With waiting lists in the NHS at record highs and with the social care system in crisis, there have been growing calls for increased funding for both health and social care. The UK government has just announced tax rises to raise more revenue for both services and has specified new limits on the amounts people must pay towards their care.
In this blog we look at the new tax rises and whether they are fair. We also look at whether the allocation of social care is fair. Clearly, the question of fairness is a contentious one, with people having very different views on what constitutes fairness between different groups in terms of incomes, assets and needs.
In terms of funding, the government has, in effect, introduced a new tax – the ‘health and social care levy’ to come into effect from April 2022. This will see a tax of 1.25% on the earned incomes of workers (both employees and the self-employed) and 1.25% on employers, making a total of 2.5% on employment income. It will initially be added to workers’ and employers’ national insurance (NI) payments. Currently national insurance is only paid by those below pension age (66). From 2023, the 1.25% levy will be separated from NI and will apply to pensioners’ earned income too.
The starting point for workers will be the same as for the rest of national insurance, currently £9568. Above this, the additional marginal rate of 1.25% will apply to all earned income. This will mean that a person earning £20 000 would pay a levy of £130.40, while someone earning £100 000 would pay £1130.40.
There will also be an additional 1.25% tax on share dividends. However, there will be no additional tax on rental income and capital gains, and on private or state pensions.
It is estimated that the levy will raise around £14 billion per year (0.7% of GDP or 1.6% of total tax revenue), of which £11.2 billion will go to the Department of Health and Social Care in 2022/23 and £9 billion in 2023/24. This follows a rise in income tax of £8 billion and corporation tax of £17 billion announced in the March 2021 Budget. As a result, tax revenues from 2022/23 will be a higher proportion of GDP (just over 34%) than at any time over the past 70 years, except for a short period in 1969/70.
Is the tax fair?
In a narrow sense, it can be argued that the levy is fair, as it is applied at the same percentage rate on all earned income. Thus, the higher a person’s earnings, the greater the amount they will pay. Also, it is mildly progressive. This is because, with a levy-free allowance of just under £10 000, the levy as a proportion of income earned rises gently as income rises: in other words, the average levy rate is higher on higher earners than on lower earners.
But national insurance as a whole is regressive as the rate currently drops from 12% to 2%, and with the levy will drop from 13.25% to 3.25%, once the upper threshold is reached. Currently the threshold is £50 270. As incomes rise above that level, so the proportion paid in national insurance falls. Politically, therefore, it makes sense to decouple the levy from NI, if it is being promoted as being fair as an additional tax on income earners.
Is it fair between the generations? Pensioners who earn income will pay the levy on that income at the same rate as everyone else (but no NI). But most pensioners’ main or sole source of income is their pensions and some, in addition, earn rent on property they own. Indeed, some pensioners have considerable private pensions or rental income. These sources of income will not be subject to the levy. Many younger people whose sole source of income is their wages will see this as unfair between the generations.
Allocation of funds
For the next few years, most of the additional funding will go to the NHS to help reduced waiting lists, which rocketed with the diversion of resources to treating COVID patients. Of the additional £11.2 billion for health and social care in 2022/23, some £9.4 billion will go to the NHS; and of the £9 billion in 2023/24, some £7.2 billion will go to the NHS. This leaves only an additional £1.8 billion each year for social care.
The funding should certainly help reduce NHS waiting lists, but the government refused to say by how much. Also there is a major staff shortage in the NHS, with many employees having returned to the EU following Brexit and fewer new employees coming from the EU. It may be that the staff shortage will push up wages, which will absorb some of the increase in funding.
The additional money from the levy going to social care would be wholly insufficient on its own to tackle the crisis. As with the NHS, the social care sector is facing an acute staff shortage, again aggravated by Brexit. Wages are low, and when travel time between home visits is taken into account, many workers receive well below the minimum wage. Staff in care homes often find themselves voluntarily working extra hours for no additional pay so as to provide continuity of care. Often levels of care are well below what carers feel is necessary.
Paying for social care
The government also announced new rules for the level of contributions by individuals towards their care costs. The measures in England are as follows. The other devolved nations have yet to announce their measures.
