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| Credit: The Week |
Much as been written about the state of the Welfare State. I am prompted to ponder this subject by a recent gift of the book 'Racial Help', by Hillary Cottam. Also the review of the book by Duncan Green's review on From Poverty to Power, where Green says Cottam makes great points, but feels she is not specific enough.
Here are my thoughts.
Ironically it is now clear that the Welfare State has consistently distributed wealth from the poor to the rich. The main reasons for this are that the middle classes tend to live ten years longer that poorer people. They also use the health and care services more than the poor because the elderly disproportionately use NHS service. 19% of the population use 51% of NHS funds. The middle classes also use the system and assert their rights more fervently. This was shown recently when the Labour government removed the winter fuel allowance for most elderly and disabled people. Because so many incomes were affected, many people had their entitlements reviewed. The result was that more benefits were claimed than the savings being made through the axing of the winter fuel allowance.
The reasons for having a welfare state are various. The most important aspect of the Welfare State is that it provides security. No one need worry that they will be put in an impossible situation with draining funds and terrible dilemmas, such as prioritising food over, heating or medicine. In the forties many working class people spoke of the relief they felt with the coming of the NHS, given that many also worked in dangerous jobs. In 'Sitting Pretty', by Rebekah Taussig, Taussig explains how she got married at a young age because she feared that she would not be able to afford the medical fees she might incur due to her disability. The marriage did not last, and in actual face the American State does make provision for health needs relating to disability, but no one told her.
The Welfare State also intends to provide equality of opportunity. Everyone gets the same basic standards of housing, food, health and education. It is proven that societies where people have similar living standards also report to be happier. levels of crime are less, and people live longer.
So what are the main issues for the Welfare State?
Finite Resources. The political spectrum correlates almost exactly with amount of taxation dedicated to state provision. However, no matter how much is paid into the state, it has been shown that 'need' is almost infinite. There is a never ending cycle of need; Schools (special education and managing behaviour), to health, with an aging population, and new medical innovations. Then there is infrastructure with the need to renew and replace everything from buildings to bridges and sewage systems. Much private infrastructure require state support. It is too important to fail, and private companies know this.
The entanglement of private capitalism and public services.
So much that goes wrong in society is because there is an economic reason why common sense cannot prevailed. The water companies pour sewage into rivers because the government lets them. They pay their fines, which happen to be less than fixing the problem. To quote Joan Robinson, economist, "The misery of being exploited by capitalists is nothing compared to the misery of not being exploited at all." We are in a perfect bind, where wealth requires compromise. For countries that can afford a welfare state, the power relationship between multinationals and their power is incestuous. The two feed off each other.
Affording a welfare state is also ironic. Rich countries maintain the advantage the have in the world in much the same way that rich families maintain their wealth across the generations. It can be argued that the reason why western countries can continue to provide a welfare state is because they have (and continue to) exploited poorer countries for many hundreds of years.
What would I do?
For me the fact that the whole population looks identical when dressed in a hospital gown is important. In Britain we would not outlaw private health, but we can tax it to create a disincentive. We do not need private health. Private health is simply a first class service that queue jumps the NHS, and could not exist without the NHS. The way to moderate the power of private companies to to have health priorities decided by multi-agency groups including representatives from 'user groups'. It is essential that the health service uses realistic priorities. Priorities can change, and certain needs might be given their moment where innovation can be supported (such as mental health services for deaf people.) Not everything can be given a priority, but some people must never be left just below the priority cut off line.
Waiting lists can be managed if priorities are agreed, and early intervention programmes are in place. Early intervention cost about a tenth of the cost of crisis interventions, and balanced planed structure of provision must be agreed, and made public. At the moment to political consensus is to be opaque, and pretends that everything is important, and everything is being dealt with, "if only the mean fisted treasury would just give us more".
Care of the Elderly, and Pensions.
We all know that the growing elderly population is the modern challenge for the Welfare State. Some of the changes I propose are slight and subtle.
The age of receipt of state pensions is going up across the western world. This saves money because a percentage of the population will die from old age each year that the pension goes up. The down side is that also the older people become, the more who become eligible for sickness benefits. Average sickness benefit is £117. Average state pension is £165 per week. One solution is to be clear about the money available are ensure a good quality of life to all retired people. This would mean greater sharing in old age. It is crazy that some people are at their most wealthy when not in work, and in their latter years.
Some political systems see the Welfare State as a 'safety net', and only there to catch people from 'returning to a Dickensian dystopia'. Other systems see the Welfare State as a 'parent' that offers a secure base. I think that we are all more dependent on the welfare state more than we imagine. The key for me that the welfare state should act as a buffer to ensure that our society does not separate into two classes, the haves and the have nots.
This means that care, education, and health should be at a similar level and quality for everyone, where ever they are. Inheritance is one of the greatest inequality we see in society. Leicester school catchment used to be in 'pie slices' of the city to try to mix each school community.
I would like to see much greater local democracy defining how communities operate to address their own local needs, such as social cohesion, and shared problem solving.
Creating Services that Serve, rather than control and monitor. The Welfare State (such as the NHS) should be rebranded as a service controlled and run by communities. If surveillance is felt to be important, the Welfare State can be used to do this as a service to the community. An example of this is addressing the abuse of the vulnerable. Public health strategic approaches can be used to agree the controls we need on Capitalist pressure, such as food, drink, entertainments including the internet.
The more people feel they have a voice through local democracy, the more we are likely to agree for controls on commercial avarice.
