While surfing the web, I came across this delightful essay by Debora Price, a UK gerontologist. It reminds me how different the health-care systems of the US and the UK are.
August is a funny month in UK universities. I wandered into the corridor yesterday to find two young South Korean students waiting patiently in our waiting area, despite being surrounded by closed doors. When I asked whether I could help them, they explained in faltering but perfectly intelligible English that they were undergraduate students from South Korea who had been sponsored by their provincial government to come to England to interview academics about issues relating to ageing policy. ….
This is how I found myself explaining to them that for older people it is important for the state to provide the four essential pillars of well-being in later life – health care, pensions (income), social care and housing; that all capitalist welfare states make different political and institutional choices about how to provide these; and that in each sphere there is a mixed economy of state, market, private sector, voluntary sector and family provision. I found myself saying that in terms of state provision free at the point of delivery, the most important of these is health care, and that health care free at the point of delivery is the single most important thing a capitalist nation state can provide for its older people. They asked, did I mean for over 60s? Or over 65s? No, no. Not at all. I mean cradle to grave. Actually, pre-natal to grave, since the lifecourse is so important in understanding well-being in late life. And it must be comprehensive, from preventative public health programmes to dental care to cancer care to dementia care, and free to everybody at the point of delivery, and of the highest quality. And that Britain has chosen, over the decades, to provide that care for its citizens, as a citizenship right, paid for by taxation. And that if we were to export one thing in terms of social policy for older people to the new ageing populations of the World, this should be it.
And so there I was. My passion is pensions, but in 15 minutes I realised that my heart, mind and soul belong to the NHS [National Health Service]. State provided, free from the hideousness of the market and the means test, from cradle to grave.
Debora Price, “My passion is pensions … but my heart, mind and soul belong to the NHS“, gerontologyuk, 22 August 2012.
Debora Price lectures at the Institute of Gerontology, King’s College London, and has an interest in “social policy for an ageing society”.
I agree that South Korea and other countries should consider importing the UK’s simple system of universal health care … but definitely not its complex system of old age pensions. UK pensions are not universal. They are means- or contribution-tested, so leave many in poverty, just as means-tested insurance in the US (Medicaid) leaves many without adequate health care.
Thanks Larry! Couldn’t agree more on the pensions side. Our Pensions Commission called the UK system “the most complex pensions system in the world” and those of us active in the field agree. In this context, complexity is the enemy of social welfare – whatever your political leaning in pensions and social securityI have long thought you ought to favour meaningful, straightforward, universal & progressive provision.
Debora, On pensions, we are in full agreement if by “straightforward, universal & progressive provision” you mean that eligibility for a basic state pension depends only on age and residence, not on a person’s financial assets, employment history or current income. This is the New Zealand model, which a group of like-minded scholars are promoting at PensionReforms.com, based at the University of Auckland’s Business School.
A universal pension is flat-rate, not ‘progressive’, but its provision is progressive if it is funded from general government revenue, and the wealthy pay more tax than the poor.