Camilla Cavendish on US Healthcare, Boris Johnson and the British Election
Guy Spier
June 09, 2020

 

Introduction, Camilla Cavendish

My conversation with Camilla Cavendish took place before the coronavirus – and hence in another world. Yet despite reminding us of cherished, past habits like routine trans-Atlantic travel – resident in London, she is a fellow at Harvard, and normally flies over every six weeks – the discussion was remarkably prescient.

This should not be surprising: Camilla is a high-flying author, journalist, policy expert and – as Baroness – a parliamentarian in the British House of Lords. Currently a columnist for The Financial Times, chair of the 2013 Cavendish Review into health care in Britain and previously with the Number 10 Policy Unit under Prime Minister David Cameron, she is the author of Extra Time: 10 Lessons for an Ageing World, an exceptional book looking at the implications of our increased life expectancy.

As Camilla – an old classmate of mine from Oxford – explained from the outset, her journalistic, policy and humanitarian passions have coalesced into a specialization on public health, which could hardly be more urgent and essential in these challenging times. When Harvard Medical School asked her to give a lecture on journalism and public policy, all three strands came together, and as she says, “I suddenly felt as if my life made sense almost for the first time in my career.”

Back in November 2019 when we spoke, anticipating the British election and with Brexit still unresolved, we could not anticipate the global turmoil we face today. Yet Camilla was excoriating about US health care – facing “catastrophic” health issues, “shocking” in the number of people without coverage, and “extremely expensive and not saving people’s lives”. She hailed the NHS as Britain’s Holy Grail, with its admirable universal care, but unequipped for preventing illness and “sagging under the weight of incredible, exponentially increasing demand”.

Camilla emphasized the threat of a determined, despotic China, and bemoaned America’s retreat from the values it has historically sought to project around the world. Against rising strains of populism in both the US and the UK, she underlined her faith that a pragmatic, “more rational and evidence-based” politics would emerge, driven by increasing engagement from both business leaders and the emerging generation.

So many of Camilla’s remarks presaged the Covid crisis. But it was not all policy and politics, as we discussed the pleasure (for her, not me!) of writing, the vital importance of exercise, her favorite music (see below), and her guilty reading pleasure (you’ll have to see the full interview for that).

When I get the chance to follow up with her, I’m looking forward to asking Camilla to provide an update on her views on the impact of the pandemic and the murder of George Floyd and on the prospects for political regeneration from that.

See below for a number of links relating to Camilla’s work and interests.

Transcript:
Link here: https://aqfd.docsend.com/view/dq43impw5bk5pxmu

Works:

Financial Times Column

https://www.ft.com/camilla-cavendish

 

Extract from Extra Time:

https://www.weforum.org/agenda/2019/11/why-we-should-take-advantage-of-our-extra-time/

 

Purchase Extra Time:

https://dauntbooks.co.uk/shop/books/extra-time/ (break the Amazon habit, why not!)

 

The Cavendish Review: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf

 

Rachmaninoff’s Second Concerto:

https://www.gramophone.co.uk/features/article/the-best-recordings-of-rachmaninov-s-piano-concerto-no-2

 

Ikigai & the Language of Longevity

https://message-house.co.uk/blog/ikigai-the-newest-language-of-longevity

 

 

 

 

 

 

 

 

Conversation with Camilla Cavendish

“You change the world through culture and conversation.”

Guy

Hello. This is Guy Spier, and welcome to Cappuccino & Conversation.

Many of you may be asking, Why a podcast? There are thousands of new podcasts almost every day – enormous amounts. It’s an exploding medium and I’ve gone back and forth on the idea. But there are two main reasons.

First, although I have written a book, writing is not the easiest way for me to express myself. I’m far better expressing myself in the spoken world, and many of the conversations I wanted to bring to a broader audience are conversations I’m having anyway. Conversations that I’m having because of due diligence or just conversations I have with people I meet along the way. And that’s the second reason. I often feel these conversations are so interesting that it’s a shame they don’t get shared with a broader audience.

So, my plan with this podcast, with the permission of the person I’m talking to, is to offer them to a broader audience. To give you the opportunity to eavesdrop if you’d like. With some of the people I talk to, it will be an experiment. Some of my best experiments have failed miserably. Yet some of the ones I expected to fail have ended up being extraordinary. I have no idea how this will turn out, but I thank you for being willing to indulge me and to join me in the experiment.

In this episode, I invite you to listen into a conversation with Camilla Cavendish. We invited some of our investors, some friends, and some members of the general public, and we conducted a Zoom seminar with around 50 people on the call, including people from the UK, and the United States, India and Taiwan. Several of the listeners, as we progressed, sent in great questions by text, which helped direct our discussion.

Camilla Cavendish is a columnist for The Financial Times and former Director of Policy at Number 10 under Prime Minister David Cameron. As Baroness Cavendish, she sits in the House of Lords. Currently a senior fellow at the Kennedy School of Government at Harvard University, she is author of Extra Time: 10 Lessons for an Ageing World. This fantastic book takes a close look at the implications of our increased life expectancy, where many of our institutions are set up to deal with a population living into their sixties, while today people are living into their eighties, nineties and beyond. So, there is a whole second part of life to deal with, and Camilla addresses this challenge.

Our conversation took place in the run-up to the UK elections in December 2019, with Camilla speaking to me from London. I also spoke to her about populism, the state of politics in the UK and what to do about China. In a post-script, I asked her for updated thoughts on Prime Minister Boris Johnson, Donald Trump and the impact of Covid-19 on our world. Camilla has a fiery intelligence and speaking with her is an enormous amount of fun. Full disclosure, Camilla and I have been friends since our university days together at Oxford.

Welcome everyone, and I hope you enjoy the conversation.

Guy

Camilla, you’ve ended up in a role of writing about the world. But if I pull up your Wikipedia page, you did not start out as a writer. You were a management consultant for a while, you regenerated the South Bank. What pushed you to end up in journalism?

Camilla

My CV is a terrible CV for any kind of headhunting. It kind of makes no sense until almost now. I was lecturing at Harvard Medical School a few weeks ago because I’m doing a fellowship here. They wanted me to do a lecture about journalism and public policy, and I suddenly felt as if my life made sense almost for the first time in my career.

I loved writing as a child. I always secretly wanted to be a journalist. But I grew up with two parents who wrote books all their lives and split up actually over money worries. I basically grew up with a mother who said, For God’s sake, don’t ever be a writer. So, if you ask me why it took that long, that’s why it took that long.

But also the great benefit of it is that having done quite a lot of other different jobs along the way, actually when I finally went into journalism, I think I had more to offer. So, kids who are graduating, who want to get into newspapers or media, I tend to say, Go and do something in the real world, create some jobs, run a company, whatever it is, and then come to journalism because you’ve got something to say. Also, you need to understand numbers, you need to understand statistics if you’re really going to add value. They don’t like hearing that, but I think the kind of people we need in journalism are people who can do proper forensic investigative reporting.

Guy

How many people do you meet in journalism who actually started off and spent their whole lives at a newspaper or similar?

Camilla

Quite a lot. In our generation, quite a lot still. And I’m not saying they’re not brilliant, because in the old days, the training schemes were incredible. But equally I think there’s quite a lot of value in people who come in a little bit later, just because they have a better sense of what they’re actually writing about.

Guy

Do you think you have a broader set of sources effectively or relationships from which to draw upon?

Camilla

Yes. When I went to The Times, I basically joined as a leader writer, and then I became chief leader writer, which meant I was writing five editorials a week. It’s the best possible training in learning how to write. You’re writing 600 words every day on a different subject, which is whatever the editor wants you to write about. And if the editor wants you to write about the Japanese currency and you know nothing about the Japanese currency, exactly as you say, you have to know enough people to call. I was very lucky, that was a huge advantage, that I had people to call on almost any subject to tell me how to look at the issue.

Guy

Is the first place you go to verbal conversations or do you go for written sources? Or when do you go for written sources?

Camilla

I love verbal conversation because I tend to get my ideas from verbal conversation, but I will usually pull up the press cuts on any issue. If I don’t really know about an issue, I will pull up the press cuts first, because obviously you can’t engage experts unless you’ve got to a ground level of understanding. Otherwise they’re not going to give you the time of day.

