Is world-leading NHS healthcare an affordable proposition?

Authors:

David Laws, Consultant Anaesthetist, City Hospitals Sunderland NHS Foundation Trust, Sunderland, Tyne & Wear, SR4 7TP

Professor Charles S. Adams, Department of Physics, Durham University, Durham, DH1 3LE

Introduction:

The unquestioned assertion that a highly developed currency-issuing nation cannot afford high quality healthcare [1] is based upon a set of inter-related and almost universally-held false assumptions:
  • Money is in limited supply (as there is no ‘magic money tree’).
  • Taxes fund government spending.
  • Private banks lend out pre-existing savings.
  • NHS spending is a burden on the economy rather than a boost to the economy.

 

1) Money is created ‘out of nothing’ on bank computers

In 1973 the Bretton-Woods international exchange rate system, where currencies were ultimately pegged to the price of gold, was formally ended. Since that time we have used an international fiat monetary system where the value of each currency is determined by the workings of international financial markets. Fiat (Latin: ‘let it be made’) money is created from nothing on the basis of a promise – a promise to deliver goods or services in the future. Only if we believe in these promises and the systems that support them, does money have value.

The following description of the monetary system and its components is highly schematic to aid elucidation of the underlying principles. Money is created either when the government spends or when a bank makes a loan.[2] We can think of government spending and bank loans as the beginning of two interconnected money circuits. The government and bank circuits form the duopoly of money creation, rather like the pulmonary and systemic circulations of the cardiovascular system only in this case the circuits work in parallel. Both circuits are supported by the central bank which creates a unique type of money held within the bank known as electronic reserves (Figure 1). To extend the analogy of the cardiovascular system, the central bank is akin to the heart, individual bank accounts would be equivalent to the capillaries and the wider economy would be the working cells of the body.

The two monetary circuits commingle through banking transactions so bank money and government money become indistinguishable to bank account users. After money is created it flows through the economy and eventually returns to the issuer.

 

Figure 1: Schematic diagram of the monetary system of a sovereign nation. Bank account users cannot distinguish the origin of their deposits.
.

 

2) The government money circuit – taxation removes money from the system

In the government circuit, money is spent into the economy and is effectively cancelled when it returns to the government via the payment of taxes. The collection of taxes is not a prerequisite for government spending as many people assume, but exists at the end of the government money cycle when taxes removed prevent too much money being created. Taxation mainly helps to control inflation and alter peoples’ behaviour in a way that should be beneficial to all. The net result of deficit spending is to leave savings in the form of Government Bonds in the hands of the private sector (Figure 2).

Figure 2: The government spend and tax circuit with a deficit. The difference between spend and tax equals private sector saving and is known as the deficit.

 

Conversely a government surplus (where taxation exceeds spending) would destroy these savings. The superficially sensible idea of running a balanced government budget simply prevents saving in the private sector. This is illustrated in models a) and b) within Figure 3. In a) the government injects money via a fiscal stimulus in year zero. Taxation means that over time all this money is returned. In b) the public choose to save a fraction of their income which leads to the deficit. Savings simply delay the return of money in the circuit. In other words, the private sector is only able to save money because the government supports this activity by running a deficit. The government circuit is leaky by design. For example, people are encouraged through tax breaks to save for their future (e.g. pensions & ISAs). Therefore, the national debt is not what we currently owe but what we currently own.

Figure 3: (a) model which shows that after government spend (fiscal stimulus) if people do not save then all the money comes back as tax, whereas if people save this leads to the deficit (b).

 

3) The private bank money circuit – banks create credit and don’t lend out savings

Most of our money is created in the form of bank loans (credit). When a loan agreement is signed the bank creates a new bank deposit to the value of the loan in the borrower’s bank account. Money is returned to the bank by the repayment of the loan plus interest (Figure 4). Similar to government spending, bank lending influences private sector behaviour but the allocation of money creation is not democratically controlled. The primary purpose of bank lending is to enable individuals and businesses to function and to generate profits for bank shareholders, both over the short and long-term.

Figure 4: The bank circuit where loans concurrently create bank customer deposits and private debt leading to bank profits.

 

Banks must have a licence issued by the government to create money in this manner and aspects of their activities are regulated. However there are no formal economic, social or environmental responsibilities associated with the creation and allocation of bank credit despite the significant influence these decisions have over our lives. Bank credit creation is predominantly distributed towards land (property) and financial asset speculation which dwarfs their support for entrepreneurship. The majority of UK small businesses are actually self-financing.[3]

As the proportion of unproductive private debt increases in an economy a correspondingly increasing proportion of economic output is directed towards servicing this interest-bearing debt. Consequently the private bank money circuit tends to be inherently destabilizing as it drives assets towards the already wealthy making the economy increasingly fragile.

