Wednesday 4 January 2012

Reform of funding for old age care

From today's CityAM Forum:

It is easy to see why politicians want to delay reform [of the funding of old age care]. Many people believe that the state will cover the cost of care as it does with the "free at point of use" NHS. Yet the reality is different and many people only discover they need to pay for care when they or a family member enter it. It is a rare politician who will acknowledge that families have to pay for care and, indeed, that for the future system of care to be affordable contributions will have to increase.

The obvious source for contributions is the equity in assets like housing. Yet too often discussions on elderly care reforms are concerned with protecting children’s inheritances. So England persists with a system that is patently unfair, where too many people only find out they are required to pay for care in a moment of crisis. The political consensus favours people being caught short rather than admitting to the reality of hard choices.


The largest chunk of that "equity in housing" is of course not the bricks and mortar, which at best hold their value: depreciation and maintenance net off with normal price inflation. So what is the largest chunk and why? For possible answers, let us refer to two earlier articles...

March 2011: The importance of urban centres to progress – economic, cultural, scientific, social and political – cannot be underestimated. Across all continents, 23 megacities—metropolitan areas with at least 10m inhabitants—generate 14 per cent of global GDP, according to McKinsey. The world’s top 100 cities generate $21 trillion of GDP, 38 per cent of the total.

The 600 largest urban centres generate $30 trillion, 60 per cent of the total, yet house just 22 per cent of the world’s population. But what is most impressive is that the London urban zone is the world’s third largest by GDP, beaten only by Tokyo and New York.*


November 2011: The US’s share of population in larger metropolitan areas rose from 30 per cent to 55 per cent from 1951-2009, focused in suburbs. Relentless long-term decline saw our metropolitan areas’ population share fall 22 per cent from 1951-2009.

In the first part of the 2000s, almost 1m people left our large cities [in the UK]. Only high immigration prevented serious declines in population. This matters, as larger cities improve worker productivity. A meta-analysis found a doubling of urban population raises productivity about 6 per cent. So someone going from a town of 50,000 to a city of 800,000 raises their productivity 25 per cent – and vice versa.


* Well duh, London pop. 7.8 million, Tokyo 12.8 million, New York 8+ million.

29 comments:

Anonymous said...

The only comment I make is that I hate this constant assertion that it is to protect "inheritance".

No, it's the fact that people who make no provision and piss their money up the wall get it paid for by the state, and people who have been responsible get their house taken away to pay for it.

Mark Wadsworth said...

Anon 11.22, yeah but no but.

Isn't a core Home-Owner-Ist argument that the homeownership should be encouraged so that people don't end up relying on state benefits in their old age?

That's sounds all well and good, but what happens when their bluff is called and they have a choice between being self-reliant and claiming state benefits?

Robin Smith said...

Anonymous is exhibiting classic symptoms of a slave. Working harder. Paying higher taxes. Cost of living rising. Wages falling. Blaming the poorest class. Apologising to his masters.

I sympathise. We should help him.

Bayard said...

Anon, this is the problem with any means-tested benefits. The answer is either not to have the benefits or not to have the means testing. In this case, the former would mean that some demented grannies would end up in hospital, but many others would be cared for by their relatives somehow, and the latter would upset the Envious, who are against all universal benefits (why should he get as much as me when he's richer than I am?), as well as being expensive in an area where politicians are reluctant to spend money (not fun/macho/supporting a politically powerful group).

Mark Wadsworth said...

RS, I am trying to help him.

B, yup. Benefits should be universal or not at all.
So free school dinners for all children = great.
Ending free school dinners for children of dole claimants = also great, but a bit less great than free for everybody.
It's a simple equation.

And don't worry about the 'cost' because at present those whose children don't get free dinners are paying for their own kids' dinners + a share of others' dinners anyway, it all comes to the same thing.

Robin Smith said...

Bayard. On Envy I tjink you have ot the wrong way around. Isn't it:

"Why should he get as much as me when I'm richer than he is"

A slave mind set where everyone domehow eorks harder than anyone else and must have that protected.

Proof? See the US's objection to universal healthcare.

"Why would I want free healthcare, when the poorest class have not contributed?"

Insanity. Lets get an army of psychologists to deal with that. Not economists.

Robin Smith said...

Apologies for typos. Using a useless social media slave device. Will take more care next time.

Mark Wadsworth said...

RS, you raise another interesting point re envy.

B says: "Why should he get as much as me when he's richer than I am?"

You say: "Why should he get as much as me when I'm richer than he is?"

Clearly the two cancel out! But people are so into this slave mentality that they simultanesouly believe both.

