NHS-Worship, Non-Contributory Welfare And Britain’s Idea Of Fairness

Save Our NHS

Blind devotion to our indifferent, non-contributory welfare state plus a warped definition of “fairness” are holding Britain back

The Guardian’s ongoing “This Is The NHS” series is really pushing my buttons at the moment. The newspaper is clearly particularly proud of their feature project, which makes the series’ blatant NHS hagiography and stunning lack of intellectual curiosity especially infuriating to read.

As a journalistic exercise it has been utterly contemptible, constantly telling people what they want to hear – that the NHS saves lives (as though that were not a feature of every healthcare system), that it employs many hardworking people – rather than what they need to hear in order to make an informed, dispassionate judgement about whether the UK’s unique approach to healthcare delivery is sustainable in the future.

Any and every inconvenient fact which suggests that the NHS is not in fact the “envy of the world” is immediately shot down in the series of articles – like when the Guardian quotes a professor of European public health‘s dismissal of reports criticising the NHS as being “market oriented”, as though the accusation automatically ends the argument, and as though we could not have foreseen that opinion by simply reading his job title.

For the better part of a month now we have been treated to statements such as this, comparing the NHS to other healthcare systems and – unsurprisingly – finding it to be the best in the world:

A mission statement set in 1948 for a universal service free at the point of use is under strain like never before. People are still able to see a GP free of charge – though booking an appointment is becoming harder. It will cost nothing to call out an ambulance and go through A&E, to undergo chemotherapy or major surgery. And yet about 11% of the population prefer to pay for private health insurance.

“And yet”! And yet despite having this state-provided, socialist wonder on our doorstep, an astonishing 11% of the population elect to pay for supplementary coverage. Could it possibly be because cancer outcomes in the UK are about the worst in the developed world, or because getting to see the specialist who can actually treat your condition requires going through the gatekeeping step of booking a GP appointment, often with a month-long wait before each step? No. The people who pay to go private are clearly just ungrateful, verging on insane, to want to circumvent such a benevolent system.

Yesterday, this saccharine coverage – and the Guardian’s publication of a parsimonious little online calculator enabling readers to calculate how much they “cost” the NHS – prompted me to write:

But of course we all know exactly why the Guardian is so eager to talk about how much we cost the state (and chide us for doing so) yet desperate to avoid talking about how much we contribute. Because to look at both sides of the equation simultaneously would be to encourage the public to ask whether they getting value for money. And it would reveal – as we now know – that the majority of us are net takers, or beneficiaries, from the system.

The Guardian’s whole anti-Tory, anti-austerity schtick is built entirely on the notion that we all contributed to our public services, and that the dastardly Evil Tories are cutting services to which we have all made substantial financial contributions. They seek to perpetuate the vague notion that we have a contributory welfare system, when in reality Britain’s welfare system is defiantly, depressingly non-contributory.

And that, right there, is the real problem.

Not the NHS itself – a flawed but well-meaning organisation filled to the brim with mostly hard working and well intentioned people – but rather, the warped view we have of the concept of “fairness” in this country, and the desperate lengths the Left will go to to stop us from thinking rationally about important issues.

In Britain, the word “fair” has been taken by the Left and forcibly redefined to mean “redistributive”. You’ll see it in public discussions of any issue from tax policy to healthcare – no policy can ever be described or promoted as being “fair” unless it takes from the privileged few and given to the “disadvantaged” many. Everything now has to be redistributive – or at least, nothing can ever move in a less redistributive direction, resulting in a one-way ratchet to ever bigger government.

Thus Gordon Brown’s decision to hike the top rate of income tax from 40% to 50% was bold, progressive and generous, while George Osborne’s decision to undo just some of that punitive and unproductive tax increase (cutting the top rate from 50% to 45%) was a corrupt, almost immoral “giveaway to millionaires”.

And thus a healthcare system based on insurance – which might see people who make unhealthy lifestyle choices pay more, rather than being subsidised by their peers – is considered unthinkably bad, while the NHS model, funded through our progressive tax system, is lauded as being inherently good and virtuous. Indeed, the only way that the NHS could be improved in the eyes of its most ardent admirers would be if wealthy people could be targeted and forced to pay arbitrary additional “NHS tributes” every time they experienced success or felt any kind of joy in their unfairly privileged lives.