What are the outcomes when the two circuits combine?

If all the money was returned to the issuers the quantity of money would go back to zero (the balanced budget illustrated in Figure 3a). In practice the rate of new money creation is usually higher than the rate of money cancellation and the total amount of money in the economy grows over time to support economic growth (Figure 5). Ideally growth in the money supply should match the growth in economic activity, such that prices remain roughly stable and we maintain confidence in the value of our currency unit. Control of the rate of money creation and destruction in the government and banking circuits are known fiscal and monetary policy, respectively.

Figure 5: UK Money (M4) Supply 1987 – 2017. Source: Bank of England.

 

The money supply increased significantly in the decades prior to the Global Financial Crisis (circa. 2007) primarily through bank credit expansion. In contrast, between 2009 and 2014 net credit was negative.[3] As bank credit creation wavered from 2008 onwards, government deficits rose to prevent a deflationary depression. The actual sector balance data for the UK is shown in Figure 6 and there is similarity with the simple model we presented in Figure 3. Note that the rest of the world is a net saver of UK money (these savings have to be spent in the UK ultimately). Note also that when these three sectors combine, the balance is near zero as this is nothing more than an accounting identity.

Figure 6: UK sectoral balances data from the ONS. The inverse correlation between Private and Public sectoral balances. Private sector savings mirror the public sector deficit as illustrated by the model in Figure 3.

 

Why two circuits?

Why do we need this duopoly of both a government circuit and a banking circuit? Why do we need both fiscal and monetary policy? As money is a collective good, should we transfer all money creation powers to government and demote private banks to the role of intermediaries as some propose? Or could we hand over all money creation to private banks as free-market fundamentalists would prefer?

Put simply, the commercial bank circuit serves private needs while the government circuit serves collective needs. The bank circuit exists to serve individuals and ‘capitalism’, while the government circuit exists to deliver on democratically controlled promises.

Economists often call our collective interests public goods. The failure of the private interest bank circuit to provide public goods is easy to understand by exploring healthcare. The market solution is to cater for the patient offering to pay the most. Even worse, the market may deliberately create a scarcity in order to charge a higher price. A market cannot operate effectively in matters of life and death. Kenneth Arrow a highly-respected pioneer of neoclassical economics and winner of the Nobel Prize in Economics in 1972 wrote ‘the laissez-faire solution for medicine is intolerable’.[4] In situations where competition is not viable, where demand is unlimited like health, and supply delivers societal benefits, then collective democratic control is the optimal solution. The House of Lords Select Committee on the Long-term Sustainability of the NHS report in April 2017 reaffirmed that the principal method of funding the NHS should be via government spending.[5]

What has gone wrong?

The art of economic management is to balance fiscal and monetary policy. An over dependence of one or other is doomed in the long term. The core failure over recent history lies in the inability of politicians and central bankers to regulate the banks and to use fiscal policy appropriately. There now exists UK Department of Health data to support the assertion that government austerity may be the primary underlying cause for the deterioration of health inequality measures in England.[6]

‘In her present condition, Great Britain resembles one those unwholesome bodies in which some of the vital parts are overgrown…and through which an unnatural proportion of the industry and commerce of the country has been forced to circulate, (which) is very likely to bring on the most dangerous disorder upon the whole body politick’. When one considers the unhealthy dominance of the financial sector within the UK and global economy today, it may be surprising to discover that Adam Smith wrote these prescient words in the Wealth of Nations over two hundred and forty years ago.[7]

In a similar vein, using central bank monetary policy alone to rescue the global economy has been misguided. In 1969, the world-famous economist, Milton Friedman said ‘The available evidence . . . casts grave doubts on the possibility of producing any fine adjustments in economic activity by fine adjustments in monetary policy’.[8] More recently, Mark Carney, the Governor of the Bank of England, reinforced this point in his ‘The Spectre of Monetarism’ speech published in December 2016 where he stresses that monetary policy needs to be in ‘better balance with fiscal and structural policies’. [9] The sudden change to no money growth after 2010 in Figure 5 is evidence of the complete failings of recent monetary and fiscal policy.

