towards lower quality work that predate the pandemic, and these trends suggest improving job quality is an important step towards tackling the underlying causes of economic inactivity.


Another big section of the economically active population who cannot be ignored are those who have retired early and deliberately left the labour market behind. These are people who want and value – and crucially, can afford – a life without work.

Here, the effects of the pandemic can be seen again. During those years of lockdowns, furlough and remote working, many of us reassessed our relationship with our jobs. Changed attitudes towards work among some (mostly older) workers can explain why they are no longer in the labour market and why they may be unresponsive to job offers of any kind.

Sign on railings supporting NHS staff during pandemic.
COVID made many people reassess their priorities. Alex Yeung/Shutterstock

And maybe it is from this viewpoint that we should ultimately be looking at economic inactivity – that it is actually a sign of progress. That it represents a move towards freedom from the drudgery of work and the ability of some people to live as they wish.

There are utopian visions of the future, for example, which suggest that individual and collective freedom could be dramatically increased by paying people a universal basic income.

In the meantime, for plenty of working age people, economic inactivity is a direct result of ill health and sickness. So it may be that the levels of economic inactivity right now merely show how far we are from being a society which actually supports its citizens’ wellbeing.

David Spencer has received funding from the ESRC.

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Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal…



Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal immigrants are flooding into U.S. hospitals for treatment and leaving billions in uncompensated health care costs in their wake.

The House Committee on Homeland Security recently released a report illustrating that from the estimated $451 billion in annual costs stemming from the U.S. border crisis, a significant portion is going to health care for illegal immigrants.

With the majority of the illegal immigrant population lacking any kind of medical insurance, hospitals and government welfare programs such as Medicaid are feeling the weight of these unanticipated costs.

Apprehensions of illegal immigrants at the U.S. border have jumped 48 percent since the record in fiscal year 2021 and nearly tripled since fiscal year 2019, according to Customs and Border Protection data.

Last year broke a new record high for illegal border crossings, surpassing more than 3.2 million apprehensions.

And with that sea of humanity comes the need for health care and, in most cases, the inability to pay for it.

In January, CEO of Denver Health Donna Lynne told reporters that 8,000 illegal immigrants made roughly 20,000 visits to the city’s health system in 2023.

The total bill for uncompensated care costs last year to the system totaled $140 million, said Dane Roper, public information officer for Denver Health. More than $10 million of it was attributed to “care for new immigrants,” he told The Epoch Times.

Though the amount of debt assigned to illegal immigrants is a fraction of the total, uncompensated care costs in the Denver Health system have risen dramatically over the past few years.

The total uncompensated costs in 2020 came to $60 million, Mr. Roper said. In 2022, the number doubled, hitting $120 million.

He also said their city hospitals are treating issues such as “respiratory illnesses, GI [gastro-intenstinal] illnesses, dental disease, and some common chronic illnesses such as asthma and diabetes.”

“The perspective we’ve been trying to emphasize all along is that providing healthcare services for an influx of new immigrants who are unable to pay for their care is adding additional strain to an already significant uncompensated care burden,” Mr. Roper said.

He added this is why a local, state, and federal response to the needs of the new illegal immigrant population is “so important.”

Colorado is far from the only state struggling with a trail of unpaid hospital bills.

EMS medics with the Houston Fire Department transport a Mexican woman the hospital in Houston on Aug. 12, 2020. (John Moore/Getty Images)

Dr. Robert Trenschel, CEO of the Yuma Regional Medical Center situated on the Arizona–Mexico border, said on average, illegal immigrants cost up to three times more in human resources to resolve their cases and provide a safe discharge.

“Some [illegal] migrants come with minor ailments, but many of them come in with significant disease,” Dr. Trenschel said during a congressional hearing last year.

“We’ve had migrant patients on dialysis, cardiac catheterization, and in need of heart surgery. Many are very sick.”

He said many illegal immigrants who enter the country and need medical assistance end up staying in the ICU ward for 60 days or more.

A large portion of the patients are pregnant women who’ve had little to no prenatal treatment. This has resulted in an increase in babies being born that require neonatal care for 30 days or longer.

Dr. Trenschel told The Epoch Times last year that illegal immigrants were overrunning healthcare services in his town, leaving the hospital with $26 million in unpaid medical bills in just 12 months.

ER Duty to Care

The Emergency Medical Treatment and Labor Act of 1986 requires that public hospitals participating in Medicare “must medically screen all persons seeking emergency care … regardless of payment method or insurance status.”

The numbers are difficult to gauge as the policy position of the Centers for Medicare & Medicaid Services (CMS) is that it “will not require hospital staff to ask patients directly about their citizenship or immigration status.”

In southern California, again close to the border with Mexico, some hospitals are struggling with an influx of illegal immigrants.

