State and family

We voluntarily give up a lot of our income to the state. Public spending is now 55% of GDP, which means that, on average, more than half of the income of the population is spent by the state, and therefore not available for discretionary spending. As we get old, our bodies wear out. The NHS spends 80% of its budget treating people who will be dead within a couple of years. As we get old, we become incapable of looking after ourselves, we become immobile and in need of ‘personal care.’ Of course, many of us die in the prime of life, and have no need for the indignity of ‘toileting.’ But the rest do, and it is expensive, and we have no money left over to pay for it. A civilized society cannot allow its oldest members to die of neglect.

The UK government tries to make a clear distinction between medical care and personal care. But this is an arbitrary distinction, which makes those that fall on the wrong (expensive) side of it very unhappy. Insurance seems the obvious solution, as it will allow us to pool the risk, but when society cannot bear the pain of an uninsured person suffering, the cost explodes.

The current situation is untenable, although it has endured for a long time. Eventually, some NHS style solution will be adopted. Families will have a reduced role in caring for their oldest members, which is a real cost. But those members will have a comfortable senesence. It’s not an ideal tradeoff, but it’s probably the least bad which is achievable.