 

4) NHS spending boosts the wider economy in excess of the money spent

Fiscal policy is very powerful but needs to be carefully managed. The NHS was conceived and built in times of high national debt. This could occur because creation of money is not an inherent constraint. Thanks to the government spend and tax circuit, the NHS nurse, doctor, physiotherapist or pharmacist need not cost anything as long as (they serve a useful purpose and) the money spent on them is also spent. In fact, it is more likely that society will profit through ‘crowding in’ more economic activity through NHS employees’ subsequent spending and a healthier public.

It is estimated that the fiscal multiplier for UK healthcare spending currently lies between 2.5 and 6.1. This means for every £1 spent on the NHS approximately £4 of economic activity results.[10] If you had a cash-back card that gave you £4 back for every £1 spent, you would not cut back on your spending! Only when we reach a position of over supply when NHS staff wait forlornly for patients to present do we reach a point where the multiplier falls to below one. We are, at present, an unsafe distance from a workforce oversupply scenario.

As a sovereign nation, the UK can always afford high quality universal NHS healthcare. Money is essentially an accounting system designed to facilitate our collective activities and development. Fiscal policy needs to be activated to meet the needs of our society as there is now observable failure of the prevailing reliance on monetary policy and preservation of rent-seeking private interests. It is evidently wrong to assert that healthcare access and quality is limited by the availability of money. The constraint, in truth, has never been the potential availability of money, but the desire to resource the NHS appropriately. In the words of John Maynard Keynes, ‘Anything we can actually do we can afford’. [11]

References

[1] Department of Health annual report and accounts 2016 to 2017 https://www.gov.uk/government/publications/department-of-health-annual-report-and-accounts-2016-to-2017 (accessed August 2017)

[2] Money Creation in the Modern Economy. Bank of England Spring Bulletin 2014

http://www.bankofengland.co.uk/publications/Documents/quarterlybulletin/2014/qb14q102.pdf (accessed August 2017)

[3] Bank of England interactive database

http://www.bankofengland.co.uk/boeapps/iadb/newintermed.asp (accessed August 2017)

[4] Uncertainty and the Welfare economics of medical care. Kenneth J. Arrow. The American Economic Review December 1963. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf (accessed August 2017)

[5] House of Lords Select Committee on the Long-term Sustainability of the NHS. The Long-term Sustainability of the NHS and Adult Social Care Report Published 5th April 2017. p44. https://publications.parliament.uk/pa/ld201617/ldselect/ldnhssus/151/151.pdf (accessed August 2017)

[6] David Buck, King’s Fund  https://www.kingsfund.org.uk/blog/2017/08/reducing-inequalities-health-towards-brave-old-world (accessed August 2017)

[7] Smith, Adam. An Inquiry into the Nature and Causes of the Wealth of Nations. p468-9. Edited by S. M. Soares. MetaLibri Digital Library, 29th May 2007 (accessed August 2017)

[8] Milton Friedman and Walter W. Heller, Monetary vs. Fiscal Policy, W. W. Norton and Company Inc., New York 1969.

[9] ‘The Spectre of Monetarism’. Speech by The Governor of the Bank of England. December 2016. http://www.bankofengland.co.uk/publications/Documents/speeches/2016/speech946.pdf (accessed August 2017)

[10] Does investment in the health sector promote or inhibit economic growth? Aaron Reeves et al. Globalization and Health 2013. https://doi.org/10.1186/1744-8603-9-43

[11] The Collected Writings of John Maynard Keynes. Vol. 27 p270. Activities 1940–1946: Shaping the Post- War World: Employment and Commodities ISBN 978-1-107-65156-2

 

 

 

 

 

Comments

  1. Sean Danaher -

    Thanks,
    this covers many of the themes presented and discuss at Progressive Pulse over the past six months. It is very nice to have them together in one paper

  2. Peter May -

    “Only when we reach a position of over supply when NHS staff wait forlornly for patients to present do we reach a point where the multiplier falls to below one.”
    If only….
    Mind you I think we could have a much less interventionist health policy if only we properly controlled all soft drinks, the take away food industry and partcularly prepared meals in supermarkets. This would encounter a lot of vested interest opposition but would otherwise be simple.That would help to control causes rather than results. But when Jeremy Hunt, health secretary, wears a Tate & Lyle sposored lanyard at the Conservative Party conference it becomes a sick joke – almost literally.

    1. David Howdle -

      I absolutely agree. I believe that Finland, for one, has greatly improved its national health by adjusting taxation.

  3. Graham -

    As you point out the main constraint is political priorities; but also, politicians’ understanding of the arguments so clearly expressed in this article. They still seem to believe the economy is like running a household.