And this is why it is almost impossible to imagine real reform of the NHS, the welfare state or any other major modern edifice of British public life. Because “fairness” has been corrupted from its more authentic meaning, the meaning which we might apply in any other context in life – the principle of reward being commensurate with effort, or “getting out what you put in”. And while we may still be taught The Little Red Hen as children, as adults we much prefer to virtue-signal by nodding along to the mantra that fairness means the state blindly treating everyone exactly the same.

But there is nothing “fair” about the status quo. As this blog noted last year while discussing Britain’s homicidal welfare system:

Usually it’s good when government does not discriminate. Justice, for example, should certainly be blind, as the old saying goes. But when it comes to social security, we choose to regard our welfare system as a “safety net”. Yet any fisherman knows that different nets are needed for different environments, and likewise a one-size-fits-all safety net for citizens experiencing unemployment or hard times simply won’t catch everybody. Some will slip through entirely and crash to the ground, while others will become ensnared and trapped forever. In other words, when it comes to welfare we should actually want the government to actively discriminate.

[..] The problem – and the great moral rot at the heart of the British welfare system – is that the state makes absolutely no distinction between the perfectly-fit, perfectly-able eighteen year-old who can’t quite be bothered to look for a job, and people of more nuanced and complex circumstances. Worse still, the system treats people who have worked hard for many years, often contributing enormous tax payments to the Treasury throughout their lifetimes, in exactly the same perfunctory way that it treats a person spat out of compulsory education at eighteen without the curiosity or drive to find a career.

[..] People talk about the welfare system as being a “safety net” without thinking, and for some people it may function as such tolerably well, if they ever use it at all. But for many thousands and millions of others, our universal and non-contributory system – which remarkably, despite being the product of classic Big Government, takes absolutely no account of our individual lives and circumstances – is no such thing.

If a person is born into deprived circumstances, our social safety net is far more likely to resemble deadly quicksand, seeming benign at first but quickly trapping the victim without hope, dragging them ever deeper with each desperate exertion to break free. And if they are even moderately well-off but suddenly fall on hard times, Britain’s universal welfare system certainly isn’t like landing in a soft safety net – it’s more like smacking into a concrete floor from a fifty-foot drop.

Contributory vs non-contributory. Kristian Niemietz of the IEA perfectly encapsulated the difference between these two principles in an IEA article from 2013:

The difference between a contributory and a means-tested welfare system is not just an administrative one. The two reflect completely different conceptions of fairness, and different understandings of what a welfare system should be there for.

A contributory system is based on an understanding of ‘fairness’ in the sense of ‘proportionality’, or reciprocity: the more you have paid into the common pool, the more you should be entitled to take out of it. Quid pro quo, something for something. In a means-tested system, meanwhile, fairness is understood as supporting the needy, with support being proportional to need. The more you need, the more you get, and if you don’t need support, you won’t get any.

And goes on to explain that despite originating from an utterly perverse interpretation of “fairness”, re-establishing the contributory principle is politically toxic in Britain because it would mean breaking the association – forged in the many decades since the Beveridge Report was first published – between the word “fairness” and the idea of the state treating everybody exactly alike, regardless of merit:

Due to their emphasis on proportionality, contributory systems are not, in themselves, redistributive. They are only redistributive to the extent to which they deviate from the contributory principle, which no system adheres to in an entirely pure form. But a welfare state that honours contribution cannot, at the same time, be strongly redistributive, and a welfare state that is strongly redistributive cannot, at the same time, honour contribution. In this sense, those who have recently discovered their love for the contributory principle are not telling the full story. They are right to point out that the British welfare state offers those who have worked and contributed for a long time a rough deal. But they fail to mention that this is precisely what redistribution is all about. If the welfare state has little left for those who have a paid a lot into the system, it is because all the money has already been spent on non-contributory transfers.

So unless our new contribution enthusiasts are also planning to substantially expand the welfare state – and I take it that that is not their intention – then they can only restore the contributory principle by reducing the extent of redistribution. Since nobody appears to be prepared to do that either, ‘something for something’ is hollow rhetoric. There will be no return to contributory welfare.

