Thursday, January 1, 2009

Long term care: who should pay?

This is a graph showing Population: by gender and age, mid-2007 The Torygraph reports today that adults could be forced to take out private insurance to pay for 'nursing home' costs in the future. Of course, the paper is missing the distinction between nursing care and residential care that we have in this country (currently the nursing aspect is broadly covered by the NHS and the 'non-health' aspect is paid for either by individuals or social services), but that is not really the problem.

Clearly there are a very difficult questions to be answered on how long term care is funded but also how it can be delivered.

Should people pay for it themselves (currently they pay out of their savings / house sale until they are down to £22.k savings)? The government is considering forcing people to take out private insurance to pay for this. The suggestion in the article is that critics are claiming the NHS already has enough money and long term care should be paid for out of this, is simply barking mad. These 'critics' have obviously failed to have any insight into health care - do they really want NHS services to be cut? Perhaps they want to pay healthcare staff less?

So is private insurance the right way to go?

Firstly private profit from health care: the short answer is NO! But the private sector can do it better the privateers / capitalists will be screaming... as history has taught us time and again they can't. Just look at the US if you want to find out why private insurance should have nothing to do with healthcare (15% of GDP, tens of millions without access to health care etc.).

Secondly, if you want a form of insurance to cover long term care then taxation is easily the best option. Progressive taxation is fair and just, ensures that 'premiums' are used for care - not profit, and ensures that care provision can be controlled to a democratically agreed standard (i.e. fair and equitable).

Strangley the Shadow Health Minister doesn't like Labour's idea. Strange because it is a real Tory type policy. He doesn't suggest an alternative so I guess his comments are just political sour grapes. The Lib Dem health guy, Norman Lamb, seems to be suggesting that the current system is OK but not enough money is being spent. I'm not sure he is suggesting more taxes to cover this or more money from individuals...

I think a much more demanding question is who is going to provide this care when the population bubble centred around the current 41 year olds hits 80 ish. The proportion of people in caring roles will soar and it likely to be in crisis.

This is the start of the article in the Telegraph:

"Taxpayers would have to pay hundreds of pounds in premiums every year while working, and would receive payouts if they later have to move into a nursing home.

"The radical plan is being considered by ministers as a way to tackle the system of long-term support for the elderly in England, which is widely considered to be unfair, underfunded and too complex.

"Currently thousands of middle-class pensioners are forced to sell their homes to pay for nursing home accommodation - which can cost £700 a week - while a postcode lottery of eligibility gives people in some parts of the country far more free help than elsewhere."

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