    But a naive question, so why not double, quadruple etc spending on the NHS? Would there not be some negative consequences?

    Re Peter’s post, what we have is a NIS – National Ill-health Service. More resources need to be addressed to prevention.

    1. Charles Adams -

      There is an optimal level of funding so yes you can have too much. When there are no waiting lists and NHS staff are waiting for patients to turn up you know you have created too much capacity.

      A harder question is to decide what drugs and treatments to support but the medical profession has mechanisms to decide on such matters (still not always black and white though, which is why I think we need the discussion to be open).

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  5. Brian Stobie -

    Nice article describing the actual role of money and debt in a country with its own sovereign currency such as the UK. I like particularly the diagrams and descriptions of inter-linking monetary flows.

    However, I would have expected the authors to at least mention that all this has described for years in Modern Monetary Theory. with at least a nod to its authors such as Mitchell and Wray?.

    1. Charles Adams -

      Thanks. On MMT, I would say that what we write about is simple Keynesian fiscal stimulus in a fiat money era. The sectoral balance idea originates with Wynne Godley and predates MMT. However, I would acknowledge that the MMT people have done excellent work in explaining these things to the rest of us.

  6. Allen Bell -

    Correction required on point 10 – the article claims that NHS spending has a positive multiplier, the linked source does not say that in the headline, just mentioning ‘investment’ whatever that is, it’s not the same as all spending.
    In my view the UK public does get high quality care from dentists, vets, opticians, cosmetic surgeons, fitness centres, park run organisers and slimming world consultants etc.
    What seems to be a problem is getting high quality care from the socialised sector – and the two answers that NHS worshippers seem to approve of are more money with the queens head on it for the socialised sector ( which is what we’ve had already as around 1/5th of government overspending goes on the NHS and existing QE facilitates funding for that ).
    And ensuring that limited resources come through the training system
    http://www.bmj.com/content/337/bmj.a748

    1. Charles Adams -

      Correction required on point 10 – the article claims that NHS spending has a positive multiplier, the linked source does not say that in the headline

      We know that the multiplier is one if the spending does not crowd out or crowd in more activity in the private sector. If you think that spending will crowd in more spending in the private sector then the multiplier is greater than one. We are free to choose (!) what we think is the right thing to do.

      In my view the UK public does get high quality care from dentists, vets, opticians, cosmetic surgeons, fitness centres, park run organisers and slimming world consultant

      but these are lifestyle issues, when about life threatening issues?

      What seems to be a problem is getting high quality care from the socialised sector

      The evidence from the US is that private means higher costs (between 2 and 3 times UK spend per capita) and worse outcomes (lower live expectancy and worse coverage).

      as around 1/5th of government overspending goes on the NHS

      In terms of GDP UK is relatively low on health spend (9.1% compared to 17.1% for US), partly because a socialised system is more efficient and does not suffer from rent extraction!

    2. AliB -

      You seem to be unaware that a lot of people do not access dentistry any more because the costs are so high. If forced to through pain, then they take the cheapest option i.e. have the tooth removed, rather than treated. Very few people have cosmetic surgery, and not surprisingly you appear to have already forgotten the breast implant scandal where the NHS largely had to pick up the tab and the work due to the failure of the private sector to address the issue. Your ideological blinkers are on full display.

  7. Ms Christine Bergin -

    Currently reading Bread for All by Chris Renwick. We have had Poor Laws in this country since 1600s following the dissolution of the monasteries. At some point the workhouses also developed into rudimentary hospitals. Given that large numbers of young men were deemed not fit enough to be soldiers in the Great War the development of some sort of collective care system, all be it in a manner we would not recognise today, was almost inevitable as is the resistance of the wealthy classes that can fend for themselves. I think it is forgotten that disease doesn’t stop at the Estate Gate.

    1. Charles Adams -

      I have not read Bread for all, but it looks like perhaps we all should. Thanks.

  8. David Wallace -

    I would have thought that the limiting factor is not so much little bits of paper with the queen’s head on, but more the number of nurses, beds, consultants, anaesthetists, etc. These are finite, and because of the universe’s conservation laws, these can only be created from some other form of matter.
    So the question is not, and never has been, can we create money by fiat, but can we create resources by fiat.

    1. Charles Adams -

      can we create resources by fiat

      Good question. As the resources are mainly knowledge based I would say yes. It is not the conservation of energy that is limiting us here.