I always prefer to pick up the phone to somebody. It doesn’t mean I’m going to agree with them, but then they will get me to think more clearly about the issue.

Guy

So, for those of you on the call, I was talking to Camilla just beforehand and I was telling her that from the last third of my book, I’ve changed my thinking on just about everything. But one thing that I have not changed my thinking on is, in terms of investment research, getting the order right. So, there’s this idea that the first idea that enters your brain is the one that sticks. And so, at least when you read material, you have a lot more objectivity. You can move it around a lot. Whereas the first person you speak to, in my case, if it’s a sales person from the corporation, they can really mess with my thinking. And if you pick up the wrong phone or pick up the phone to the wrong person, the PR person for Japanese currency, who really wants you to think a certain way, are you not going to be a little bit in their hands?

Camilla

Yes, and that’s why you don’t pick up the phone to the PR person. Ever. And that’s why when I worked in government, if I wanted to find out what was going on, I didn’t go to a minister. I would try and find the person in the mid-level rank of Whitehall, who really knew what was going on

Guy

How hard was that to speak to them?

Camilla

In the beginning, they used to take fright because they’d get a call from Number 10 Downing Street, you know, and if they weren’t at their desk, there’d be a message. And they would all get incredibly hyped up, which I didn’t realize because I had spent ten years as a journalist just ringing people like that.

Guy

And not getting your calls returned.

Camilla

Yes, of course.

Guy

I want to just go back to writing. So, for the audience, this is a very personal question for me. When I came to Switzerland from New York City, one of the things I had an ambition to do was to write a book. I had some friends who had written books. But the first three years, I was just pushing myself to write some drivel, 500 to 1,000 words, that I kept actually in Evernote. Then when a book contract came through and I was under real pressure, I had to start producing chapters, draft chapters. That was one of the most difficult, stressful, awful times of my life. I felt like I was on a rock face. I can see that somebody could actually enjoy doing that, because I think there’s incredible power in writing if you like to do it. But when people ask me if I am ever going to write a second book, the answer is, Absolutely no way. It doesn’t make me happy.

 

Camilla

It’s interesting you say that because when I read your book, it’s very compelling because you tell personal stories and because you actually start that book with a story about your own failure. It’s really compelling. A lot of people are not willing to share anything about themselves, and that’s why they’re not actually very good writers.

 

Guy

Let me help you out how this happened. So, Palgrave Macmillan gives me a contract, and I say, Well I definitely have to take it. I have no idea how this is going to work, but I got to the point where I said, even if it’s a bad book, I’d rather have published a book in my lifetime than not have published a book. It’s a bit like having a child, you want to become a parent. In this case. I wanted to become the parent of a book. And now I’m at the rock face, scared stiff, because I’m saying, What on earth can I write about that is going to be compelling for an audience? Part of why the book is so personal is I say to myself that the only thing that I’m truly an expert on, that I can truly be instructive on, is my own experience of the world. So that kind of deep dive into myself was born out of the pure fear that I produce something that is worth reading.

 

Camilla

It is worth reading.

 

Guy

Thank you. It is also worth saying that the book was extraordinarily heavily edited. A friend who was editor of Time magazine basically lived with me for three months and we pretty much extensively rewrote every chapter to make it readable. What I understand from you is that you don’t really have an editor. What you submit is pretty much what gets printed.

 

Camilla

Well, I have a great editor, but he tends to do a slightly more high-level thing. But that’s because it’s like exercising a muscle. I think writing is like anything else. I have spent 15 years of my career writing and certainly for ten years writing pretty much every single day. Now I defy anybody not to get better at it if they put that many hours into it. I happen to love it, but I’ve made a hell of a lot less money than you. So maybe you made the better decision.

 

Guy

When I was writing, I got better at it, Camilla, but I still didn’t enjoy it any more. I just found it really hard.

 

Camilla

When you look at how many books are published, which is really intimidating, actually it’s extraordinary that anybody at all has read my book. I’m so grateful that my book has actually been relatively successful because I look around me and it’s extraordinary how many books are published and how many people take the view you just expressed, which is that I’d really like to have written a book.

 

We have this veneration for literature and books, which I grew up with, and I think it’s just wonderful that we still have that. Because actually committing to reading through an entire book – and I do that because I review books as well for newspapers – it’s quite a big deal, that we are still willing to stop and take the time to read what someone else has put two years of their life into.

 

Guy

We’re all grateful to you for spending your life not thinking about how to make money, or as I sometimes say, how to make rich people richer. But rather how to communicate. Now, I’ve not been in the UK, but there have been some topics that you’ve picked up on as a journalist, one was a focus on the NHS, the British National Health Service. I really know so little about it ever since Brexit, so maybe you could tell us about what you did there and perhaps actually also give the audience a quick overview of the way the British health-care system is organized.

 

Camilla

We’re going through an election in the UK. So, health is the number one issue after Brexit in this election, it continues to be a major political issue in this country. We don’t have a US-style insurance system. We have, as everybody knows, a universal free-at-the-point-of-need system. But it is sagging under the weight of incredible, exponentially increasing demand. The weird thing is you don’t really get interested in health until you come into contact with the system yourself. So, when I had my first child, ironically in the same hospital that I myself was born in, I had a terrible experience and it switched me on as a journalist to wondering what on earth this was about. You know, how something so routine could be so appallingly badly managed.

 

At some point during the 2010 election, the Conservatives made a big deal about health. The editor of The Times, he and I sat down and we said, What’s our editorial line going to be on the NHS? And we realized we didn’t know. So, he said, and this is very unusual for an editor, he said, Go out and spend a month – and a month is quite a lot of time actually to invest from a newspaper – and dig around and see what you come up with. And that’s when I got hooked.

 

Health-care systems are some of the most complex, human and intellectually challenging things. The NHS still employs, it’s one of the largest employers in the world, after the Red Army. But these people are employed in all these different silos, which don’t talk to each other. So, from a systems dynamics point of view I remain fascinated by it. I went onto the board of the hospital regulator in England, and I did an independent review for the government on nursing, and I made some programs for the BBC about it.

 

My worry now is that we don’t invest in prevention. This is common all over the world. We treat people who are sick, but we don’t try and actually prevent those illnesses, even though we know quite a lot about how to do it. And we’ve got tech, we’ve got AI, we’ve got fantastic analytics coming along, but we’re not always linking them to the human. So, we tend to talk about tech as this kind of a wondrous science without remembering we’ve got to link it to the human. That’s my preoccupation at the moment.

 

Guy

Your preoccupation at the moment, it’s quite beautiful because, if you think about me, making rich people richer, you’re actually trying to make the overall happiness of the British people as a whole greater. You’ve gone to health care because it’s one of the key elements of that.

 

It’s interesting for me, it was really surprising for me, in the 2012 Olympics, that the NHS played such a strong role in the actual ceremonies. It’s amazing to see in the election, observing the election, how important the NHS is.

 

Camilla

The NHS is our sort of Holy Grail. It’s our national treasure. It’s the reason the current debate about a US-UK trade deal is so fraught with difficultly, because we know that there have been some conversations between American trade officials and British trade officials about prescription drugs, for example. You can have a perfectly sensible conversation about prescription drugs, but the minute it filters out, people leap to the conclusion you’re trying to privatize the whole of our health-care system. And so it is not possible to have any sort of conversation at all at that point.

 

Guy

The nearest thing to that in the United States, to the extent that I’ve observed it, is that when you have people talking about a single-payer health-care system, the first place that people lead to is “death panels”. There’s this idea that you do not want to take the decisions over life and death at end of life and put them into the hands of somebody else, essentially, the government.

 

The minute you bring that up, people who might be inclined to accept a single-payer system turn away. It’s funny for me that some of the same kinds of people who love the single-payer national health care system in the United Kingdom, they are the same sort of people who hear death panel and say, not on my life, I would never ever want that.

 

Camilla

People are rightly skeptical about state ownership of services and whether the state runs things well. So one of the tragic things about the NHS is how much variation there is. There is still far too much variation in even routine operations in different locations. That’s tragic. These are basically management issues. The NHS is a weird hybrid. It’s centralized and decentralized, simultaneously, and that actually makes it very, very challenging to run.

