The assault on universalism: how to destroy the welfare stateBMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7973 (Published 20 December 2011) Cite this as: BMJ 2011;343:d7973
- Martin McKee, professor of European public health1,
- David Stuckler, university lecturer2
- 1Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- 2Department of Sociology, University of Cambridge, Cambridge, UK
- Correspondence to: M McKee
Christmas is a time to count our blessings, reflecting how they came to be. For people living in England this reflection is more relevant than ever, as the coalition government paves the way for the demise of the welfare state. This statement will be seen by many as reckless scaremongering. The welfare state, not only in Britain but also throughout western Europe, has proved extremely resilient.1 How could any government bring about such a fundamental change?
To answer this question it is necessary to go back to the 1940s, when Sir William Beveridge called for a national fight against the five “giant evils” of want, disease, ignorance, squalor, and idleness.2 His call secured support from across the political spectrum. Although he sat in the House of Commons as a Liberal, his plans were implemented by a Labour government, and continued under successive Conservative ones.3 The reasons for such wide ranging support varied but, for many ordinary people, the fundamental role of the welfare state was to give them security should their world collapse around them.
There were good reasons to seek security. The British people had just emerged from a war that had shown that, regardless of how high they were on the social ladder, they could fall to the bottom in an instant. The death and destruction of war were not the only threats; a serious illness could blight a family’s prospects. People wanted to be sure that they would not be on their own if disaster struck, and they were prepared to ensure this through taxes and insurance contributions. They were, literally, “all in it together,” accepting rationing …