      1. Steve J -

        Surely the main resources are staff time, real estate (eg hospital sites), equipment and stock (eg medicines, bandages, food etc.)???

        Are you saying these are infinite?

        1. Charles Adams -

          Are you saying these are infinite?

          Are you suggesting that demand is infinite? If not then the resources required are finite.

    2. Tim Hammond -

      Exactly the point. Money is not the issue and never will be. What we have are scare resources. If I become a doctor, I cannot become a vet or a policeman. So do you want a doctor or something else, because you cannot have both.

      The fact that these writers do not udnerstand the very simplest of economic concepts shows that this is silly nonsense, written by people with the understanding of seven year olds.

      1. Charles Adams -

        Money is not the issue and never will be.

        Actually it is an issue. Money influences whether people become doctors or bankers, and when junior or senior doctors are not happy with their terms and conditions, they leave.

        So do you want a doctor or something else

        Doctor – because waiting lists in too many cases are too long. But as I said it is not a zero-sum game – more doctors, people fixed, back to work, higher productivity, everyone wins. As Neil asks:

        What exactly are the people and resources that could be used in the NHS doing that is so much more important than the NHS?

  9. Steve J -

    Thanks.

    You suggested to David that these real resources can be created by fiat, but now you’re saying they’re finite. Which is it? It is an important issue to the overall point of this article.

    The demand for these resources isn’t just the demand from the NHS. For a particular site (for example), there are lots of competing demands – the site can be used for residential purposes, a park, commercial property etc. Same for the time and effort of workers. Whilst demand isn’t infinite, it is certainly much greater than the supply, and vastly so.

    In other words, there is an opportunity cost for all these things.

    Based on this, then the NHS is effectively a politicised rationing system. We can argue about the size of the pie, but there will always be a rationing decision on who gets served and who doesn’t.

    1. Charles Adams -

      I do not disagree. For me fiat does not inevitably imply infinite which I would reserve for the realm of mathematics. Fiat means we are not constrained by pots of gold. I accept that we are constrained by people, time, land, and energy but there is no evidence we have reached the limits of what is possible, and in fact, the acquisition of knowledge keeps on extending these limits – call it efficiency/productivity gains if you like.

      NHS is effectively a politicised rationing system

      Yes, but there is no reason why those rations should not grow, and it should be ‘politicised’ as that is about democratic accountability.

      1. David Laws -

        Thank you for responding to the comments Charles. There is a great need to invest in public health. Prevention is much better than ‘cure’. That ought to make future collective decisions about NHS spending and resources easier in the long term

      2. Tim Hammond -

        Of course they can grow, but only at the expense of something else, unless you are talking about increasing productivity – which is trivially true as everybody knows.

        We cannot make more land or more people (at any given point in time). And if we use steel for a scalpel, we cannot use that steel for a ship.

        Yes, health care is “rationed” because we choose to devote only a certain amount o our resources to it. We can choose to devote more. but that means we will have less of something else.

        1. Charles Adams -

          We can choose to devote more. but that means we will have less of something else.

          But it is not a zero-sum game.

          1. Sean Danaher -

            Indeed not. The other failure of the UK economy since the GFC is the complete stagnation of productivity. If productivity is fixed then Tim Hammond makes some sense. I think it would help his argument if he was less patronising. Possible he has done a modern very limited Economics degree or a very heavily neoliberally biassed MBA or is even a PhD student very focused on his own narrow view of economics? Mathematical models can be seductive; I have seen it so often in my Physics and Engineering students that they are so pleased they have mastered the complex mathematics they seem not to notice some of the basic premises are doubtful.

      3. Steve J -

        “but there is no evidence we have reached the limits of what is possible, and in fact, the acquisition of knowledge keeps on extending these limits – call it efficiency/productivity gains if you like”

        This is really what your article needs to be about – the issues about creating money are not that relevant.

        Sean in a comment below says that productivity has stagnated. This was well predicted as far back as the 60s by Baumol, who said productivity gains in labour-intensive activities (particularly involving highly skilled workers) is incredibly difficult.

        There are armies of people who are looking into improving NHS productivity – it’s hard.

        If you have reason to disagree with Sean, Baumol or these armies, please do let us know.

        “Yes, but there is no reason why those rations should not grow, and it should be ‘politicised’ as that is about democratic accountability.”

        NHS spending is due to rise by about 1% in the next year in real terms. You may or may not agree with the decision, but I assume you are satisfied with its legitimacy.