 

As a result, it is also highly political. There are by the way some really important reforms going on at the moment below the radar. But anybody who does try to reform it, to make it more efficient, tends to get into political hot water.

 

Guy

It would take somebody like me or participants in this call probably a couple of years of reading to get to the level of knowledge that you have of the British health-care system. So now you’re considered an expert. You’re contributing to national debate. And you’re talking to people like me who understand nothing.

 

Camilla

That’s what I’ve learned in journalism. You always start from where people are. I actually find that people have a very shrewd sense of what matters. When I go out and talk to audiences about health, people are very clear. They know that obesity is a major problem. They don’t understand why we don’t put the prices of prescription medicines on the boxes, so people might actually take them and not throw them away. They don’t understand why nurses don’t have proper autonomy to make decisions and why they exist in a difficult bureaucracy. People are pretty shrewd about this stuff because they do interact with the health-care system.

 

The actual structures of the NHS are very, very difficult to understand, but actually delivering better patient care is not difficult to understand.

 

Guy

Having spent myself almost 20 years in the US, the ideology of the free market is so strong. The idea that something could be owned by the government and managed well is anathema.

 

You’re in the US, in Boston, every six weeks or so. So, I’ve no doubt that you’ve gone into multiple conversations and you understand quite well the debate that’s going on over there.

Massachusetts actually has a single payer system. But let me ask you bluntly, Is Obamacare a good thing or not?

 

Camilla

Gosh, there are people on this call who will know this better than I do. Of course, it’s a good principle. The fact that when I’m in the US, people are worrying on a daily basis about whether they can afford to cover the costs of any catastrophic health-care emergency is absolutely shocking when you come from Europe. And you’ve now got life expectancy falling in the United States for the third consecutive year, which it hasn’t done since World War I. There is something I’m afraid seriously wrong with the American health-care system. It is extremely expensive and it is not saving people’s lives.

 

People are in a situation of deep anxiety and also confusion. One of my colleagues at Harvard has done some really good work on why patients aren’t more proactively shopping around. Why do they not even ask the surgeon about cost? Because we don’t, we don’t treat it as a market, even when we are in a market, because it’s actually about life and death.

 

Of course, to try and get more people covered was absolutely the right principle. I would have quite liked it if Obama had taken on the tort lawyers as well, because litigation in the US is a real problem and drives up costs. Unfortunately, he ducked that one.

 

Guy

Well, they all vote Democrat, so it would have been hard. . .

 

We are not going to stay entirely on health care but one person on our call who did interact with me is a heart surgeon, Jehangir Appoo Take a second to introduce yourself.

 

Jehangir

I’m calling from Canada. Thanks for having me on the call, Guy, you are always doing interesting stuff and it’s fun to be part of it. I focus currently on working with startup companies using technology and health care and what you were referring to around Artificial Intelligence and the internet of things in health care. Health care has generally been slow to adopt technology. There’s an inflection point, so I work with a lot of these companies, invest in those companies. I do some consultancy looking at the future of cardiovascular intervention and I do some health-care policy work around innovation and research. Previously I worked for 20 years as a heart surgeon. I trained in the UK and in Canada and sometime in US as well, so I got to see three different systems in terms of their pros and cons and how they work.

 

Guy

So Jengir, what questions should I have asked that I didn’t about health care?

 

Jengir

Obviously, health care is not easy and it’s a question of trying to arrive at an optimal strategy. My thoughts are that in the US, there’s this issue of getting to universal care and the definition of universal care. Unlike the rest of the Western hemisphere, in the US there’s an issue about my neighbor not having a job, not paying for health care and getting the same service I get. But I work every day, nine to five, I put my boots on and go to the factory and this person doesn’t. The US just can’t get over this stumbling block.

 

Camilla

I agree.

 

Jengir

The rest of the world has gotten over it. And then it’s a question of how do we provide health care as a basic right for everyone? How do we do it efficiently and how do we do it economically and what are the quality of care outcomes? But the US has a huge stumbling block mentally to get over that.

 

Guy

Camilla, are you known in the United States as a public commentator? The FT is broadly read in the US.

 

Camilla

Yes. But I wouldn’t say I have a great profile in the US at the moment. My book is coming out in March, so I’m going to have to up my profile in the US no doubt.

 

Guy

So, if you were to get in front of an American audience and talk about the NHS, do you think that you could convince them of anything?

 

Camilla

I think Jengir is right. I think he’s made absolutely the right point. You do see this concern here about fairness. The common thing I find in most audiences, at some point someone will say, why should I pay for people who’ve been smoking for 35 years? Or, why should I pay for people who’ve been eating to excess and now have got type 2 diabetes?

 

We actually have a similar view here because of course it’s coming out of our income taxes. But Europe has, most of the rest of Europe, has solved that problem by having a sort of co-payment system. So if you’re in France or Germany, you have a social insurance system where actually most people are paying. And the prices are more transparent. However you set it up, I will defend a single-payer system forever, because I actually think it is a great leveler, it does provide as you say, health as a human right.

 

Jengir

When you say single payer, do you mean co-payment as well?

 

Camilla

In some parts of Europe you’ve got co-payments. That’s just a more Bismarckian model if you like, you’ve got a hybrid. In Germany, I think about a third of the hospitals are privately owned, about a third a public and a third nonprofit. You have a much more relaxed attitude to that kind of mixed economy, as long as they’re getting a good service. But then it comes down to how you regulate.

 

I have many problems with the US health-care system, and one of them is that it’s so opaque. It’s really, really difficult for patients to know even what they are getting. But I do think you’re right. There’s a stumbling block about people, they’ve paid in and other people have health problems. But the health problems the US is facing, they’re catastrophic.

 

Jengir

The one thing on that, in terms of the opaqueness in the US health care system, my experience has been that the US offers a spectrum of absolutely world-class, outstanding health that is really hard to get anywhere else. But then also on the other end, there’s a lot of below average care providers. And therefore when you take the sum of all that, it’s actually not very good. When you average out the excellent with the below par, for the public overall in the US, it’s not very good.

 

So, getting back to the NHS, the NHS, on a global scale, is well looked upon and actually measures metrics and it has a lot of really good deliverables.

 

Camilla

That’s a really important point. Actually, as we move into this world of big data, having a universal single-payer system is a huge advantage because we ought to be running big clinical trials. We ought to be making the results of those trials available to our patients much quicker. We’re now beginning to realize that in this new world we’ve got a huge opportunity. And the question is, can we overcome some of the resistance to bringing life sciences companies into that conversation? This is a big debate at the moment.

 

Guy

So Jengir, one last question before I move you back to listen-only mode. What is the last question you would like to ask Camilla?

 

Jengir

  1. So, Camilla, one of the things I really liked in your book was the chapter on Ikigai and the Venn diagram. For the other listeners, there is a Venn diagram of what you’re good at, what the world needs, what you can get paid for, what you like. That Venn diagram I think applies very differently to all of us at different times in life. So, for someone who’s going off to university, it is weighted to thinking about where I want to get into. Someone who’s sort of mid-career, who’s accomplished a lot, says what I want to do next. When I talked to people about this Venn diagram, nobody thinks about it for the elderly. And I thought that was beautiful how you brought it up. Like maybe when you’re 65 and 75 what opportunities there are. I wanted to sort of reflect on that and say that you’ve accomplished so much in your career, done so many different things, that maybe over time your Ikigai has changed. And I was wondering what is your Ikigai, you know, for tomorrow going forward now that you’ve done X and done Y and done Z? What is your Ikigai today and tomorrow?

 

Camilla

Well, that is such a profound question. Thank you so much for reading the book in such detail. For those on the call who haven’t read the book, Ikigai is translated as reason for being. It is quite a complex Japanese concept that I think we in the West don’t relate very well to because we’re so used to pursuing our own hedonistic goals that this concept of balancing out the different parts of our lives and finding a kind of inner calm is really, really difficult. And I do think that when you go into extra time, which is, you know, my book is called extra time because I think they’ve got a whole bunch of people who are now in extended middle age. What are we going to do with that extra time? It’s really what I’m asking in the book. Thank you very much and it’s a very interesting point that when you get a bit older and have possibly a bit more time and you might very well change your approach.

