I’ve
often heard people – including some who should know better – argue that the UK
is now in a state of post-ideology politics.
Insofar as there is any validity to this at all, it is because the
government and opposition parties, to a significant extent, have accepted the
victory of one particular ideology.
Sometimes however, even in the pretend world of manufactured outrage
which generally passes for political debate, proposals come to the surface
which demonstrate and underline the need for ideological differences to
reassert themselves. One such is the
Tory proposal on paying for care for those who need it in the latter years of
their life.
Of
those of us lucky enough to live to a ripe old age, some will need care whilst
others will not. The reasons for needing
care will vary; it could be physical disability but there is also an increasing
incidence of dementia, bringing a need for expensive round the clock care. It’s mostly not ‘healthcare’ as such, but it
is unquestionably a need generated by a health problem, and the distinction
between health care and social care is close to meaningless in this
context. The question, at its most
fundamental, is whether we pay for that care by pooling the risk, or whether we
push the costs of that care onto individual sufferers and their families.
That
is, in essence, a question of ideology.
The Tories have pinned their colours very firmly to the mast of
individual responsibility – pay low taxes and pay the costs of care yourself. That is not the principle which underpins the
NHS, which is rooted in the idea that we all pay in through taxes and NI, and
can access the services as and when we need them. In effect, we are pooling the risk, and the
tax and NI contributions we make are a form of insurance against needing the
services provided. There is no
fundamental practical reason why we could not adopt exactly the same approach
to providing other sorts of care.
There
would be a financial consequence, of course – the cost would be distributed
over the population as a whole, and it would mean that many of us have to pay a
bit more tax, of one sort or another.
For those of us who need the services – and none of us can be sure that
we won’t – it provides the certainty that the care will be available when we
need it. For those who don’t – well,
it’s like paying any other insurance premium; if the event insured against
doesn’t happen, it’s a sunk cost.
One
of the most common arguments used against such a collective approach is that
the more well-off get the benefits as well as the poor, and that applying a
means test (which is what the £100,000 limit proposed by the Tories amounts to)
means that the help is targeted at those who need it. But a proper taxation regime means that those
who can afford it will be paying more in advance; the extra cost of providing
services to all is recovered by extra taxes on those who can afford to pay. The argument against providing universal
benefits is a fallacy used to rationalise a desire to keep taxes low for the most
well-off in society. In this specific
case, it’s also a means of protecting the assets of the very wealthiest by
raiding the assets of those whose assets are limited to a modest home. The astounding thing is that so many fall for
it – at least, until the problem hits their families.
There
was a report last week about the
reaction of voters in a solid Labour constituency to the idea of extending
means testing in general, and it showed the extent to which the individualist
ideology has triumphed over a more collectivist approach. It related to the means-testing of the winter
fuel allowance rather than the social care policy, but the underlying attitude
applies to both. And although it’s easy
for people to think that ‘those who can afford to should pay’, they’re usually
thinking about someone else. What many
don’t yet seem to realise is that, in the case of the new Tory policy on paying
for care, ‘those who can afford to pay’ is being defined as ‘every home-owner’. The legacy of New Labour has a lot to answer
for.
The
problem is partly that people are looking at only one side of the equation –
payments made by the government. A
balanced system needs also to consider the other side – payments to the
government, aka taxes. As Chris Dillow posted last week, if the
objective is to ensure that those who can most afford to pay stump up the most,
then a progressive taxation system coupled with universal benefits is a more
efficient means of achieving that than a system of means-testing.
After
being slammed by the Tories and their
media friends prior to the last election for talking about introducing a ‘death
tax’, Labour back-pedalled on their proposal to place an extra tax on estates
to pay for the increasing social care costs.
Given that history, I can’t blame them for seeing an opportunity here to
attack the Tories in the same terms, but what they don’t seem to be doing is
pointing out the essential difference in the two approaches, which is that
their proposal was based on taxation of all to pay for those in need, whereas
the Tories’ proposal is based on charging those receiving the services, albeit
posthumously.
They
seem to have lost sight of the essential difference between an individualistic
approach and a collective one. Yet
failure to make that distinction turns the debate into merely an argument over
taxation and expenditure rather than one about what sort of society we want to
live in. And allowing the debate to take
place only at that more limited, ideology-free, level is allowing it to take
place on the Tories’ terms. It’s a very
strange situation when the most vociferous opposition to this individualistic
approach is likely to come not from those who should traditionally be promoting
a collectivist approach, but from those who fear that traditional
Tory voters are the most likely to be hit financially by the proposal.