It's Always More Complicated

Not just because I see no point to continuing the argument discussion I was having with someone in the comments of someone else's journal, but because this occurred to me as a bigger and more general issue.

I don't think you're going to get a decent healthcare service if you're overly concerned about 'the undeserving' and people freeloading on the system and therefore want to restrict any provision to people who are clearly and demonstrably in a position to need and deserve it.

I will concede, she concedes, that my feelings on this matter may be inflected by specifically British historical, classed, phenomena: the emotions aroused by the terms pauperism, less eligibility, Means Test, deserving and undeserving, scholarship child. And my feelings on these may well be influenced by the fact that I am closer to those generations for which those were very real things, and for whom the advent of the Welfare State was a wonderful thing.

Because at least until 1929, and in some areas until 1948, to get free medical care you needed: either to be provably below a certain poverty line, in which case you were eligible under the Poor Law (which was a huge stigma - cf people putting away money they could ill afford to avoid being buried 'on the parish'), or, if you needed hospital treatment, you had to get a letter of recommendation to a voluntary (i.e. funded by charitable subscription) hospital to say that you were a deserving candidate for treatment and care (I have among my papers a photocopy of a printed letter form of a leading maternity hospital, late 1930s, to be issued only to married women and unmarried women pregnant for the first time only - and some maternity hospitals, I suspect, did not even make that concession).

Male breadwinners might be covered 'on the panel' under National Insurance or workplace insurance schemes, but this didn't always cover their wives (except possibly for accouchements) or children.

As a result, when the NHS came into being there was revealed a vast amount of sometimes quite serious illhealth which had gone untreated because the individuals in question were not covered or could not afford it.

The concept of deserving/undeserving also resonates for me with people who aren't exactly anti-abortion as such, or say they aren't, but are against those (chimerical?) women who have abortions for 'frivolous' reasons.

The idea which I find problematic, because, well, it's Always More Complicated, and people's situations and perceptions of those situations are theirs and their sense of desperation is formed by where they're at, is that some people are deserving of something (but have to prove it, it's not exactly going to go by on the nod) and that others are trying to get away with something, and we have to be very careful to the extent of being punitive to make sure they don't get away with it.

That some people may not be entirely deserving and may be exploiting the system is I think something that just has to be accepted if people who 'really' (whatever that means) need the benefits are to get them as and when needed.

Systems need some slack: I think of the 'downsizing' 'lean and mean' mania of the 80s/90s and how problematic that is - there comes a point where the system needs a little flab in it.

(This reminds me of the scene in Thomas Armstrong's The Crowthers of Bankdam in which the university-educated son of the socially-climbing brother goes into t'mill and sees a man just standing around, reading the paper, apparently doing nothing. He tries to dismiss him and is told that the fact that he's standing around means he's good at his job - all the looms are running well and he will pick up at once if there's a problem about to happen and deal with it.)

And I really don't think you should say that people who are already working in hard and ill-paid jobs just to cover food and shelter should be working more hours or second jobs in order to fund health insurance. Partly because I strongly suspect that to make food and shelter they're already working as hard as they can (quite probably to the detriment of their health), and partly because when you're in that situation, long-term planning? - not a priority. Just surviving from day to day is hard enough.

I don't think suffering is good for people, really. So I am never really going to be able to encompass the idea that people who are already struggling, ought to be struggling harder, rather than given some kind of help.

But perhaps I am softened and corrupted by all the things that gave me a hand up.