Opinion

Before you argue for universal health care in America, look at the disaster in England

Any government powerful enough to give you everything want is also capable of taking everything you've got

Plenty of people love government welfare when it seems like someone else will pay for their benefits. The problem with that, as Margaret Thatcher famously pointed out, is that eventually you run out of other people's money. And when that happens, the state goes after your money.

Never forget that a government that is powerful enough to give you everything you want is also powerful enough to take away everything you've got.

That logic is now playing out in England, where Thatcher's own Tory Party, having abandoned its commitment to rolling back the welfare state, is doubling down on taking away "your" money. Just consider conservative Prime Minister Theresa May's proposal to reform her country's system to provide long-term care for the elderly.

As things stand, anyone who gets terminal cancer or heart disease can get long-term free care through the National Health Service — Britain's chronically underfunded government-run universal health-care system — because they can stay in the hospital. However, the NHS bolts when it comes to chronic mental conditions that don't require hospitilization. To get help for those, the elderly have to turn to their local councils (municipal governments). However, these councils depend on London's central government for funding, and that body has been cutting back (partially to offset NHS's ever-ballooning costs). So they refuse to pay for in-home care of the old and senile if these seniors have anything over $30,000 in savings, not counting their homes.

This leaves many older Britons, some dealing with serious conditions such as Alzheimer's, in the lurch, a problem that will only get worse as Britain's population ages. (In the next 16 years, the country's 65-plus senior population is expected to grow by 40 percent.) May's Tory predecessor, David Cameron, had pledged to cap the lifelong out-of-pocket long-term care costs of such elderly at around $93,000 by 2020.

But it's fiscally unsustainable for the government to pick up the remaining tab. So May initially proposed to scrap that cap. However, she was forced to beat a quick retreat after a maelstrom of protest that threatened to plunge her party into crisis ahead of special elections she herself called on June 8. Still, she hasn't withdrawn the other part of her proposal, namely, to let seniors keep up to $128,000 of their savings before state assistance kicks in — up from $30,000. That sounds good, right? The catch is that their home values will now be counted in those savings.

May assures seniors that she won't make them sell their homes to pay for their care so long as they are living in them. Instead, her plan is to recover the state's costs from the sale of their house after they (and their spouse) die.

At first blush, this may not seem like a bad deal: The elderly get to keep more of their savings and live in their homes while taxpayers ultimately get paid back. But if the elderly are going to have to pay for their care anyway, what is the point of government welfare in the first place? Isn’t a safety net supposed to protect you from catastrophic events that wipe you out financially?

Conservatives have long lampooned liberal plans to impose "death taxes" on the estates of rich people. Yet here they are proposing "dementia taxes" — as the liberals have dubbed the Tory scheme — on practically every homeowner. And conservative "dementia taxes" may arguably require even more intrusive government than liberal "death taxes."

For starters, the elderly who turn to the state for their care (and pretty much everyone but the wealthiest will have to because as the government expands its role in the long-term care sector, England's already small private insurance market will inevitably shrink more) could well lose say in how their property is disposed after their death. Their children could supposedly try and scrape up enough funds to pay off the government, but how many will be able to do so?

Furthermore, what the government is owed will be determined … by the government itself. If it offers inflated estimates of how much long-term care costs, who's to stop it?

It is hardly a stretch to suggest that over time the government won't confine its recovery efforts to what it has paid in any individual's case. Once the notion that it is okay for the government to go after private homes to pay for its services becomes acceptable, what's to prevent it from arguing that the relatively better off and healthier should be required to cough up some of their home equity for the less wealthy and sicker? Is it so unfathomable that liberals will make this argument in the name of equality and Tories in the name of fiscal responsibility?

England's welfare state has grown to a point where it is no longer possible to obfuscate the basic existential dilemma that it poses, namely, that there is no such thing as "free" universal coverage for anything: Either individuals take charge and make provisions for their own care, and maintain control over their funds — or hand them over to the government, and lose control. The first requires rolling back the welfare state, the latter expanding the tax collection state.

There is no third way, at least not one that is sustainable over the long run. It's a pity that after Thatcher there is no party — or political figure — left in England to point out the inevitable.

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