Resurrecting Demand-Side Socialism: Marching 2 × 2 to Health and Social Care Reform

In this chapter, two separate 2 × 2 analyses are used to examine two issues, these being: the role of the private sector in publicly funded health care systems; and to diagnose and repair the unfairness and inefficiency in adult social care. With respect to the former, by separating out financing (public vs private) from provision (again, public vs private), it can be seen that we might not rule out a role for the private sector in providing care within an NHS-type system. History and evidence support this, the key being that the dominant source of financing, but not necessarily provision, should be public; a form of demand-side socialism. Secondly, by examining social care in terms of its location (either at home or in a home) and the funding source (public vs self-funding), it is shown that there is a strong case for a system of social care financing similar to that for health care, which in the UK, takes the form of the NHS. It is now recognised that health and social care act in parallel. A well-functioning social care system helps prevent people entering the health care system and also facilitates their earlier discharge. The main policy distraction to be assessed here is that reform of the financing of social care (in the UK) is unaffordable. It would cost very little. Indeed, given the growing number of people with Alzheimer in the social care system, there is an inevitability to the case. There is no reason why the market failure arguments applied to caring for people with other medical conditions, and thus in support of an NHS, should not also apply to this group who just happen to be placed in social care.