THE WELFARE STATE

Thirty years on

Patrick Cosgrave

The Welfare State' is a phrase, a myth, an idea, a condition which, in one way or

another, epitomises for our moment of

history the age-old idea of communal responsibility for the individual, and

especially for the weak or vulnerable individual. It is important to grasp that rather simple historical fact if only to avoid the doctrinaire perils of the two dominant systems of ideas which condition argument about problems of welfare, social security, and health care today. These two

systems may be described as statist and znti-statist.

The 'statist' idea — as put forward prin:.ipally by Professor Richard Titmuss and • pupils and followers and, at intermittent periods, by the Labour party — dictates that care and welfare, of the old, the sick, the poor and the needy, can be organised only by the state, and paid for only by taxation and, ultimately, by such a redistribution of national income as will ensure a more equal share of the nation's cash for each citizen regardless, more or less, of his ability, ingenuity or desire. The 'anti-statist' idea — as put forward principally by Professor Karl Popper and subsequently by the Institute of Economic Affairs and, at intermittent periods, by the Conservative party — dictates that, by and large, most welfare should be paid for by the individual, that only by fostering the will to freedom and wealth of the individual can the national resources required to pay for decent welfare standards be generated, and that systems should — and can successfully — be invented which painlessly differentiate between those in need and those not in need, so that the bounty of the community can effectively be concentrated on the former.

The model of the 'statist' school is the National Health Service, and of the 'anti-statists' negative income tax, which is a brilliantly conceived, but as yet untested, idea for paying money to the poor and receiving it from the rich through the machinery of Inland Revenue, and without the offensive apparatus of means testing.

The case against the statists now depends largely on the failures in social provision of the last Labour government, and on the growing disparity on a national scale between provision and demand. The unproven statist assumption is that a socialist economy inevitably generates the resources required for social welfare (including health): the naivety of those supporting this idea was sufficiently demonstrated in Professor Brian AbelSmith's pamphlet Labour's Social Plans, published at one of the darkest moments of the last government's freeze, when he wrote of a boom and a new National Plan to come, " with luck."

More fundamentally, we have seen in recent years the failure of the system created between 1945 and 1951 adequately to provide for need and, perhaps more important, its failure so to redistribute income that the better off pay more for common

services than the worse off. Instead, the lower income groups contribute pro

portionately higher sums to the common

services, while those who make most effective use of the Welfare State apparatus are those who least need help. The 'statist' answer to this problem is a more socialist economy. But, aside altogether from the fact that socialist experiment in the welfare field has been notably lacking in its ability to predict both need and resources, it is extremely doubtful if a socialist economy can generate resources of the order required; while the destruction of the present mixed economy which its creation would involve is politically impossible. Discontent with various aspects of the Welfare State is growing and, in some areas, becoming virulent. The 'statists' suffer from this because their ideas and aspirations, or modifications of them, prevail in the structure as it exists. The anti-statists ' can, therefore, fairly claim that their schemes have never been seriously tried. The trouble, however, with their individualist economic philosophy is that it depends too fundamentally on a purely economic idea of man's capacity and motivation, and presumes too readily that moral values — like freedom and charity — come wholly, as no doubt they do in part, from a liberal economic structure of the nineteenth century variety. One sometimes feels, indeed, that the laissez-faire Liberal party of the nineteenth century never really died, but instead took over sections of the Conservative party.

There is in fact no real evidence for the assumption that a wholly liberal economic system would be able to generate, mainly through the economic effort of individuals, the resources required to meet needs and aspirations as they are now defined in the welfare field. The conscience of society has expanded, as new welfare problems are discovered — as, for instance, the cultural has gained ground over the purely financial conception of poverty — while the conscience of the anti-statist, though real, has remained simple: his understanding of need is too much a nineteenth century affair to cope adequately with the complexities of late twentieth century needs and pressures.

In my own view the basically statist conception of the National Health Service, much reformed, and the basically antistatist conception of occupational pensions and negative income tax, will provide important elements in the Welfare State of the future, given that resources will always be inadequate, and demand for health and welfare is However, although the 'statist debate has dominated politics discussion about the Welfare many years — and still does some serious indications that it is out of date.

In provision for the old, f°,,r4 recent figures produced V; Klein and John Ashley suggee` 1992 73.5 per cent of hospital occupied by men, and 93.7 Per those occupied by women will befi old age pensioners, while reasonable projection of statistPf will become increasingly short ° Further, the prevailing and patterns of urban and suburli will make it increasingly diffic d old and the incapacitated to with their families, and thus gni. from the community to the resources of the state. At the the medical — and, more imPor medical-administrative — undere the distinction between a ge and a geriatric case is still ve" Again, in the present structure* inhumane to provide motor facilities for one kind of disebidllii while excluding another — haemophiliacs — from provi'e-fra] language. of priorities, in til plq Welfare State, is brutal. A AI Given the scale and likely vebou of these and other such Pr°,0ao debate about the economic society in relation to welfare 7ity, problems, and the habit of se ot,h, problems wholly through ec°;11trA income spectacles, will seem 'J.„/At irrelevant. We need both a more a more sophisticated system o,..tf r'-ovs ing priorities according to hurtwepii we need, in particular, a diagnostic criticism in medicins-: overall planning of the hospilPik: and in the general disposition °'ett, and suburban growth, and 1141 clearer understanding of the c'kci and needs of society •in, say, 'No years' time.

The greatest move in kd tion has been the creation,* multi-disciplinary Local Authollf Services Committees, which c:iin the problems of families and? as a whole: but these comminut40, fragmented and still resp°'"is different government ministers:At Keith Joseph has tried 'both to resources according to reasolloirr rities, and to reform the structure and improve the effio,Ivier Welfare State machine: but 1115#i this direction have been, t rather crude. We are enterin4, which the patterns of need understanding of and applio8 structure of society as a W than its economic and incollie istics.

The age of Beveridge, W 'statist/anti-statist' argument 115 b it, is passing; a more difficult3e4 t cated age of revised and revalo is about to dawn. the,