Is it right to buy a right?

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Are we turning our market economy into a market society, where everything can be bought for a price, including privilege and rights?

This is the question set out in a new book by Michael Sandel, Professor of Philosophy at Harvard University; “What money can’t buy; the moral limits of markets”.

I believe such a question is valid to the development of health and social care policy here in Scotland.

Ever since the Second World War we have been advocating the moral virtue of queues.  We used to queue for shopping when food was rationed both during and after the war.  We now queue at the bus stop, at the theatre door; we queue for medical care in hospital and for social housing.  But now we can jump queues at airports by buying a speedy boarding ticket; and we can go to a private hospital to get treatment quicker.

We can also treat fines as fees.  In a study in Israel, a nursery school started to fine parents who were late picking up their children.  Instead of decreasing, they found that the rate of late pick-ups actually increased, as most parents considered the fine as an extra fee for longer child care.  Within my own experience, I was once talking to a rich disabled person, a land owner in Dumfries, who used to drive from his home to London to attend a meeting and drive back the very same day.  He was caught for speeding in his Jaguar one day, but instead of bemoaning the fact, he thought it was just the price for speeding all the other days.  His fine that day paid for his choice to break the morality of safe driving, avoiding harm to himself and others on the road.

Within the field of health and social care, we can see the increasing marketization of services.  To some extent this has favoured the growth of independent living for disabled people, for it has allowed us to choose and control our own support.   Instead of being at the mercy of state controlled services, we now have money from the state, to buy and control the type of support we want, from the people we want to provide it and at a time we want it.

However, for that privilege, we are being charged, often at a rate which maintains our poverty no matter how hard or how long we work; assuming of course we have the opportunity to work in the first place.  Community care charges paid by disabled people only contribute 4% towards the total budget of local authority social care.  However, that same community care charge can constitute up to 90% of an individual disabled person’s income.  As one such person said:

“What you’re buying with your charge is a human right, and I don’t believe that anyone in our society should have to pay for a human right. No-one else pays to go to the toilet or to get out of bed in the morning.”

This person was right, independent living is a right under the United Nations Convention of Human Rights of Disabled People; and has been signed up to by the UK Government.  But until it has been put into ‘domestic’ law, no-one can take any legal action to safeguard such a right.

However, despite disabled people working with the Convention of Scottish Local Authorities to re-write its guidelines on implementing community care charges, the legal basis to give local authorities the choice to charge or not is still on the statute books.  Yes, local authorities can choose not to impose such oppressive taxes on disabled people, but only two in Scotland have made that sensible and correct choice.

Now that social care is being integrated with health care, there is a fear at large (justifiable or not) that rather than social care eventually becoming free at the point of delivery (as is the case for health care) more and more aspects of health care may well become chargeable.

However, as Michael Sandel points out, people can and have used ‘market forces’ to advance their philosophical and moral beliefs.  In Paris, a group of citizens felt that having to pay to use the Metro (the underground railway system) barred their freedom of movement.  They, therefore, created an insurance fund into which they paid £5 per month instead of £50 for a monthly rail ticket.  This “mutuelle” would pay for any fine and legal expense if anyone were to get caught.

Several prominent disabled people have already refused to pay their community care charges, like Professor Michael Oliver.  Mike was a professor of disability studies in London who refused to pay his community care charges and challenged his local authority to take him to court – which, of course, they didn’t.

But there has never been a concerted nationwide boycott of community care charges.  Confidence and commitment are certainly major factors in such a boycott.  There may well still be a fear among many of being taken to court; and of losing services.  As stated above, an insurance fund, or “mutuelle”, might alleviate the former.  Confidence may also be bolstered by understanding the fact that the local authority is still obliged to keep providing the services they have assessed, even when the person withholds payment.  The only way they can withdraw the service is by re-assessing the person; and if there were to be a mass boycott, it seems unlikely they would want to do that

One other drawback is that for many on self-directed support, the local authority takes off the charge before they issue the direct payment; i.e. the direct payment given is minus the community care charge owed.  But even here the local authority itself may be at jeopardy of the law, for it should treat all of their clients, whether receiving a direct payment or not, equally and fairly.  And obviously they do not.

