Social Care: who foots the bill?

Carer with elderly woman on a bed
Elderly woman with carer CC licence from PxFuel

The Tory government has been claiming that it has (in the freezer) an oven-ready solution to something we’ve been needing for a long time: a way to address the costs and burdens of what we call “social care”. They’re now threatening to put up our National Insurance contributions as if that were a solution!

Social care is the help that’s provided for people who through illness, disability, frailty, old age, or dementia, can’t manage their own personal day-to-day needs. Some of these people are children or working-age adults with special needs. But our increasingly elderly population means that there are more and more elderly people who need help with daily life. And as people live longer—but not healthier—lives, we’re spending longer in ill-health into old age.

Longer life expectancy means longer social care

In England over the last five years the number of years of life we can expect to live free of disabilities has fallen significantly, and for women especially. The years we’re likely to spend in poor health has increased. Healthy life expectancy in the East of England is currently just short of 65 for women, and just over 64 for men. That’s in a total life that’s likely to be about 80 years for men and nearly 84 for women.

Those years in ill health are when we need assistance, but few can afford to pay for it. Many working-age people devote hours of unpaid time to providing it for family members and neighbours where there’s insufficient support from official providers.

Unfair burden of costs for social care

The burden is by no means evenly shared. It’s often those who worked the hardest all their lives, and yet lived in relative poverty nonetheless—the great shame of our society—who suffer the poorest health in later life.

Many aspects of this problem need to be addressed. Not least:

  • the crisis in public health
  • the prevalence of in-work poverty and low wages
  • unhealthy housing
  • work-related stress
  • the effects of air pollution
  • nutritional deficiencies

all of which reduce your chances of a long healthy life, especially if you live in poorer urban areas.

Social care needs fair funding

But addressing just the sticking-plaster solution that is the provision of social care for those who need it, no matter why, or how little money they ever had, would be a start. We need to find a way to provide real care and not leave people destitute and neglected.

Mother in a wheelchair holding her son's hand
Images of ability by Andi Welland

We’ve been mocking the government for their empty promise of a magical solution. But let’s also mock them for their utter cowardice about how to pay for it.

Their big error about economics (or is it deliberate deception?) is assuming that a benefit, or handout, that funds something, and is spent on buying it (in this case employing a carer to visit, or paying for a place in a care home), is money lost. They don’t view it as money circulated. So they think it needs to come from extra taxation. It’s an assumption made by other political parties too. So, suppose we all think that we have to increase the tax burden somewhere. Where then?

Well, taxes serve two purposes. First, they aim to rebalance poor distribution, by stopping the market forces that would naturally take away all the wealth from the workers or the unemployed, and deliver it to the capitalists. So taxation takes some back from the people and companies at the top of that pile, and directs it back in the form of services (roads and schools for everyone) or state support to the others at the bottom.

Second, taxes aim to discourage certain undesirable practices, such as smoking, by making them expensive and hard to afford in large quantities. Putting a tax on something that’s damaging and costly to health and to the economy is a good idea. Putting a tax on something that’s beneficial to health or the economy is not a great idea, least of all if it makes the unjust distribution of wealth worse.

National Insurance to fund social care is unfair

Nothing, then, could be worse than proposing that the tax increase to fund social care should be put onto National Insurance. National Insurance, a tax that takes from workers a bit of what they earned, and adds to the cost of employing a worker for the employer.

Do we want to decrease the returns from getting a job, so that it’s less worthwhile to go to work? Do we want to add a further incentive to employers to use bogus “self-employment” schemes to avoid National Insurance? Or make it impossible for them to pay a living wage on top of all the taxes?

This is economic nonsense.

And besides, NI is a grossly regressive tax. It affects those in work, not those in retirement (many of them more than wealthy enough to pay taxes). It affects the young, struggling to find the costs of housing and start a family. It doesn’t fall at all upon those who earn their money from renting out property, property development, investments and other forms of unearned wealth.

But should we be surprised that this government feels it would prefer to take from the workers what little they earn, while leaving the super-rich to keep all the wealth that they never earned?

Well indeed, who’d a thunk it? After all, we know well that they’re never at all influenced by the prospect of donations from wealthy friends towards party funds, or the redecoration of the Prime Minister’s hovel.

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