The difference is more fundamental than many think

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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.