Social care reform and the west’s fiscal future | OC Comment

The Prime Minister’s new social care reform is an attempt to reform the outdated and dysfunctional care system. Unfortunately, it has stumbled on the issue that perennially flagellates all economic activity: scarcity. Even with increased taxes that are projected to raise £12 billion over the next three years, the fact remains that there is not enough money to go around.

The Prime Minister has stated that this money will go to both the NHS and social care. In this case, the crucial detail of ”how much?” has been omitted - a not insignificant omission, especially as a recent report has found that the NHS requires around £10 billion in additional funding. After all, if a social care reform plan allocates only 16% of its funding to social care, can it truly be defined as such?

Yet it may be possible that the Prime Minister believes such an outcome is necessary, if not desirable. After all, he has oriented the Conservative Party away from its historical opposition to taxes and government spending. Indeed, one of the most recent declarations from the Conservative majority leader stated that “We are the party of the NHS” - a statement that would have puzzled any voter prior to the COVID pandemic due to the historic association the Labour Party has enjoyed with the NHS, the organisation having been formed by Clement Attlee in 1948.   

What could be driving this shift in Conservative strategy? Of course, it has to be remembered that Boris Johnson is not unopposed in his social care reform plan, as many traditionally small-government conservatives have expressed disquiet at the unorthodox actions taken by the Prime Minister. Yet the PM is a rational person - something must be driving this break from long-held conservative dogma.

One possible reason may be a recognition that battles over healthcare and social care funding will become ever more strident and urging in the future. This trend, having only been accelerated by the COVID pandemic and the wrenching of public attention back to health issues, will transform such issues into the central battleground for political campaigns. Anticipating such a shift in the discourse, could the PM be trying to gain an early start on competitors by dipping a Tory toe into such waters?

The massive (and growing) fiscal burden of healthcare and social care is a trend that will shape the next half-century in Europe. This is mainly due to a dyad of interrelated trends in modern society: increasing life spans due to medical technology and the ageing population.

The first is a product of the wonderful ingenuity springing from the human mind. Rapid progress in medical technology, from cancer therapy to vat-grown organs to life support, has allowed us to push back the inevitable end to life to an extent that would have been unthinkable a century ago. This is of course a marvellous achievement, one that every human is thankful for. Having the possibility to cure a previously terminal disease means that more people can live happier and healthier lives. Yet these treatments, obviously, have a cost, and the ones that are used in extreme or end-of-life situations are the most expensive in economic terms. This provides a moral dilemma that unfortunately has no clear answer: How much should we spend to save lives? 

  This question is a deeply uncomfortable one. It is morally disturbing to be forced to quantify the economic value of the life of another human being, especially knowing that the same calculation can be performed upon a loved one and indeed, on oneself. This is exacerbated by Western and Christian cultural and moral norms. Being a culture that prizes individuality, mercy, and charity, one that believes that every human being is made in the image of God, it is tempting to say that all human life is infinitely valuable and cannot be measured in dollars and cents.

This is a perfectly reasonable statement to make as a private citizen, but it is of no help to a policymaker in making decisions about healthcare spending. If this statement were to be applied in political practice, then the electorate should be perfectly happy with a government that spent half of the national economy to keep a small group of terminally ill patients alive for a few more hours. This hypothetical example would of course be unacceptable to any voter. Yet the exact answer of what is the “right” amount to spend has not been resolved, and may never be. But the increasing cost of high-technology operations that enable longer and longer lifetimes will ensure that government spending on healthcare and social care will factor more and more into voting decisions, especially due to the second issue, the ageing population. 

The increasing average age of the population is not a uniquely European phenomenon, though the West seems to be in a far graver position than comparable countries, save for Japan. Plummeting birth rates and higher life expectancy have already shifted the average age in the UK upwards from 38 to 41 in only twenty years. Extrapolating this trend, keeping in mind that fertility will continue to decline, indicates an increasing demand for late-stage medical care in the future. This once again points to the centrality that such an issue will possess in future political battles.

With these two factors in mind, Boris Johnson’s seemingly in-congruent actions can be seen in a different light. Whether intentionally or accidentally, the Prime Minister is making a preemptive foray into the issues over which future governments and elections will be decided. Eroding Labour’s historic monopoly of pro-health care political positions, the Conservative Party may one day end up thanking Johnson for his actions.

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