 

One of the things I write about in the book is getting to silver centers in Japan, which were set up to help older people get part time work and maintain that sense of purpose rather than feeling completely redundant and unwanted in their lives. And these are kind of marvelous. They’re coffee mornings, but they are coffee mornings with a purpose where people sit around and they might draw beautiful handcrafted calligraphy for local businesses. And they’re adding genuine value to local businesses.

 

If you ask me, it’s a really good question because it reminds me that I have spent literally no time thinking about this for myself. I have three children still at school and I just have tried to cram as much into my life as possible. I don’t know. I suppose I’m really, really lucky going back to the early in conversation and able to spend quite a lot of my career doing things I really enjoy and I’ve always said to my kids in a funny way, you know if you can find something you’re passionate about and you can get somebody to pay you to do it, that you are extraordinary lucky and I regard myself as extraordinary lucky, able to get paid to write about things that I’d want to write about anyway, even if nobody wants to read about it.

 

Guy

I’m going to go to a selfish place again for me, which is if you experience any mild degree of success, then suddenly your time, everybody wants a piece of you. I have an extraordinary assistant who helps fend all sorts of things off and gets me a little better at saying no. So, how do you structure your days? When do you write? When do you see your family? What does that look like?

 

Camilla

When I was in Number 10, I had a proper full time job. I just had that structure and I had to cram in my family at the end of it. When I was on The Times, it was fairly similar, although I always did a four day week. Basically since I’ve had children, I’ve tried to do a four-day week just because I’ve been lucky enough to do that and I think you have to be able to give enough attention to your children when you’re not simultaneously looking at your Blackberry and checking your emails. We’ve all been guilty of that.

 

So how do I structure my day? At the moment because I wear so many different hats, I have different days for different things. So I write my column on a specific day. I’ll go into Parliament on specific days. I try to structure it that way.

 

Guy

So today is what kind of day, for example.

 

Camilla

Today’s the day when I’ve just decided what I’m going to write about in my column and I will start making those calls once we’re off this one and finish it tomorrow afternoon.

 

Guy

So you divide your week into different types of days basically.

 

Camilla

I try to! But that makes it sound far to . . .

 

Guy

So, I’m extremely respectful of and in awe of people who are the mothers in their families and they are professional. I actually strongly feel we have to give credit to that and allow you to share about that because it’s something I know very little about as part of transitioning from a male dominated world to one where males and females are equal.

 

Camilla

I’m not sure we’ve entirely transitioned there yet.

 

Guy

Yes, but part of that is to understand. You seem to be managing it well. If you’ve not finished your column by 10:00 PM do you continue till 3:00 AM and then you’re dreary-eyed the next morning?

 

Camilla

Remember the journalist part of my life, I have worked to deadlines for 15 years. I’m a complete deadline junkie. I love deadlines and I can’t function without deadlines, so the only way I operate is to put in deadlines for myself even if they’re artificial. So, writing the book – which by the way I never wanted to write a book because my parents had written books and I saw the agony first hand. I just had to put in deadlines and I would say to my agent and my publisher, will you now ring me in three weeks’ time? In three weeks’ time you’ve got to ring me and say, Send me that chapter.

 

I find the deadline creates adrenaline. Not everybody’s like that.

 

Guy

People around me know about deadlines and then I procrastinate for one day beforehand and then it’s still half a day late.

 

Camilla

Well, this is what doing PPE [Philosophy, Politics and Economics] at Oxford actually leaves you with, isn’t it?

 

Guy

To those of us who did it, it seems to have got an extraordinarily bad name, because it seems that a lot of PPEs are associated with some policy disasters. I don’t know if that’s a good thing. We’re accused of being shallow, of skimming everything the last minute and then sounding erudite.

 

Camilla

You’ve just admitted that that’s what you do!

 

Guy

Ha, but I’m doing all sorts of discursive reading before I get there . . .

 

Camilla

But we don’t see any of that. We don’t expose any of that, do we?

 

The other thing I would say is that I do a huge amount of exercise and I always have. And I think exercise is the only thing that keeps anybody’s sane.

 

Guy

That is an important part of your book, I think it’s a whole chapter or probably more, how even at an older age it reduces decline.

 

Camilla

It’s unbelievable. When I started actually reading the studies, having always done quite a bit, I was just blown away. It is just extraordinary. There’s a bunch of septuagenarians in Illinois, for example, who started jogging when it became a fad in the 1970s and who’ve continued some form of aerobic exercise ever since. The research has found that these people are 30 years biologically younger now than their chronological age. And that’s not unusual. These are not professional athletes. Exercise is a magic cure, and figuring out how we can get more people to do it is vital.

 

Guy

For those of you who haven’t read it, the book starts with this entertaining anecdote of a man who applies to a court to have his legal age changed because there were all sorts of things that he’s not allowed to and he feels 20 years younger, so why can’t he be considered 20 years younger.

 

Camilla

He can’t find dates on Tinder, that’s his main problem. He can’t get a date because it says he’s 65 and actually he feels, he wants to be 45.

 

Guy

What exercise do you do?

 

Camilla

Nothing new, I do aerobics, I do something called military fitness. And I do tennis. I mean I try. I’m not a fanatic, but I do try and do something pretty much every day.

 

Guy

How many hours a week?

 

Camilla

Well, a minimum of five hours a week.

 

Guy

OK, I have to catch up with you, I don’t think I’m on that.

 

Camilla

I’m not showing off. I’m just trying to say that that’s the key to sanity. All of us have to do something to remove stress.

 

Guy

Another chapter in the book talks about mental agility. I read some articles not so long ago on how if you play bridge, it prevents the onset of all sorts of mental disease.

 

Camilla

I would just warn people against this. There are millions of these articles written. There were loads of articles written about how crossword puzzles were really good for your brain. And there was a study that showed that the people who did crossword puzzles had less cognitive decline, they were still sharp. The problem with it is that the study also showed that the people who did crossword puzzles had started off smarter in the first place.

 

What neuroscience is showing us is that the brain remains plastic. That is incredibly exciting. It creates new neurons forever. The question is how do you incorporate those neurons into the functional circuits of your brain? Experiments on rodents show that exercise that includes social connections and is a challenge are vital to incorporating these functional circuits. So, if you give a mouse a new environment with new wheels and toys and some other mice to meet, they will get better at navigating mazes than the mice stuck in a boring old cage.

 

And this does read across to humans by the way. The terrifying and awful thing for those of us in our forties or fifties right now is that we have to challenge our brains. So it’s not necessarily bridge. It’s something you find really, really hard because you have to get out of this – we’re all, probably a lot of us on the call are having a rather enjoyable time exercising the same old muscle. We’ve done something for many years and we’ve become quite good at it and maybe we’re quite senior. The terrifying thing is that you’ve got to actually learn Arabic or take up the violin or do something that for you represents struggle. I mean this is what the neuroscientists – they actually call it struggle. That is what your brain enjoys and responds to and what will change its mapping.

 

Guy

So, what is that for you? I every now and then have somebody come and read Hebrew newspapers with me. What’s a little disappointing is that I have a subscription to the Israeli equivalent of The New York Times, and there’s a woman who comes and looks at this stuff and I thought I’d improved just through that. I’ve been doing it now for about a year, and there’s zero improvement. So, I’m not sure it’s helping my brain circuits.

 

Camilla

Well, I don’t know, because maybe you’re struggling, it sounds like you don’t find it that easy. So that could be quite a good thing.

 

Guy

So, what is it for you?

 

Camilla

Well, I love the piano and I thought I could get back to the piano. I find myself playing the same Chopin Nocturnes, which is not terrible. But I know what I need to do, which is I need to master Rachmaninoff’s Second Concerto. And if I can do that, I think that will be genuine struggle.

 

Guy

That’s one hell of a piece of music. Why that particular piece?

 

Camilla

Because it’s one of my favorite pieces of music. And because our youngest child already quite enjoys listening to it, she’s soon going to be better than me. That gives me an impetus to keep going ahead.