  10. Derek Henry -

    Fantastic piece,

    Once you fully understand that the numbers don’t really matter in the spreadsheets at the BOE because we can’t run out of those.

    Then the focus should be on what really matters and that’s what we can run out of and that’s people.

    You have to make sure you have the people with the right skills to absorb the spending because Doctors and nurses don’t magically appear from the pavement. This is the crux of the issue.

    Smart people talk about government buying because that’s what it is

    https://medium.com/modern-money-matters/smart-people-talk-about-government-buying-f805c18c4d31

    Then the real problems surface because the real answer to the problem is there should be no private healthcare service in the UK. Why should the private healthcare service be allowed to compete for those limited resources when the NHS needs them. Then why should people who can afford it be allowed to jump the Queue just because they have more money.

    Now, try selling that to the NHS doctors who work in both and earn big bucks in the private health service.

    You’ve brilliantly pointed out what’s wrong and the many myths that are told about the NHS. But, those that work in the NHS won’t like the solution that’s really needed.

    1. Tim Hammond -

      Oh dear. I mean, really, oh dear.

      They have made so many basic errors it is pitiful. Money is utterly irrelevant. Economics is about scare resources and how we allocate their use, not how we create money.

      1. Charles Adams -

        Money is utterly irrelevant.

        No it isn’t. According to market rules, money is the means by which we allocate our scarce resources efficiently. Money influences whether people become doctors, whether they stay or go overseas, and whether they work for the NHS or private sector.

  11. Neil Wilson -

    What this article correctly shows is that money is irrelevant to the political argument. When the state run out of things to buy at a price worth paying, then the spending stops – automatically.

    Which moves us onto the political question that many politicians appear to want to avoid: What exactly are the people and resources that could be used in the NHS doing that is so much more important than the NHS?

    Quite a lot of them are discouraged by our lack of investment, but quite a lot are in private medicine. If you drive through Windsor there is no shortage of fully staffed hospitals available at the beck and call of the rich, which shows you that private medicine isn’t actually freeing up resources in the NHS. It is reserving part of the finite supply of medical resources for the wealthy.

    If we are a country that believes that healthcare should be available to all based upon need, not ability to pay then there is a political debate to be had that is currently being avoided, by hiding behind the money myths.

    1. Charles Adams -

      @Derek, Neil. Excellent points. The private sector diverts resource from need towards wealth. If the NHS were properly funded there would be no need for a private sector, except may be for lifestyle fixes (which of course we need to define).

    2. Tim Hammond -

      Or people are choosing what to do with their skills and their lives. How awful of them. You always speak as if people are just little toys you can move around to meet your requirements – a bit Stalinesque basically.

      People make their choices. The alternative is tyranny, with jobs allocated by the state. There is no “deabte” to be had about tyranny.

      1. Peter May -

        Their skills were presumably acquired independently of society in a vacuum? So they have never stood on the shoulders of others in order to acquire them?

  12. Simon Cohen -

    Excellent article David/Charles. I think the point about Government spending ending up as Gilts is significant. The Gilts are actually a form of asset creation (the Government creates its own asset without a corresponding liability). Kalecki described it thus.

    ‘To understand this process it is best, I think, to imagine for a moment that the government pays its suppliers in government securities. The suppliers will, in general, not retain these securities but put them into circulation while buying other goods and services, and so on, until finally these securities will reach persons or firms which retain them as interest-yielding assets. In any period of time the total increase in government securities in the possession (transitory or final) of persons and firms will be equal to the goods and services sold to the government. Thus what the economy lends to the government are goods and services whose production is ‘financed’ by government securities.’

    This reveals that the Government doesn’t really ‘borrow’ at all, it is just the accounting that makes it appear that way.

    Really good article – how long it will take for the world to realise it has been scammed for the last 40 years remains to be seen.

  13. Bob Edwards -

    David/Charles, a brilliant article, I followed a link from Richard Murphy’s blog (thank you Richard), I assume you have no objection if I post this on my blog with due credits, I have 4,500 UK accountants on my list?

    Debate is the key.

    1. Charles Adams -

      Thanks and yes, please share it.

  14. Syzygysue -

    May I have permission to post your excellent article on Think Left website (naturally fully credited)? We have published many posts on MMT over the last 7y.

    1. Charles Adams -

      Yes, please go ahead.

  15. Syzygysue -

    PS Charles It’s silly of me but I wanted to say that my father taught the optics MSc at Reading. It is the 23rd anniversary of his death in a few days but you may remember him … Harold Hopkins? Obviously no need to publish.

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