The former prejudice leads to "means testing" and the latter leads to "the contributory principle", each of these in isolation is complete bollocks, try having both and you are in a real mess (which we are!).

Jonathan Bagley said...

I've not much sympathy for those who want their parents' assets protecting so that they can inherit them. Think of it as their renting a room in a nursing home, rather than living in their own house. Anyone whose parents have a lot of assets has probably benefited from a good education, among other things, and should be doing OK. I thought the idea floated by, I think, the previous government - correct me if I'm wrong, of being able to pay a lump sum - then £8000, to buy immunity from old age care costs, was a good and fair one. Suppose two children stand to inherit £100K each; they can protect the whole of their inheritance by each raising £4K. Even this small cost was too much for most people. There is no way of getting round the problem of people being penalised for thrift and hard work (and luck) unless there is no means testing, but to me this seemed a reasonable solution. Any comments?

Mark Wadsworth said...

JB, in principle, good idea, but what do you do for the people who don't pay up the £8,000?

And as I've said before, one of the main functions of 'the state' (i.e. the phenomenom whereby people organise themselves into a cohesive whole) is low-cost mass insurance; old age care (small risk of huge costs) is crying out for low-cost [compulsory] mass insurance.

Anonymous said...

"old age care (small risk of huge costs) is crying out for low-cost [compulsory] mass insurance."

Which would probably be, or should I say would and should have been a relatively easy sell, were it not for the various shenanigans, wheezes, and er let us be blunt, basuically criminal behaviour exhibited by the insurance industry time and time again demonstrating that "insurance" - 'Promise of reimbursement in the case of loss; paid to people or companies so concerned about hazards that they have made prepayments to an insurance company' is anything but because the 'insurance providers' take um 60% of premiums as their profits and use the other 40% resisting claims, downgrading claims, or in the worst cases just take the money and er run ....

Jonathan Bagley said...

Those who don't pay up are either taking a big risk, if their large inheritance eventually goes West, or else don't have much to lose. i.e the assets involved are barely bigger than the £20K or so which can't be got at for old age care.

Mark Wadsworth said...

Anon 12.30, yup, the only people I trust less than the government are insurance companies.

JB, but is the £8,000 the right figure? I suspect it is heavily subsidised for the benefit of Home-Owner-Ists. Total annual cost old age care = £20 billion or so, there's no way 2.5 million people a year would pay up, it would be more like 0.5 million (half of those reaching retirement age).

So far better to just stick two-thirds on Council Tax* as "old age care premium" and work on a pay-as-you-go basis.

* Or even better, have a flat annual property value tax of about 0.4%.

Jonathan Bagley said...

At the time 8k was criticised by some as being too low. It was calculated on basis of 1/5 of population requiring nursing home care, with average duration 2.5 years. I don't know what a realistic figure is. Wouldn't sticking it on tax end up with the costs getting out of control, and continual arguments about whether enough was being spent - as with the NHS? I'd prefer the Government's role to restricted to administering the 8K (or whatever) scheme, preferably with a definite figure for what you get for your 8k. I can see problems - it would need stringent inspection of nursing homes were they bidding to provide places according to some specification, but surely we don't want another NHS bolted onto the end of this one?

Anonymous said...

JB: why don't just give cash payments for degrees of reduced capability, leave it to the elderly and their families how to use the proceeds. Could encourage alternatives to nursing homes. I've observed that the cost of a nursing-home in my vicinity could buy me a full-time nurse.

In Norway, the costs are 1300£ per capita, 10.000 £ per over-67, for a fully public long term care system. This can probably be reduced significantly, but is still a pretty hefty price tag to put on a universal premium, depending on what risk adjustment is done for age.

-Kj

Anonymous said...

"Why should he get as much as me when I'm richer than he is"

No.

"He is just as rich as me, but pissed his money away on booze and tv's and cars and toys"

I know many people that are as "wealthy" as I am, but spend their money on shit, and then get housing benefit etc.

Fuck, I am sitting across from someone who earns twice what I do, and pays half what I do in rent because they have a council house.

My father is currently livid as he personally knows someone who earned MORE than him, spent his money on alcahol and drugs, and gets free care.

Means testing is wrong, I can't be arsed to address your drivel about slavery, stop toking when you type.

Mark Wadsworth said...

JB, pay-as-you-go compulsory mass insurance always works out a bit cheaper in the end.

Kj, that seems very high!

Anon: " I am sitting across from someone who earns twice what I do, and pays half what I do in rent because they have a council house."

Easily fixed - build more council housing! Council housing for all!