 

Guy

Forgive me, I’m going to have a little bit of fun here. Rachmaninoff’s Second Concerto is this incredible gush of emotions and, if you kind of go with the music, it takes you to this emotional peak, there’s like this river you’re just sliding down, and I just thought I’d ask, Is that somehow revealing of your inner emotional life?

 

Camilla

Oh, god! I don’t know. Maybe I’m deeply repressed and I can only express it through music. Can I just say that the reason I mentioned that is because for me to master that would be an unbelievable struggle.

 

Guy

I can imagine.

 

Camilla

It would probably take me 10 years. But as you say, it just takes you over.

 

Guy

But it’s not Beethoven. It’s not one of Beethoven’s piano sonatas.

 

Camilla

No. Rachmaninoff has a flow, it’s much more emotional, isn’t it?

 

Guy

That’s fascinating. That brings up so many things I’d love to dive into.

 

Camilla

Someone said on here on the text commentary that people can maintain brain plasticity by finding their Ikigai. Yes, that is absolutely right, staying engaged.

 

Guy

Now, I want to ask you about the Number 10 Policy Unit. But let me see what is written here on the Q and A. John Green has written here, Hi, Camilla. Apologies to bring the conversation back to health care. I was wondering what your thoughts are on the so-called dementia tax introduced in order to relieve the NHS of some of the burden of care for the elderly?

 

Camilla

Okay, so I actually used this phrase, dementia tax, in 2017 in the election because I wanted people to focus on the issue. I hadn’t expected that Theresa May would then unveil a policy that was effectively a dementia tax and that policy, by the way, sunk her, it was so unpopular. It was one of the moments in the campaign where the public turned against her and of course she lost her majority, which is one of the reasons Brexit remains in limbo.

 

Social care is a huge issue in most countries. We don’t link it to our health systems. Germany and Japan have done quite well actually in creating essentially social insurance schemes, which people pay into. They are slightly different, but basically after 40 most workers are paying in. Then taking out later. And this is essentially for people essentially to come into your house when you need help and you can’t function on your own, but it keeps you out of hospital and keeps you out of care. The way that our health-care system is organized, the NHS is not incentivized to keep people out of hospital and we don’t pay the NHS for social care. So, we essentially have to pay for it ourselves.

 

I am looking after the finances of my wonderful aunt, who has sadly got Alzheimer’s. She’s moved into a care home that is costing her an incredible amount of money and she will only afford that by selling her home. Now there’s a whole question and it’s very live and in our election debate at the moment about whether you should have to sell your home to pay for the care that if you had cancer, you would have got for free on the NHS. But because you have dementia, someone else is asking you to pay for it. So, we have this essential inequity in a way between the two systems.

 

Dementia tax, it means different things to different people, but essentially paying more in has got to happen. The only question is how we pay more in, and how do we get one single system that works for all of us. Because we ping in and out, right? You know, you’re in a care home, you fall over, you fracture your leg, you go into hospital, you come out, you see your family doctor. These things at the moment are not joined up and we have two completely different sets of staff who manage them. And we need that to be one. And that is very, very challenging. It’s where the future has to be.

 

Guy

I think I’m going to go down this path, we’ll see where it goes. You might have to explain what a people’s assembly is or a citizens’ assembly, where you pick a random group of people and you have them discuss an issue. This is not politics. The people aren’t elected. There’s no lobbyist. They have not spent time trying to get into a career in politics. They are kind of like an expanded jury of anywhere from a hundred to a thousand people. I would imagine that that question over dementia tax, for example, would be something that would be great to put to a people’s assembly.

 

Camilla

Yes, exactly. What we discover is that so many of the issues that confront us right now are big cross-generational cross-boundary issues. You know, climate change, long-term health care, they are things that governments are not good at grappling with because you are voted in for four or five years. You need to see some progress. And if you are a minister, you may only be there for a year, and ministers want headlines. So you’re completely right. If you take it out to a wider group of people, this is the concept of the people’s assembly, and you give them more granularity and more time to actually probe the budgetary implications, sometimes it can take the politics out of it.

 

In Ireland they did this recently. They had a commission looking at abortion rights. And they essentially delegated that to a people’s assembly and they got much, much wider support as I understand it for changing the law. That was the only way they were ever going to achieve that.

 

It’s now very in vogue, the idea that you can use a people’s assembly. It’s been suggested for all sorts of things, Brexit and so on. We do need something like it on social care or a commission or something. To, as you say, take the politics out of it and look at it in the round.

 

Guy

Is there any chance in the UK environment of getting at least some issues dealt with through a citizens’ assembly?

 

Camilla

I don’t know. Gordon Brown in fact suggested about a year ago that, after Brexit, we would need something like that to bring the country back together. I was very skeptical at the time because I thought, well citizens’ assembly just sounds like another talking shop for years. But know I wonder whether he might be right, there might be something in that.

 

Guy

What I have experienced here in Switzerland, whether it comes to health care or other issues, is that any institution that raises the public’s trust in the decision-making process is helpful. And the amount of trust here in Switzerland is just enormous on so many issues.

 

Camilla

You have cantons, you have much more local democracy, you have referenda, people feel consulted.

 

Guy

It’s really fascinating, it’s impressive, because you really care about the outcomes here. You haven’t abdicated the way I have, just to think about making rich people richer, which is wonderful. And as you said to me on a call before, the life of the average MP is horrible. Politics is a really tough job. But you spent time with the leadership, that’s the Number 10 Policy Unit. It must have been wonderful. You were finally there at the center with the leaders of government. Tell us what that’s like.

 

Camilla

When you get there, at the central government, and then you find you pull levers and they don’t connect to anything. As David Cameron always said, actually. But it was an extraordinary experience and a great privilege. What is very interesting is where do you have real power and where do you not? David Cameron was always going into that job very humble. He always knew that he would eventually be out and he’d probably be unpopular. He was very conscious and a lot of his ministers were very conscious. They needed to use the time effectively. So, they were all worried.

 

They’d all looked at what Tony Blair had done. And they remembered that Blair had himself said, I wasted time. Because he spent a long time setting up strategy units and trying to figure out what to do. And then he got to the end of his first five years and he, Tony Blair, felt he haven’t achieved enough.

 

So, they all go into this thing like a roller coaster. What you learn is that there are certain powers the prime minister has. There are executive powers you have over foreign policy and intelligence, which by the way is what Mr. Jeremy Corbyn would acquire should he get the keys to Number 10. He would not be constrained by a hung Parliament, because there are certain executive powers the prime minister controls, obviously.

 

But you can also make speeches. Speeches become a hugely powerful weapon. I was always a bit skeptical because I thought, Why is there so much management of the press and why are we doing so many speeches? Well you quickly discover that that is the way the prime minister can actually set out his stall and try to change the conversation. You don’t change the world just through legislation. You change the world through culture and conversation.

 

Islamist extremism was one area where David Cameron really did shift the dial in terms of the way society defined extremes. It was one of the biggest battles he had. Theresa May believed, as the security services did, that extremists should be in a small box where we could watch a certain limited number of SOIs, subjects of interest. What Michael Gove and David Cameron came to believe was no, there is a long road that leads people up to becoming an extremist and actually we can’t just ignore them until they try to set off a bomb. We have to address all the way through the societal factors that might or might not lead them to becoming extremists. We have to set up programs that will instill British values in their language or in some way turn people away from extremism.

 

I’m sorry, that’s a distraction. You can start to set out your stall through speeches. You can use prime minister’s questions to some extent to change the tone. But it’s amazing when you sit at the apex of power as a prime minister or many other political leaders, and you have a Rolls Royce civil service stretching out through Whitehall, and yet you want something done and you’re told, well you need a feasibility study and then you need a consultation . . .

 

The system is brilliant at inertia. That can be good if you’ve got a prime minister you’re worried about who’s going to be reckless. Or it can be quite frustrating if you think you’ve got a guy who’s on the right path.

 

Guy

Are you able to give an example of something that passed across your desk, where you believe your time in office was successful? Where it was like, wow, we actually managed it. You gave an example of, just through speeches, changing the conversation over how people become extremists. Which, by the way, for me, is, well, How hard is that to understand?

