This article is based, with his kind permission, on a presentation by Prof Martin McKee at Sandwell Health’s Other Economic Summit 2014.  This event in the romantic setting of Dudley brought to mind very clearly the industrial and post-industrial history of the West Midlands.

Disraeli described “Two nations between whom there is no intercourse and no sympathy; who are as ignorant of each other’s habits, thoughts, and feelings, as if they were dwellers in different zones, or inhabitants of different planets. The rich and the poor.”  But in reality the rich and poor mostly lived in quite close proximity at least until the mid twentieth century. Rich people had servants who often lived in. Domestic service was the biggest employment until the First World War. 1.5 million people  were employed as domestic servants in Britain in 1901. Rich and poor lived in close proximity.

The experience of armed service, air raids, evacuation and rationing in which people were mostly “all in it together” further reduced the social distance between rich and poor all over Europe. The experience of losing wealth and social position overnight was common. Mass Observation found that as early as August 1942 one in three people had changed their political views, overwhelmingly to the left.

The British Welfare State, which was essentially agreed by all political parties, was developed in this political context. The fundamental role of the welfare state as far as most people were concerned was to give them security should their world collapse around them  One Nation Conservatism – belief in an organic society in which the different classes have natural obligations to one another – dominated British politics until the 1970s.  The European social model in which there is a system of transfers from rich to poor, from young to old, from employed to unemployed and from healthy to ill was accepted by politicians from all parties across Western Europe.

John Rawls in the  “Theory of Justice” (1971) proposed a theory in which “no one knows his place in society, his class position or social status, nor does anyone know his fortune in the distribution of natural assets and abilities, his intelligence, strength, and the like. I shall even assume that the parties do not know their conceptions of the good or their special psychological propensities. The principles of justice are chosen behind a veil of ignorance.”  Rawls hypothesised that if an individual does not know how he will end up in his own conceived society, he is likely not going to privilege any one class of people, but rather develop a scheme of justice that treats all, and in particularly the disadvantaged, fairly.

The historical situation in the USA was very different. There was no history of social disruption caused by war, and privileged white people did not wake up in the morning to discover that they had become part of the black underclass. Martin Luther King’s “dream that one day, down in Alabama, with its vicious racists … little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers.” was just a dream.

Obama Hitler

Opposition to “welfare” and to an equitable system of healthcare in the USA, is, to British eyes, conducted in amazingly extreme tones.  Obama is widely compared to Hitler.  According to Dacher Keltner, a psychology professor at the University of California-Berkeley, “Extreme wealth in our lab makes people less compassionate, they care less about the suffering of others, they’re less empathetic. They tend to think that they have their tons of money because they have a stronger genetic profile.”  Billionaires’ extreme wealth allow them to be “psychologically insulated” from the realities of being poor, Keltner said. They “couldn’t even imagine what it would be like to earn $35,000 and worry about things like paying bills or taking a long ride on public transportation to work or to pick up your kids.

Racial division adds a further dimension to anxiety about welfare provision – ie transfers from Us to Them.  In both nations and US states spending on welfare measures is inversely related to racial division. More homogenous societies are happier to spend money on welfare. Support for welfare in the USA is higher among people who live near to many welfare recipients of the same race, but lower among people who live near to welfare recipients of another race. People have a hostile reaction to recipients of another race, but sympathetic reaction to recipients of the same race. Support for welfare is  greater among whites who  “have …had a black person for dinner in your home in the last few years?” Geographic isolation may be a cause of “separate-group” thinking, but in many places racial and geographic isolation go together.

Never waste an opportunity

Repeatedly, neo-liberal politicians have taken advantage of crises to undermine social solidarity. In some countries they are rubbing their hands with glee in the  current economic crisis. In the UK measures supposedly taken in order to reduce the deficit include:

  • Increase tuition fees and set up student loan system that costs more than what it replaced
  • Remove child benefit from higher rate taxpayers so 500,000 more people have to complete self-assessment forms
  • Cull QUANGOs and spend millions in redundancies, and then rehire people

Even though means testing introduces complexity, costs money to administer, and lets people fall through gaps, removal of middle classes from welfare system erodes support for welfare. There is strong support for welfare in Scandinavia with universal benefits, but low support for welfare in USA with poverty relief.  As Richard Titmuss  famously asserted: “A service for the poor is a poor service”.

At the same time there is a determined demonisation of the undeserving – mostly immigrant – poor.  In the benefits system we are clearly moving back towards the principle of less eligibility which dominated the Poor Law regime – a determination that conditions for benefit recipients should be more undesirable than any possible alternative.   This has developed as we have, over a long period, moved away from a contribution based system towards one where benefits are almost all means-tested, or targeted on those who need them most.  National Insurance Contributions, which many people still think are the basis of entitlement to both benefits and healthcare, in reality are now only linked to State Pension – a benefit which seems in political discourse not to count as welfare.

So far this judgemental approach has not had much effect on attitudes towards the NHS, but there are signs that the notion of a universal service is under threat.  The Government has made much of the cost of “health tourism”, despite the lack of any substantial evidence that it is a problem, and a system is to be instituted to subject migrants and overseas visitors to extended prescription fees, the introduction of charges for some emergency care and higher rates for optical and dental services. Details of how this scheme was to work were supposed to have been announced in March 2014, but have not yet appeared.  As Bevan said in 1952 “The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine.”

The fundamental question

  • Who are we?
  • And who are we not?

See also:

The assault on universalism: how to destroy the welfare state  Martin McKee British Medical Journal December 2011

Can the Tories abolish the welfare state?   Iain Ferguson International Socialism January 2014

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One Comment

  1. Mervyn Hyde says:

    Excellent article.

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