American patients are enduring longer wait times for doctor appointments due to a nursing shortage in the state, two health care professionals told The Epoch Times in January.

A health care worker at a hospital in Southern California, who asked not to be named for fear of losing her job, told The Epoch Times that “the entire health care system is just being bombarded” by a steady stream of illegal immigrants.

“Our healthcare system is so overwhelmed, and then add on top of that tuberculosis, COVID-19, and other diseases from all over the world,” she said.

A Salvadorian man is aided by medical workers after cutting his leg while trying to jump on a truck in Matias Romero, Mexico, on Nov. 2, 2018. (Spencer Platt/Getty Images)

A newly-enacted law in California provides free healthcare for all illegal immigrants residing in the state. The law could cost taxpayers between $3 billion and $6 billion per year, according to recent estimates by state and federal lawmakers.

In New York, where the illegal immigration crisis has manifested most notably beyond the southern border, city and state officials have long been accommodating of illegal immigrants’ healthcare costs.

Since June 2014, when then-mayor Bill de Blasio set up The Task Force on Immigrant Health Care Access, New York City has worked to expand avenues for illegal immigrants to get free health care.

“New York City has a moral duty to ensure that all its residents have meaningful access to needed health care, regardless of their immigration status or ability to pay,” Mr. de Blasio stated in a 2015 report.

The report notes that in 2013, nearly 64 percent of illegal immigrants were uninsured. Since then, tens of thousands of illegal immigrants have settled in the city.

“The uninsured rate for undocumented immigrants is more than three times that of other noncitizens in New York City (20 percent) and more than six times greater than the uninsured rate for the rest of the city (10 percent),” the report states.

The report states that because healthcare providers don’t ask patients about documentation status, the task force lacks “data specific to undocumented patients.”

Some health care providers say a big part of the issue is that without a clear path to insurance or payment for non-emergency services, illegal immigrants are going to the hospital due to a lack of options.

“It’s insane, and it has been for years at this point,” Dana, a Texas emergency room nurse who asked to have her full name omitted, told The Epoch Times.

Working for a major hospital system in the greater Houston area, Dana has seen “a zillion” migrants pass through under her watch with “no end in sight.” She said many who are illegal immigrants arrive with treatable illnesses that require simple antibiotics. “Not a lot of GPs [general practitioners] will see you if you can’t pay and don’t have insurance.”

She said the “undocumented crowd” tends to arrive with a lot of the same conditions. Many find their way to Houston not long after crossing the southern border. Some of the common health issues Dana encounters include dehydration, unhealed fractures, respiratory illnesses, stomach ailments, and pregnancy-related concerns.

“This isn’t a new problem, it’s just worse now,” Dana said.

Emergency room nurses and EMTs tend to patients in hallways at the Houston Methodist The Woodlands Hospital in Houston on Aug. 18, 2021. (Brandon Bell/Getty Images)

Medicaid Factor

One of the main government healthcare resources illegal immigrants use is Medicaid.

All those who don’t qualify for regular Medicaid are eligible for Emergency Medicaid, regardless of immigration status. By doing this, the program helps pay for the cost of uncompensated care bills at qualifying hospitals.

However, some loopholes allow access to the regular Medicaid benefits. “Qualified noncitizens” who haven’t been granted legal status within five years still qualify if they’re listed as a refugee, an asylum seeker, or a Cuban or Haitian national.

Yet the lion’s share of Medicaid usage by illegal immigrants still comes through state-level benefits and emergency medical treatment.

A Congressional report highlighted data from the CMS, which showed total Medicaid costs for “emergency services for undocumented aliens” in fiscal year 2021 surpassed $7 billion, and totaled more than $5 billion in fiscal 2022.

Both years represent a significant spike from the $3 billion in fiscal 2020.

An employee working with Medicaid who asked to be referred to only as Jennifer out of concern for her job, told The Epoch Times that at a state level, it’s easy for an illegal immigrant to access the program benefits.

Jennifer said that when exceptions are sent from states to CMS for approval, “denial is actually super rare. It’s usually always approved.”

She also said it comes as no surprise that many of the states with the highest amount of Medicaid spending are sanctuary states, which tend to have policies and laws that shield illegal immigrants from federal immigration authorities.

Moreover, Jennifer said there are ways for states to get around CMS guidelines. “It’s not easy, but it can and has been done.”

The first generation of illegal immigrants who arrive to the United States tend to be healthy enough to pass any pre-screenings, but Jennifer has observed that the subsequent generations tend to be sicker and require more access to care. If a family is illegally present, they tend to use Emergency Medicaid or nothing at all.

The Epoch Times asked Medicaid Services to provide the most recent data for the total uncompensated care that hospitals have reported. The agency didn’t respond.

Continue reading over at The Epoch Times

Tyler Durden Fri, 03/15/2024 - 09:45

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