 

Camilla

That was a huge political controversy is all I’m saying, and in the end, the way the prime minister addressed it was actually by using speeches to leverage change. That’s what I’m trying to explain. Other than sitting in committees with people that don’t agree, it’s rather like the way we did the sugar tax on drinks. We just did it, we put it in a budget. We didn’t let all the people who wanted to stop us sit round in endless committees for months and months and months.

 

Look, David Cameron and George Osborne, the Chancellor, came into power after the financial crisis when Britain had a very large deficit. This is all forgotten. They came out of power with record high employment in a country that – yes, we still had a way to go to make up wages from 2008 – but a country that was doing a lot better than many people would have thought and with a substantially reduced deficit.

 

They had to make a lot of difficult decisions to achieve that. Some people say now in an environment of low interest rates, Was that really important? Did it matter? For them it was hugely important. And for our credit rating and for the country’s reputation, it was important. In that environment, there were lots of very tough decisions. But there were a lot of other decisions under the radar.

 

One thing that I cared about a lot was the way we look after children in care and the way we run social services, which is through local government. When I was in Number 10, we took over the social services for Birmingham Council, one of the largest councils outside of London, which had been failing for 10 years. And we thought, eventually, we’ll just take it over and set up an independent trust. That was a tiny little thing but it actually took a lot of work to make that decision.

 

We’ll see where we get to on this. But it’s now starting to be part of a wider policy of transforming the way we look after kids who are at the bottom of the heap. You are making decisions like this every day, impacting programs worth millions of dollars.

 

Guy

Something I feel is unhealthy in the UK is the degree to which power is centered in London and in central government. That’s nice to make a comparison with a country like Switzerland where power is decentralized. I have no idea if you’re in government how you implement decentralization.

 

Camilla

George Osborne would agree with you. It’s another thing people have not noticed fully or appreciated quite the implications of. Obviously Tony Blair devolved power to the regions. The reason you’re now seeing Scotland demanding another independence referendum is he started to devolve real power. You can disagree or agree with that. George Osborne started to devolve power to local authorities. So, in greater Manchester, where there was an extraordinary council leader, huge amounts of power have been devolved over economic development. We have mayors all over the country. Power is devolved for the health and social care system. So extraordinary amounts of innovation are happening at a local level. Again, under the political radar. So, people can get on with improving services without taking a political hit in the media. And that’s actually very exciting.

 

The next mayor will be very interesting. The next mayor of London will surely want to take more power.

 

Guy

My belief is that, as powers get devolved, people become more experienced in the exercise of local power. The initial experience may be that some bad choices are made. But over time these choices will improve. People get more knowledgeable.

 

Camilla

If you think back to Margaret Thatcher, what happened was, you know, you had militant tendency, back in the 1980s, bubbling up through local authorities. So, you had socialists trying to gain control of the levers of power and Thatcher essentially removed a lot of power from local authority in order to quell those people. But that left us with a much more centralized system, and local authorities have had their funding cut consistently. But as a result, actually some them have become extremely entrepreneurial in the way they do business.

 

Guy

I’ve spent whole afternoons here, Camilla, with Parliament live playing, watching the debates on Brexit. There’s the opportunity to do that now, which is extraordinary.

 

Camilla

Well, you’re going to miss [Speaker of the House] John Bercow.

 

Guy

Absolutely.

 

Camilla

He’s become a celebrity, he’s getting his own show, I think.

 

Guy

I’m not surprised.

 

If I understand [former MP and former London mayoral candidate] Rory Stewart’s position, he says, Brexit, not a great idea, but the British public voted for it. The point he made to me that was most convincing was that the UK cannot have a sensible discussion about Europe anymore from inside the EU. His view is that the UK has to find some position outside of Europe before it can even begin to have an effective discussion.

 

Camilla

Yes, Someone on the chat, Jonathan, asked, What did we think about Rory Stewart’s idea of mediating Brexit via a people’s assembly?

 

Guy

I love that idea, and I’m hardcore Remain.

 

Camilla

The reason Rory wanted to do that was precisely because we have not as a country really grappled with the actual trade-offs involved in exiting the EU. We’ve had this conspiracy of silence about the real economic trade-offs, in particular for services. What’s extraordinary and so depressing about our political debate over the past three years, it’s largely been about goods. Britain is a powerhouse for services. We depend unbelievably heavily on services for our economy, especially the City of London.

 

There is almost no debate either in Parliament or the media about the prospects of the services economy in whatever way we leave the EU. And because Theresa May ruled out remaining in the single market at all, we have done potentially appalling damage to our services. Now a lot of banks and insurance companies are setting up subsidiaries in Ireland, Holland and so on. And we don’t yet know how negotiations will proceed. But that is clearly a very damaging and worrying situation, which most people in this country are entirely unaware of and they will be unaware of until the jobs disappear.

 

That’s where I wouldn’t mind having a people’s assembly that exposed that. But we shouldn’t need a people’s assembly. We’ve got Parliament, we’ve got a free media. And in a way, I suppose back to your question, people aren’t listening. People have become more entrenched in their views.

 

Guy

It’s not like the moderate voices aren’t there. It’s just that nobody’s listening to them.

 

Camilla

You’ve got to understand that it’s an issue of identity, cultural identity. It’s not just about economics. So, Remainers, and I am a Remainer, Remainers tend to make the economic argument. You know, you must be able to see that we may lose all these jobs from Toyota and so on, which is completely true. A lot of Leave voters, including my late father, were not interested in that at all. They didn’t believe it either. My father never believed that the economy would suffer. He didn’t understand global supply chains, didn’t want to know about them. It was an issue of cultural identity. And so, if you were wealthy and middle class, as my father was, well not particularly wealthy, but middle class and educated, his view was that we want our sovereignty back.

 

Since 2004 and opening the doors to the EU accession countries as Blair did – ahead of most other countries and of course deceiving people about how many Eastern Europeans will arrive – this was his big mistake. He should have just been honest and he should have welcomed these people and then created much better infrastructure. But it didn’t. So, in large parts of the country, people will say, Actually I didn’t recognize my area. I don’t recognize this country. I’m worried about where it’s going. I want to be patriotic, and patriotism for these people means taking back control of their borders and their cultural identity.

 

Now we can all say it’s far more complicated than that. And we can also say that some of the hostility to immigration has nothing to do with the EU, it’s from the rest of the world and there are all kind of complex issues underlying that. But I think until Remain has acknowledged the identity questions, they’re not going to win this argument.

 

Guy

Here in Switzerland, within a month of arriving, I got a letter saying, please show up at the population registration office and show evidence of your health-care plan. In my wife and children’s case, we could do it pretty quick. But I had some paper issue that took four or five months. And month three comes along and I get a letter in the mail saying, You’re now three months’ late. Here’s a bill for the fact that we’ve had to send you a letter, of about 150 Swiss francs. And then by month four, I show up at the office and there’s another bill. Bottom line is the rule – and Switzerland for this purpose is part of the EU – Switzerland only has to allow somebody to be here for three months. After that, unless they have full employment and a health-care plan, they’ve got to leave. Why on earth was it never possible for the United Kingdom to take advantage of those rules which are available to it as a member of the EU.

 

Camilla

Because Switzerland is not a member of the EU.

 

Guy

No, but those are the rules within the EU.

 

Camilla

This was a major part of the negotiation in 2015. The whole question was, What is discriminatory and what isn’t? And the fundamental problem was that we have in Britain a universal welfare state with universal benefits where we say everybody who’s here gets free education and free access to health care. Most of the rest of Europe operates on a more Napoleonic, Bismarckian type system, and a lot of those countries, as you say, have been able to use all sorts of ways. I think in Denmark, you have to own a home before you can get certain rights and it’s quite difficult to buy a home. And so on. So, I think we were up against a very difficult situation which was that freedom of movement is a fundamental pillar of the European Union.

 

Guy

But the freedom to come for up to three months.

 

Camilla

One of the things that came out in the campaign was that people were very angry that British taxpayers were paying child benefits for children living in Warsaw. But the EU would not budge on those issues. I honestly think that if the EU had been a little bit more flexible on some of this we would not be where we are now.