It seems to me that there are two potential ways to go. On one hand, we could move toward a more genuinely contributory welfare system. Under such a system, the amount of (say) unemployment benefit received would vary according to prior salary and past taxes paid, making it closer to unemployment insurance – a disbursement intended to provide a time-limited “soft landing” in the event of unforeseen job loss. Means testing would cease under such a system. And while a basic payment would be available to all citizens, those who contributed most would receive more help should they fall on hard times.

And on the other hand, we could accept that this more discerning form of “fairness” is politically toxic and unachievable, cut our losses, and focus instead on making the current bloated and inefficient system of applying for a complex array of potential benefits much more streamlined. And our best hope in this case might be to follow the lead of Finland and implement a form of Basic Income (otherwise known as negative income tax).

Basic Income offers something to both the political Left and Right. For those on the Left, the principle of universality is maintained. Everyone receives a guaranteed, flat-rate disbursement from the state every month, regardless of their wealth or income level, to be spent on essentials like food and housing or frittered away on foreign holidays as the recipient needs – or prefers. And for those on the Right, the expensive bureaucracy involved in means testing is eliminated, nobody is ever disincentivised from working, and the existence of “flat benefits” may eventually help to normalise the mirror concept of flatter taxation.

Is Basic Income “fair”? Strictly speaking, not by either of the two definitions discussed here. It is neither actively redistributive, and nor does it deliver more benefit to those who contribute the most. But despite the many criticisms of Basic Income, it is eminently pragmatic. And this itself is a huge advantage. Rather than having the Left and Right continue to shout at each other and fight each other to the awkward draw which has bequeathed us our current system, Basic Income – once bedded in – could help to depoliticise welfare and guarantee a minimum living standard for all citizens at the same time.

These are debates that we could be having in this country, if only we were able to stop patting ourselves on the back for the enlightened “compassion” of our current welfare state. These are some of the radical policy ideas that we could be debating – not as fringe intellectual arguments but as serious policy discussions.

But the debate never happens. And unless something changes, it never will. Politicians – and newspapers like the Guardian – keep us nodding along to the same tired old soundtrack about how lucky we are to have institutions like Our Blessed NHS and welfare state, and we keep on agreeing, even as they kill people.

Beveridge Report - Welfare State

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2 thoughts on “NHS-Worship, Non-Contributory Welfare And Britain’s Idea Of Fairness

  1. thelyniezian February 12, 2016 / 9:43 PM

    I think trying to promote an idea of a contributory-based system as the ideal of “fairness”, whilst denigrating an essentially redistributive system as “unfair” is failing to grasp the broader problems of the system. Such an ideal could perhaps work in a system which guaranteed full, meaningful and relatively stable employment, but the modern world simply does not seem to work like that. Some of this is perfectly understandable- increasing competition in a globalized world, freeing up of markets, changing of technology- but some of it is not. It is hard to see how some of it is not down to the likes of the financial sector and other predatory corporate interests, allied to a politial establishment which favours them over others in a cronyist manner. (For example, whilst it might be argued that bailing out banks instead of letting markets take their course, it was not done without the curbs on risky practices or various cutbacks that it could have been, say some) Such a setup can hardly be called “fair”, and a redistributive element seems to be a way of balancing it out. Of course this only leads to a potentially over-bloated and inefficient state which only adds to the problem, rather than taking away from it.

    I think outside of the fact that it might break with the tradition of “if anyone will not work, let him not eat” in those able to afford to consider it, basic income is an inherently fair idea at least as long as it is open to UK citizens only. Everyone gets the same amount no matter what, no-one is unfairly penalized but at the same time those able and willing to work are rewarded over and above that.

    Liked by 1 person

    • Samuel Hooper February 12, 2016 / 10:13 PM

      Agreed – and thanks for the comment. While a basic safety net for all is vital, I think the least we can do is stop calling the system which treats the serial layabout the same as the person who works and contributes all their life but then falls on hard times “fair”.

      That being said, I am rapidly coming to see basic income as the least offensive compromise. If we can’t reward those who do the right thing, at least we can stop disproportionately rewarding those who do the wrong thing.


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