Health care is considered a universal welfare program in most of the world (other than the US). K-12 education is universal in much of the world that can afford it. Pensions for the elderly are pretty much universal in nations that can afford it. Unemployment insurance is fairly universal. Pretty much every nation that can afford these things invests in them.
So what welfare programs are currently not universal, but probably will be considered universal in upper income nations (12k+ in per capita income) within the near future (10-30 years)?
My guesses
long term care/nursing home care. Even some nations with UHC do not cover this. Medicare doesn’t cover it. But I think eventually assisted living and nursing homes will be seen the same way as hospital care, something every nation should provide its citizens via tax revenue and mandatory private spending.
Subsidized daycare.
Pharmaceuticals. In nations like Canada aren’t pharmaceuticals only covered in hospitals, and not outpatient? I don’t know if this is a common theme in other nations with UHC or if they cover pharmaceutials. The US added Medicare D back in 2006 to help with this issue.
Universal basic income. Probably wont’ happen for 30+ years though.
Australia’s Pharmaceutical Benefits Scheme (PBS) is one of the crown jewels of the UHC Medicare here. It’s been in place since 1950, substantially pre-dating Medicare itself. The comparative cost-effectiveness of the PBS is a signature burr under the saddle for US Big Pharma and a common US target for demanding repeal in bilateral trade negotiations for decades.
Universal dental care has been floated several times (usually in the same mixed private/public model which applies with Australia’s Medicare) and is more likely to be introduced than not.
The National Disability Insurance Scheme was introduced in 2016 after a trial phase beginning 2013 to cover the needs of people with disability and resources for their families and carers. We are still ironing out kinks in the process but we’ll get there.
Universal internet access. It’ll probably be pushed as an offshoot of public education and as a means of giving people better opportunities to get out of poverty and unemployment.
Yeah. I was thinking more social welfare when I created this thread, but what infrastructure programs will be considered universal, common sense and heavily subsidized is a good topic too. Things like police, roads, electricity, etc. seem to have only become universal in the last century or so.
On the subject of infrastructure that’ll become universal I agree that broadband is heading that way. I think smartphone service may be too (since a lot of people need phones to stay in contact or get info about jobs) and in the US there are programs to subsidize phones for poor people.
On those two items: Yes, in Canada basically prescription drugs are nominally only covered for in-patients in hospitals, although there are exceptions for some exotic and expensive drugs, plus there is universal coverage for low-income people and for seniors. It’s actually a provincial and not a federal responsibility, but that is that case in all provinces AFAIK. I used to take a rather expensive cardiac-related drug and the seniors coverage saved me literally thousands of dollars, even though the drug is only a fraction of the price here that it is in the US, which is a whole other topic on the matter of pharmaceutical price controls.
The universal basic income was something I was going to mention but you beat me to it. I definitely would not say it’s 30+ years away, unless you mean in the US. Here in Ontario there was already a UBI pilot project initiated recently by the former Liberal government that was canned when the Conservative Party came to power, so it’s not inconceivable that it could be revisited in the relatively near future.
Our NHS has had, since very early on, fixed, more or less nominal charges for medicines prescribed outside hospitals (but with exemptions for the elderly, children and chronically sick, and help for the low paid. I don’t see any pressure to change the general principles, but as ever there are arguments about potential adjustments in practice, just as there are occasionally proposals to charge [some supposedly nominal cost] for GP appointments, or missed appointments, or unnecessary emergency calls. But the latter are always swallowed up into general arguments about the overall level of funding - you have to bear in mind that under recent governments of A Certain Party, public expenditure has been squeezed down to around 35% of GDP from 42% ten years ago.
That squeeze has affected almost all public services, but funding for local government most of all, and that has impacted badly on the social care sector (which for all sorts of historical reasons has never been part of the NHS, which despite its title is a primarily medical service for keeping the body going, rather than ongoing social support for general health, well-being and social functioning). What with the financial squeeze and demographic change, the funding and organisational support for social care (whether in care homes, assisted living, daycare centres or visiting care at home) has been a live issue for a long time, and made more acute by the impact of Covid, which showed up how the sector has been the poor relation in central government thinking. There have been lots of different ideas bandied about as to how to raise funding on a secure longer-term basis, but no sign of a consensus as any one idea not arouses all sorts of opposition. Sloganeering about “death taxes” have in their time damaged Labour and Tory governments at election time. Johnson has promised (too many times) that there is a (no doubt “world-beating”) plan just ready to go, but there is no sign of it materialising any time soon.
UBI is much discussed, especially as Covid has uncovered all sorts of impacts on employment and the organisation or work, on top of the expansion of the “gig economy” and zero-hours contracts and the like, with the prospect of substantial job losses over the next couple of years as well. But it doesn’t take much to imagine the arguments about “money for nothing” and where you draw the boundaries on eligibility and conditionality.
Quebec has a prescription drug program, but there is a copay. I think it is about 20%, although there is a monthly limit on how much you have to pay. You can opt out if you have private insurance that covers them. My employee health insurance (which covered uninsured services, but mainly covered costs incurred in the US or other countries) covered prescription drugs until I turned 65 and then I had to join the provincial plan. Quebec also has subsidized pre-school, but the number of places is limited.
One thing not on your list that is, if not universal, is widespread, is family allowance. When we moved here, we got a trivial $6 per child per month, but now you get several thousand per year per child. I am not sure of the details. This is not means tested, although I think it is taxed.
In the 2017 election in the UK, Therese May tried to make seniors care less universal. Voters were not enthused (to put it mildly). I don’t see this becoming universal. Many seniors are poor and on “fixed income” but some are very wealthy and can easily afford proper care.
As first world populations fall, I expect this. The upper middle class finds this to be an incredible expense. Where I live, a decent middle class income pays about double the minimum wage. Because many childcare providers take care of multiple children, they can offer “lower rates”, but if they’re at all professional you will be paying a lot. (My sister had to pay $1,200 per month. If she had only been paying someone minimum wage, she would have to $2,240 per month instead. So there’s a “discount” for group care, but that’s still too expensive.) I looked up how much the rich and famous pay caregivers as well: typically $80,000 to $100,000 per year! (These are seriously rich multimillionaire celebrities, and for obvious reasons this is a very tiny sliver of the population.)
That seems to be right. I don’t have much experience getting drugs in hospitals though. Some parties have promised to support universal pharmacare but that has not happened yet.
I can’t imagine a post-scarcity society in only thirty years. UBI is an impossible dream, supported by those who don’t know history, human behavior, math, or politics.
UBI is an impossible dream, supported by those who don’t know history, human behavior, math, or politics.
Margaret Thatcher’s government wasn’t above using existing benefits as a sub rosa sort of no (or only proforma) questions asked UBI, if it helped massage down the headline unemployment figures.
I don’t think “money, no questions asked, until the economy improves” counts as UBI. It also doesn’t take the incredible expense into account. Right now Canada is giving $2,000 of taxable income per month to approximately 8 million Canadians (not universal) and our deficit for the year has reached comical numbers.
(Naturally an MP demanded that the program not go away, apparently ever. The news report did not tell me which party this MP belongs to, but it’s easy to guess.)