Guy

Why not just change domestic British law to be a little more Napoleonic?

 

Camilla
Actually I have argued for years for doing that. But when you say just change, we would need to create a contributory welfare system which is a completely different animal. I don’t believe we would have got it through Parliament. I don’t believe any government would get that through Parliament without a very long-term type of consultation process you talked about earlier. But I think there was a fundamental mismatch at that point, in that we were such a successful economy, and we were drawing so many people here who wanted to work from other economies which were under a cloud, it just became unbalanced at that particular point in time.

 

Guy

And now British politics has just rolled the dice. For what it’s worth, the idea that everybody is thinking about how to vote tactically to try and get an uncertain outcome even if they do all the analysis in the world – it’s kind of random what’s going to come out. Is that the political crisis that Britain is in? And is there any way to cut through that if you are sensibly minded?

 

Camilla

Clearly the number of seats in which Remainers like you who put that issue above all others c could vote tactically to make a difference is falling. It’s only about 45 now. Liberal Democrat support has cratered, according to the polls. We don’t all believe polls because those of us who’ve lived through elections and worked in newspapers know that the polls are often wrong. But the Liberal Democrats are not picking up support for their revoke policy, to stop Brexit outright. That does indicate there’s a lot of Remainers who are deeply uncomfortable with the idea that the Liberal Democrats or anybody could come to power and just say, We’re going to erase Brexit and pretend it never happened.

 

I think that most people believe in a second referendum because at least that pays some attention to the previous referendum. You can’t have a massive democratic experiment in a referendum and then just erase it overnight, as much as some of us would like to do that for the sake of the economy. I think the societal problems and backlash that would create would be disastrous.

 

Guy

We’ve all heard this response, So I support a second referendum, and people say, Oh, what, then do you have a third one, a fourth one, best of three? My answer to them is, Absolutely, we can have 10 referendums. We keep going. That’s the nature of politics.

 

Camilla

That’s the experience in Switzerland and indeed in California. But we’re just not used to that. We’re not used to referendums at all. And so we’re not used to the idea that you can have, as you say, a second and a third.

 

Guy

And there are issues that I only looked up on Wikipedia where there were about 10 referendums, and it took about 50 or 60 years to settle. But that’s fine.

 

Camilla

It isn’t fine, though, because people were asked to vote and they were told by government it would respect the outcome of that vote, and they have been told by every single party in Parliament that they will respect the outcome of that vote, all of which did vote to have a referendum and then voted to trigger Article 50 [which takes the UK out of the EU]. It is not an impressive history if you believe that this is potentially a tragedy for our nation. Maybe we’ll get a hung Parliament, but the truth is that prolonged uncertainty is really crippling us. It is crippling not just individual investment decisions but actually I think individual psychological stress. Most people I talk to in business are feeling increasingly beleaguered by this, and by the volatility of the world – this prolonged geopolitical uncertainty. And that’s why I think the Tory slogan, Gets Brexit Done, which is sort of a mendacious illusion, is very effective.

 

We know perfectly well that this is going to be far more complex, and a Canada-minus free trade deal is not a good outcome. But a lot of people feel they can’t just bear to think about it anymore.

 

Guy

Have you heard about Germany plus?

 

Camilla

No. That’s a new one on me.

 

Guy

It’s from listening to James O’Brien. So I now listen to people like Ian Dunt and James O’Brian. These are not hard leftists, but they are members of the Labour Party that I never thought I had anything in common with. Germany-plus is the deal that the UK has today with the EU. It is everything that Germany has, but without membership of the Euro, without ever-closer political union, without membership of Schengen. It’s got these amazing advantages.

 

But one of the things I’ll tell you that is distressing to me, though much less distressing for living in Switzerland, is the crisis of the West. Both the large Anglo-Saxon economies are in a crisis mode in that we have populists running those countries who are making decisions based on what feels good to the broad electorate rather than what makes sense.

 

Meanwhile, anybody who’s been to China sees extraordinary infrastructure, happy people for all of the lack of freedom. Tens of millions, if not hundreds of millions, of Chinese leave China every year and happily and voluntarily come back. We can all recognize that China is not a free society. I feel like you and I were indoctrinated into this idea of liberal democracy. Liberal democracies are failing and we’re at the center of them. What are we supposed to do? Is this the end of liberal democracy?

 

Camilla

That’s the question of the moment, isn’t it? I think I would slightly take issue with you on China. I think since President Xi Jinping took over, we’ve seen a much harder line from China. We’ve seen increased censorship. We’ve seen what happened with the Uighur Muslims. I know what you mean, but I regard it as an exceptional model and I don’t think it’s necessarily sustainable. There are deep, deep cultural issues within that society which probably will bubble up at some point, and we’ll see what happens in Hong Kong.

 

There is an increasing threat from the idea that somehow economics is all, and if you just give people enough prosperity, they’ll go along with any level of state control. That terrifies me, but I know what you mean. Liberal economies do have to reign in freedom under capitalism a bit. If free-market capitalism is going to succeed, it needs to be responsible and properly regulated. And in so many areas we have failed to properly regulate it. But I don’t think that’s impossible to deal with.

 

Guy

I’ll push back at you. I want to agree with you, but the Communist Party in China is 90 million people. It’s more than the population of the UK. As I understand it, the deal in China is you are welcome to discuss politics within the Communist Party, join the Communist Party, and then you can have raging political debates. But if you want to publish something that’s politically sensitive, we prefer you don’t publish it in public, so you restrain your freedom of speech to the general public. The people who make policy can certainly see what you write, and there are plenty of dissident writers who are invited to write for Communist Party organs.

 

Camilla

And how chilling do you think that is? Wow. I mean, how many people are going to express their genuine opinion even within the internal party, if it’s telling them they can’t express that outside. And if by the way, as I wrote in the FT recently, it is also putting pressure on institutions of free speech all over the West. That is self-censorship. So, the situation may sound plausible, but it leads to self-censorship.

 

Guy

But what that system would say is Yeah, there is a certain amount of self-censorship, but we’re not about the ability to express yourself on every topic irresponsibly. What we want is effectiveness.

 

Camilla

No, what they want, Guy, is power. They want permanent power, they are a despotism. They are an authoritarian government and they are increasingly looking like an authoritarian government and they are relinquishing small amounts of power where they know they need to in order to maintain this juggernaut that’s moving forward. And they do that extremely subtly and effectively. But don’t mistake it for any form of freedom.

 

Guy

So their response is to say, Yeah, freedom is overstated. We’re effective. We have well run cities, we have good airports, we have train systems that work,

 

Camilla

Look at Switzerland, it’s got a fantastically well run train system.

 

Guy

Switzerland is extraordinarily unusual. Singapore is a much less free society, and there are so many countries in the world that say we like the Chinese model more.

 

Camilla

Yes, I know.

 

Guy

And the western model is failing miserably, we’re not succeeding. We’re not having sensible debates. Look at the UK.

 

Camilla

The US is going through a period when it is being seen to be hypocritical and it’s not standing by the values that it has historically wanted to project across the world. That is a major concern. Whether that’s a permanent phase, none of us know. Hopefully it’s not.

 

Guy

One of the biggest fears that anybody who’s lived or lives in the US has is that the American Constitution is this amazing experiment that has lasted all of 200 years, and maybe one of these days soon the center won’t hold and it will all collapse.

 

Camilla

I think something different is going to happen. I think we’ve had a disengagement from politics of highly talented people for about 20 years. I think for about 20 years the best and brightest in their societies, certainly in the UK, just didn’t even consider politics as a career. You didn’t consider politics as a career. Most people didn’t. And now we are seeing – and I see it at Harvard because I have a lot of British students there who are the best and brightest of their generations – they are much more politically engaged than my equivalent group was there 25 years ago. We are going to see an En Marche. French President Emmanuel Macron built En Marche, which was a brand new political movement. Half of the candidates had never stood for office before. We are going to see something similar like that, which will bring it back to the center. We can debate what we mean by the center, but something that is much more rational and evidence based. And what I hope is that some of the business people who are now seeing for the first time just how dangerous politics can be, who’ve never had to worry about politics before, are going to get involved and actually going to run. Unless we get these people involved, we’re not going to solve this problem.