"Means testing is wrong, I can't be arsed to address your drivel about slavery, stop toking when you type."

Er... perhaps you should stop toking while you read, the point which we were making is that means testing is wrong! So are you agreeing with us or not?

Derek said...

When my mother-in-law got into this situation at the end of last year (ie needed to go into a care home but didn't qualify for state funding), her children planned to fund it by renting out her house and applying the rent to her care home costs. Admittedly that doesn't cover the extortionate cost of these homes and the tax man grabs some of it but it does at least help.

As it happened my MIL died shortly before moving so her children didn't have to put the plan into action. However as a matter of interest, what do you think of that as a funding method? And could it be made more tax efficient?

Mark Wadsworth said...

D, whatever the circumstances, renting out a house makes more sense than leaving it empty :-)

And yes, this whole process could be made more tax efficient (fund from LVT not income tax). The spending could be made more efficient as well (benefits should be universal and it should be up to the invalid to decide how to spend it).

Anonymous said...

Agreed, simple insurance with disability and old-age invalidity in one. Decoupling financing and provision is the most important step, no contracting out, just cash. Most people want to live at home or together with someone they know in the last years anyway.

-Kj

Anonymous said...

Sh... I just reviewed the statistics for my local council, I was wrong, I can get more than a nurse from what a nursing home costs around here, the price per boarded is 100000 £. That's insane...

-Kj

Mark Wadsworth said...

Kj, everything is more expensive in Norway, but I did wonder about your earlier figures.

From what I can make out, for the UK it's approx. 2 million old people @ £10,000 a year average = £200 per week average = 20 hours 'care' @ £10 per hour, or whatever.

That average covers a multitude of sins, full time place in full time care £40,000 a year down to three visits a week for one hour @ £10 per hour, Witterings From Witney knows more about this than I do.

Anonymous said...

The figures are correct. Even correcting for a wage difference on ca 40-50% that's still not within reason. I could build an extension to the house, hire a full time nurse and stop working to care for my parents for that kind of money. Anyway, an insurance arrangement decoupled from nursing home provision should place a figure on how many hours you'd need care for, times average wages (to buy into a nursing home if you want), plus equipment aid, medical expenses covered by separately by NHS. 300£ per capita from UK figures in premiums maybe, deducted from the CI, done.

-Kj

Bayard said...

"And could it be made more tax efficient?"

Well the government could make a rule that the rental income would not be taxed if it was used to pay for long term care, but such a subsidy would probably disappear in higher fees somewhere.

DBC Reed said...

MW's suggestion of funding old age care via LVT sounds, from memory, like what Andy Burnham, proposed in his bid to become leader of the Labour Party,

Rob said...

Given that a large part (50%+) of the equity in a property held for the past ten years or so will simply be the result of inflation in asset prices, all a home ownerist has done is occupy a property, it is bollocks all do do with "hard work vs pissing money away".

I can understand people wanting to hang onto huge gains like this, but if it is a choice between tax on earned income and a tax on windfall profits from holding an asset, there's only one winner.

Mark Wadsworth said...

Kj: "£300 per capita from UK figures in premiums maybe, deducted from the CI, done."

Yup.

B: "such a subsidy would probably disappear in higher fees somewhere"

Yes of course, it's called tax arbitrage.

DBC, yup. Great minds.

Rob: "If it is a choice between tax on earned income and a tax on windfall profits from holding an asset, there's only one winner."

You'd think so, wouldn't you? But you're assuming rational behaviour :-(

As it happens, the Lib Dems recently tried this with the Tories, i.e. "We'll agree to scrap the 50p tax rate if we can have Mansion Tax instead", and the Tories turned them down flat [or house, as the case may be].

Anonymous said...

**I can understand people wanting to hang onto huge gains like this, but if it is a choice between tax on earned income and a tax on windfall profits from holding an asset, there's only one winner.**

We are not talking of the windfall being taxed, we are talking of the whole lot being taken away to pay for care, when others get it given for free.



If you think that's fine, tell me why I shouldn't just screw my mortgage, default, get a council house and sponge of the state?

If things don't change, there really isn't any reason not to.

Mark Wadsworth said...

Anon 14.07, I'm not sure what level of reality you are operating on.

i. Our preferred funding system for old age care would be universal, non-means tested and taxpayer-funded (up to a certain basic standard, yet to be agreed).

ii. Our preferred kind of tax system happens to be a tax on land values rather than a tax on incomes.

So you are jumbling up two separate sides of the equation: how taxes are raised and how tax revenues are spent.

Feel free to disagree with i. or with ii. or indeed with both, but nowhere did anybody say that we should continue with the current system.