New Orleans In the United States, there’s a tendency to argue that we need a healthcare system that is better, and that’s the truth. Our corporate system, both for-profit and pretend nonprofit, is too expensive with too many gaps for too many people. Single payer systems like Canada’s or the vaunted National Health Service in the United Kingdom are correctly seen as better equipped to serve their people. It goes without saying, but I’ll say it anyway, that nothing is perfect. The vast differences in how prescriptions are handled from province to province in Canada is ridiculous. The underfunding of the NHS in Britain has meant long delays, bad morale, and allowed private providers to get a foothold for those with more money.
Nonetheless, reading about social care, the term used for home care in Britain, in a recent article in The Economist, I was shocked to hear how shoddy the system there is, often seemingly even worse than that in the United States, or tragically similar, especially when it comes to pay and treatment of the workforce. Homecare in the US for decades has been one of the fastest growing occupations. In the over 40-years that we have been involved in organizing homecare workers, we have seen the greatest growth in union membership from that sector compared to any other, adding hundreds of thousands of members in SEIU, AFSCME, and other unions. We have helped organize homecare workers in Canada, and we follow closely the efforts of unions in the UK who are trying to do the same. All of which is to say, I try to keep my eye on these developments, and, as important as homecare is for the elderly, infirm, and differently abled, it’s amazing what a sorry system it remains in general, and in Britain specifically.
Social care in Britain is not even a nationally supported and funded program, although most of the US program is largely support by the federal government and supplemented by the states, although miserly by many. The support is left to the councils who are mostly funded by a council tax, which is similar to US property taxes, and not only a regressive tax, more painful to lower income families, but also capped out in the UK at less than a 5% increase annually. Home care is not an entitlement, so access is deliberately restricted as more apply, as the country ages, and fewer receive support. It is also means-tested, excluding anyone with more than about $30,000 in assets, including the value of their home. Private payers of home care pay about 40% more than the government does, which means that they are in effect subsidizing the care for those that are able to qualify for state programs. In the UK, like the US, relatives end up handling a lot of social care, and though they can receive support in many US states, in Britain, a nonprofit estimates their “free” labor is “worth an estimated $175 billion annually. If a society is judged, as some argue, by how well it takes care of its poor and elderly, Britain seems to be joining the USA in a terrible rouge’s gallery.
Home care workers’ situation is also an abysmal. The wages are minimal, and even though slightly increased in recent years, the compression eliminates any incentive for workers to gain more experience and seniority, and therefore pay. Britain’s labor shortage is such that it brought in 70,000 care workers on a “special health-and-care visa” in 2022, but then under the last government denied them the right to bring in dependents, dropping demand for such visas by 81% last year.
The new Labour government might do a better job. Their proposals include raising the income threshold for eligibility and raising wages for workers, both of which would help, but what’s really needed is more money and lots of it now. It’s unclear that there is appetite or ability to deliver the goods, even when the need is so clear. Home care under any name still is more cost-effective and more humane than other alternatives like nursing or care homes, but governments, here and abroad, seem to be continued to be penny wise and pound foolish.