 

Guy

Not that I’m ever going to run, but I’m an example of that in that I’ve gone and joined all these political parties and I am politically engaged.

 

Camilla

Yes, people are more politically engaged. I’m quite hopeful about that, actually.

 

Guy

By the way, one of our listeners just wrote that they ordered your book while we were talking about it.

 

Camilla

Thank you!

 

Guy

Whoever it was – it’s Mark Hughes – Mark, feel free to order 20 or 30 copies and send them to all your friends. Camilla will be very, very happy with you.

 

Camilla

Can I just deal with Michael’s question here? So Michael’s question is how does poll attendance vary between the young and the old. Will populism and health-care concerns among the old concentrate and change political power? This is of course a very live and perennial question and at the moment poll attendance has been much greater among the elderly. I just saw a poll today that suggested that that is still going to be the case, that quite a lot of young people still haven’t signed up to vote.

 

So, you’re absolutely right. The danger of that is that we see the gray vote securing a larger and larger share of the pie and the Conservative manifesto, rather to my dismay, just plays into that again by upholding all of the pension benefits and so on. That we have helped to vanquish pensioner poverty is a great thing, but now we’ve indexed pensions not to inflation but to 2.5 percent, which in an era of low interest rates and low inflation is rather a mistake.

 

So, yes, I think we are going to see those concerns concentrate more. Except for this fact. And I write a lot about multigenerational questions. The old, the bank of mum and dad is now funding the younger generation. And the grandparents I interview are increasingly worried about the grandchildren. So, in fact, weirdly the generations are becoming more connected, not less. I think you’re getting grandparents who will vote for more housing, for example, and they’ll stop being NIMBIs. They’ll want more health care for themselves, but they are also quite concerned about the young. I just hope that will start to come through in some of these polls.

 

Guy

I was going to talk about a pet peeve of mine. I am so impressed with the way Singapore pays its top civil servants. I would love to see the UK do that. I think the parliamentarians should be paid five or six times what they are paid, to make their lives easier but also to recognize the incredibly important job that they do. It’s probably not even worth discussing because I’m just being completely naive.

 

Camilla

You are, I’m afraid. We wrote editorials on that in The Times about 10 years ago and got monstered because obviously parliamentarians get a lot more than the national average and people say, Well, these people are all mediocre anyway and they only work in  parliamentary sessions and have long holidays. So it gets really difficult. The civil service point is fundamental. Dominique Cummings, who is effectively the Prime minister’s chief of staff at the moment, has long believed that the civil service in Britain needs a major shake-up. I think he probably believes that we need fewer people who are much, much, much better paid. When you meet the officials in Singapore, they are so effective.

 

Somebody has just written, No, you pay your officials enough so they’re not suborned. Yes. Quite.

 

Guy

That by the way is Sarah Money who’s a classmate.

 

Camilla, I just want to go to what are your favorite sources. What are you reading? Books, magazines, columnists. Who needs to be amplified in my mind?

 

Camilla

That’s a good question. I don’t know about all of you, but something I always try to remember to do is read people I really disagree with as well as people I agree with. I think we should all have a few of those who just make us furious, because they always help me to crystallize my thoughts. In England I tend to read Polly Toynbee, who’s a Guardian columnist and is marvelous. I almost always disagree with her, but she is really, really well informed.

And Christopher Hitchens. I still read him now even though he’s passed on because I just think his style of writing and his incisiveness are extraordinary. I love people like Peggy Noonan and Maureen Dowd in the States. I think these women are just extraordinary and I increasingly like these kind of feisty opinion writers, I suppose. People like Tom Friedman who look for trends. Matthew Parris of The Times, he’s the golden oldie of moderates. He’s also the most interesting weather vane of the moderate center. I think he’s now left the Conservative Party, and supports the Liberal Dems or something. He’s a very thoughtful, discursive kind of writer. He’s not shrill. And I think in an age where all of a sudden everyone is getting more shrill, those people are worth a lot.

 

I’ve also started going back in my reading, to things like Rosamond Lehmann, the Virago novelist, and Margaret Atwood in her older books. Because I suppose I’m just looking for really great writing and I sometimes can’t bear to look at what’s going on in the modern world.

 

Guy

So what’s on your bedside table right now?

 

Camilla

Well, Samantha Power’s new book, which I’m looking forward to reading because she’s a fellow at the Kennedy school with me. She’s an extraordinary story, the story of her life. As a woman, what she achieved and becoming such a senior advisor to Obama and fighting for human rights. She says herself she came from a fairly modest background, that’s very impressive. I’m reading Drive, which is about motivation, because the next phase of my research is about motivation. How can we change behavior? So, I’m really, really interested in how do we get people, for example, to exercise more and how can we all stop ourselves from damaging our own health? This kind of thing is on my shelf. What else? Michelle Obama’s book, which I haven’t read yet.

 

Guy

Do you distinguish between reading for research and reading for pleasure?

 

Camilla

A bit. My secret, back to the question you asked at the top of the conversation: I love crime thrillers. It’s the way I relax.

 

Guy

So this is Agatha Christie type?

 

Camilla

Jeffrey Archer is my secret. It’s awful, my family is so embarrassed. I just love that, I love pacey plots and terrible crime thrillers. That’s what I read to relax.

 

Guy

I’m curious, have you read any of Robert Caro’s books?

 

Camilla

Yes. I have. Marvelous. Very long. You’re showing your seriousness there, Guy. They are very large tomes.

 

Guy

Actually, I was determined to read two big books. I read War & Peace on a cruise with my family and I would say that it’s such an amazing book. I kind of fell in love with some of the characters I read because I felt like I didn’t want to die having not read it. Also, James Joyce’s Ulysses. I kind of skimmed bits of it, I let it waft over me, and it was an interesting experience. Maybe I’ll read it again.

 

Camilla

Try Virginia Woolf’s The Waves. She tried to do something similar but it’s more readable.

 

Guy

Is that right? I’ve not read any Virginia Wolf. But then I discovered Audible, and I’m listening to Robert Caro’s Path to Power while riding my bicycle. With the new BEATS Sports earphones. It’s such an awesome experience.

 

Camilla

Is this where you get your investing ideas from? I wonder how much that helps you think more laterally about investment.

 

Guy

I have no idea. That is a great question for a future conversation. This has been so much fun, Camilla. We’re at 28 minutes past the hour. I’m going to leave you the last word before we stop this call. Thank you everyone for joining. It’s been an enormous amount of fun. Camilla, last thoughts.

 

Camilla

Well, it’s just been great. I mean, I love the format. It’s just like sitting in a cafe and having this conversation, but being able to keep one eye on interesting people making nice comments on the side. And by the way, thank you for everyone who’s enjoying this. I think we didn’t really know how this would work, just being able to rove across a number of issues is marvelous. It’s like a therapy session.

 

Guy

Another thought to dive into. Thank you everyone. Have a good evening, Camilla.

 

Camilla

Thanks Guy, bye.

 

Guy

Thank you very much for listening to Cappuccino & Conversation with Guy Spier. You can find me on the internet at www.guyspier.com. My social media handle is GSpier, through which you can find me on Twitter and Facebook, and alternatively via GSpier66. My book, The Education of a Value Investor, is available in hardcopy and on Audible.

 

Postcript:

 

Guy

Camilla, since we spoke, the world has changed utterly, and perhaps irrevocably. Boris won in a landslide. And the US economy was going blazes. But then the pandemic hit. Boris got sick. And President Donald Trump adopted a style of rhetoric akin to old-style Latin American strongmen.

 

Around the world, as of early June, nearly 7 million are infected, nearly 400,000 have died, and western economies have taken a historic, catastrophic hit. China, having been the origin of the virus, is now ascendant and emboldened, more than ever before. And then George Floyd is murdered in the most horrifying, public way.

 

Taking these issues one by one, where are we? How will the virus turn out? And the cup of liberal democracy – from which you and I drank so gladly in those wonderful days together at university – is it now truly running dry?

 

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