However, from a theoretical point of view, it would be interesting to speculate on how likely such civil disobedience of this type would be in the context of community care charges.  For example, a nationwide six-month boycott of paying charges by disabled people would require the generating of a significant level of indignation and sense of social injustice at large.  It would also require a great deal of leadership and organization by individuals, rather than organizations, within the independent living movement.

Certainly, compared to an issue such as ‘free public transport for all’ such a sense of social injustice does not seem to be in doubt.  Many disabled people and their supporters believe they are being subjected to double-taxation.  First they pay for local authority services through general community charges; then they are taxed again through community care charges, for one specific service.

But this feeling of social injustice is not shared by others who do not directly experience it; and whether it’s the price of tea, the poll tax, or the cost of petrol, we know there’s nothing more emotive than a widely held acknowledgement of unfair taxation to raise the hackles of a disgruntled general populace and stir up direct action.  Indeed, one wonders if this issue could manage to re-ignite the fires of direct action which we haven’t seen since the DAN protests of the last century

Franklin D Roosevelt once said, “We have nothing to fear but fear, itself”, but he had two men each morning to get him out of bed.  And there’s the iniquitous rub

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About jimelderwoodward

Disabled people's rights activist living in Scotland, promoting the principles and practices of independent living, the outcome of which is participative parity as equal citizens in all areas of community life - economic, civic, social and cultural
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16 Responses to Is it right to buy a right?

  1. Great blog Jim – I also blogged about this for The Independent last month: http://blogs.independent.co.uk/2012/07/20/social-care-not-just-an-issue-for-our-grannies/

    I love the idea of a mass action on care charging.

  2. Jim Bollan says:

    Jim, Very good thought provoking article. I agree 100% with the line you take. I remember Les and I discussing years ago when we were both on the Council what we would like to achieve for all our Leisure Services would be a completely free service for all at the point of use, all funded directly from the Council Tax or direct Taxation. Your objective is the same and so is the principle as well as the need being greater. The only down side of the blog is the tartan tie…get a red one!

    • Thanks Jim; I’m afraid we’re up against the most infamous dictator of them all – ‘democracy’.

      So long as you’re a member of a minority group (such as those who are discriminated against by society and its predominant citizens because they are physically, sensory or mentally impaired) you have to plead, cudgel and argue with those in power, simply because, in the main, they have to satisfy the needs of the majority, or they don’t get re-elected.

      The majority want free health care and child education, so they are appeased by those they put in power; and there’s the case that good health and education benefits the GNP and other wealth indicators of the ‘nation’. But there’s also other ‘popular’ free-bees, which really don’t benefit the ‘nation’ – free bus passes, free access to libraries and museums, free prescriptions (even for one-off events), etc.

      For those who are not in the majority, or who haven’t that significant political ‘swing’ factor, but nevertheless are deprived of significant participation in the lives of their families and communities, those in power look at the bottom line; a bottom line which has been drawn after the ‘needs’ and ‘wants’ of the ‘majority’ have been satisfied.

      Personally, I’m taken by the thinking of Amitai Etzioni in his book “The spirit of community” in which he postulates that citizens are bound together by feelings of ‘solidarity’. Rather than helping others, because one day we might need help ourselves, his “communitarian” thought suggests support for others should be given, simply because they are valued as being part of the same community as that of the provider.

      The principles and practices of ‘independent living’, in which disabled people of any age make their own choices in life and take control of their own systems of support, supported in both by their peers, follows this communitarian philosophy. In addition, I believe, the processes of ‘co-production’ in which disabled people are seen as equal partners, in any policy making or service development, is a more communitarian approach to policy making and service development, than the simple majoritarian process of present day local democracy.

      By the way, I’ve got two red ties already!

  3. hazel mccoll says:

    good article jim , I agree !!!! , time for a new tie then eh !!!

  4. ;Derek Kelter says:

    Excellent Jim, a great read – is there no end to your talents.

