Medicine And The Media

On welfare in a state

BMJ 1996; 312 doi: (Published 03 February 1996) Cite this as: BMJ 1996;312:318
  1. Martin Mckee

    For some people, state support for those in need is going out of fashion. We met a selection of them in the first of two programmes from the Panorama team on the future of the welfare state. We were told that costs are spiralling out of control, that many of those on benefit are too lazy to look for work, that benefits are far too generous, and even that the welfare state is contributing to family breakdown, making it easier for people to walk away from problems that they once would have had to sort out.

    But others are not so sure. While some interviewees painted a picture of feckless individuals lazing about at the taxpayer's expense rather than looking for one of the many jobs available, could it be that those who fall off the ladder of education and employment descend into a vicious downward spiral with little hope of recovery? Panorama went to Hastings to find out. With 16% male unemployment, it is one of the most deprived towns in the south east of England. The human dimension of the statistics emerged from behind the Edwardian facades as we met a series of young men descending into long term dependence and premature death.

    Jon, aged 16, had left home after endless rows with his stepfather. Ineligible for benefit, he was searching for work but Hastings offered only a few low paid jobs, none of which he was qualified for.

    Chris, also 16, had at least managed to obtain benefit although it gave him only pounds sterling36 per week to live on. It was 11 am and the noodles he had just eaten would be his last meal until the next day. Later he would be in a drunken sleep on cheap cider, his only means of escaping reality.

    Tam lived next door, alone, “smoking [his] life away”. A trained shopfitter, he had been looking for work in Scotland and all points south to Hastings. But after two years without work and on drugs, his prospects were receding fast.

    David Wiggett wasn't available to be interviewed. At the age of 22 he had been found hanging, with a leaflet on helping people back to work lying at his feet. His father reported how he felt people saw him as a scrounger, despite all his attempts to get a job.

    We were left with little doubt that the welfare state had failed these young men. But what is the alternative? In the second programme, Patrick Minford, one of the Chancellor's wise men, gave us his answer. In future most people will buy insurance for pensions and health care and pay for school fees and almost everything the state now provides. To see this idea working in practice we moved to a middle class street in Richmond, south London. Here, a cross-section of company directors and bankers face an onslaught of junk mail and statements by politicians telling them that they have to provide for themselves as the state will not. But can they afford to? Until the man from the Pru came to visit, they thought they could. Offering a basic package for pounds sterling1500 per month for a couple, that didn't include school fees, he conceded that ordinary people simply could not afford it.

    As the residents of Richmond recovered from their shock we cut to the United States. Five million Americans live behind barbed wire, not in jail, but in wealthy estates from which the poor are excluded. One resident cannot see why even one of his tax dollars should be spent on welfare. The Governor of California agrees. He plans to withdraw all welfare from adults without children after two years. Back in Richmond, a new housing complex is being built, surrounded by high walls and patrolled by security guards, and the existing middle class residents, who are excluded, are unhappy.

    These programmes were profoundly depressing. Government policies are leading to a society where perhaps 40% of the population will live in grinding poverty, 5% will be locked behind high walls terrified of the masses outside like the French aristocracy before the revolution, and the rest will be permanently insecure in low wage service jobs, struggling to pay expensive private insurance subscriptions.

    It is left to Will Hutton, author of the best-selling book The State We're In, to provide an alternative to this nightmare. He reminds us that most of our European neighbours understand the need for everyone to hold a stake in society. After all, it has allowed them to outpace Britain's economic growth and give their elderly populations decent pensions. The Panorama team showed that we do need to rethink the British welfare state. But it is not that we cannot afford it. Rather we cannot afford not to have it. If the middle classes think they can do better by withdrawing into a private world and pulling up the ladder behind them they are mistaken. We either swim together or we all sink. I fear we are still sinking.—MARTIN McKEE, reader in public health medicine, London School of Hygiene and Tropical Medicine

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