  5. Jim MacLeod says:

    Jim I love your tie. I have a nice wee tartan tie myself.

    As always you have again came up with a thougtht provoking article.

    Personally, I am a big fan of the Scandanavian model of doing things. Countries like Sweden and Norway look after all their citizens very well. But with that comes a cost and that is why their direct taxation is so high but it is a price their citizens are prepared to pay. How many of our citizens would be prepared to pay 30 to 40% income tax.

    On top of this these countries do not have to pay for an arsenal of nuclear weapoans,and so more of their budgets can be spent on social policy. And Norway of course has used its oil wealth very well.

    I think you should send this article to one of the broadsheets so to stimulate wider debate.

    • Thanks Jim; I’m too a great fan of the Scandinavian system, but unfortunately it has succumbed to the right wing neoliberalism of their conservative government and great chunks have been cut from their advanced system of self-directed support (or independent living services, as they call it).

      It’s a pity such governments follow the Herbert Spencer theory of “the survival of the fittest’, which tragically led to the process of sterilization of the eugenics movement and the eventual extermination of 250,000 disabled people by the Nazis. We do need to start valuing people for who they are and what contribution they can make to the gross wellbeing product of the nation, rather than what they are and how much they can contribute to the gross national product.

      The “Wealth” of a country should have more than one dimension – money. The “Wealth” of a country should be measured in other ways, such as the self-actualization and happiness (or contentment) of it’s citizens; alongside many other factors, too many to mention here.

      We need to start catching up on our friends further down the evolutionary scale. Cellular slime moulds, such as Dictyostelium Mucoroides are amoebae which live as individuals until they aggregate to form multicellular fruiting bodies, where they starve to death to promote other cells in the fruiting body. Other examples of what has been termed “the survival of the nicest” have been found in the behaviour of the female Pacific salmon, which after struggling to get up the rapids of Rocky Mountain rivers, past the snapping jaws of hungry Rocky Mountain bears, will quietly die to provide food for their offspring.

      Although some neoliberals would rather die than open their wallets, the “survival of the nicest’ doesn’t require such drastic forms of self sacrifice. In fact, such acts as putting others before self can be seen in both in the text of religious doctrine and the acts of Aboriginal tribes in Australia. Neuroscientists have also found basic pathways within the human brain, similar to the reward pathways of food and sex, which were stimulated when volunteers placed the interests of others before their own. This study suggests that such “altruism” is not primarily due to a superior moral code within society, but is actually ‘hard-wired’ into our own human brain, just waiting to be developed

      • Jim MacLeod says:

        Hi Jim

        Thanks for your reply.

        Sweden may have a conservative government at the moment, but as you know over time governments change and often right is replaced by left and vice versa.

        I agree that a country’s wealth should be considered in more than one dimension, and not just in a financial sense. A sense of family, friendship and personal contentment are not and should not always be aligned to how much money a person possesses.

  6. This is an excellent article. I think the idea of a mass boycott does have real merit – perhaps something that the Campaign could explore. If each boycotter put some their saved charges into a shared fund then we might have the means to defend cases, lobby and fight for justice.

    Part of the challenge here also seems to be how we think of ourselves. One of your readers rightly points to the discrepancy between social care and healthcare and education. However it is not really clear that these services are actually more universal: we are not ill all the time, we aren’t at school all the time, some of us don’t have children. Social care [although I don’t like that term myself] could be just as universal.

    What will it take to encourage everyone to think of social care as universal?

    Certainly a change in public attitude. But that change must begin with ourselves. I think that its really important that we start to think of the rights of older people, people at the end of life, people with continuing healthcare needs, people with mental illness and people with learning difficulties as all of a piece. The new model of entitlements we need must have a broader base – and those of us who feel more attached to one group than another must find ways to build the bridges necessary.

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  9. steve smith says:

    this raises very interesting questions Jim about the meaning of rights and how these are to be resourced, particularly bearing in mind the hidden costs for all, of keeping disabled people dependent via a disabling society, and wrongly assuming that non-disabled are not dependent – we are all dependent on each other the question is how dependency is managed between groups in society

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