- Those with assets of less than £20 000 will not have to contribute towards their care costs from their assets, but may have to contribute from their income.
- Those with assets between £20 000 and £100 000 will get means-tested help towards their care costs.
- Those with assets over £100 000 will initially get no help towards their care costs. This is increasing from the current limit of £23 250
- There will be a limit of £86 000 to the amount people will have to contribute towards their care costs over their lifetime (from October 2023). These costs include both care in a care home and care at home.
- These amounts will apply only to care costs and not to the board and lodging costs in care homes. The government has not said how much people could be expected to contribute towards these living costs. A problem is that care homes generally do not itemise costs and hence it may be hard to distinguish care costs from living costs.
- Where people’s care costs are fully or partly covered, these will be paid by their local authority.
- A house will only count as a person’s asset if the person is going into a care home and it is not occupied by a spouse or partner. All financial assets, by contrast, will count.
- Many people in care homes will not be judged to be frail enough to be in receipt of support from their local authority. These people’s expenditure would not count towards the cap.
Setting the cap to the amount people must pay at the relatively high figure of £86 000 may ease the pressure on local authorities, as many people in care homes will die before the cap is reached. However, those who live longer and who get their care paid for above the cap, will pay no more no matter what their level of assets, even though they may be very rich. This could be seen to be unfair. A fairer system would be one where a proportion of a person’s assets had to be used to pay for care with no upper limit.
Also, the £1.8 billion is likely to fall well short of what local authorities will need to bring social care back to the levels considered acceptable, especially as the asset limit to support is being raised from £23 250 to £100 000. Local authority expenditure on social care fell by 7.5% per person in real terms between 2009/10 and 2019/20. This means that local authorities may have to increase council tax to top up the amount provided by the government from the levy.
- An initial response to the Prime Minister’s announcement on health, social care and National Insurance
Institute for Fiscal Studies Press Release, Paul Johnson, Carl Emmerson, Helen Miller, David Phillips, George Stoye, Isaac Delestre, Isabel Stockton, Kate Ogden, Robert Joyce, Stuart Adam, Tom Waters, Max Warner and Ben Zaranko (7/9/21)
- National Insurance rates to rise to fund social care crisis – how much more will you pay?
Which? News, Danielle Richardson (7/9/21)
- Social care tax rise: Boris Johnson wins Commons vote
BBC News (8/9/21)
- Will the cap really fix the social care system?
BBC News, Nick Triggle (8/9/21)
- National Insurance contributions to rise by 1.25% from April 2022 to fund social care costs
Money Saving Expert, James Flanders (7/9/21)
- Boris Johnson plan to fund health and social care lifts UK tax burden to 70-year high
Financial Times, George Parker, Laura Hughes and Chris Giles (7/9/21)
- Boris Johnson has created a ‘social care plan’ without any plan for social care
The Guardian, Frances Ryan (7/9/21)
- Analysis: The Government’s plans for health and social care
Reform, William Mills (8/9/21)
- Analysis: What does Boris Johnson’s health and social care tax mean for Scotland?
The Scotsman, Martyn McLaughlin (7/9/21)
- Social care tax rise is austerity by another name – economist Q&A
The Conversation, Alex de Ruyter (8/9/21)
- National insurance: a UK tax which is complex and vulnerable to political intervention
The Conversation, Gavin Midgley (8/9/21)
- How would you define a ‘fair’ way of funding social care?
- Distinguish between a proportional, progressive and regressive tax. How would you categorise (a) the new health and social care levy; (b) national insurance; (c) income tax; (d) VAT?
- Argue the case for providing social care free at the point of use to all those who require it.
- Argue the case for charging a person for some or all of their social care, with the amount charged being based on (a) the person’s income; (b) the person’s wealth; (c) both income and wealth.
- Argue the case for and against capping the amount a person should pay towards their social care.
- When a tax is used to raise revenue for a specific purpose it is known as a ‘hypothecated tax’. What are the advantages and disadvantages of using a hypothecated tax for funding health and social care?
With university fees for home students in England of £9250 per year and with many students receiving maintenance loans of around £9000 per year, many students are graduating with debts in excess of £50 000. Loans are repaid at a marginal rate of 9% on incomes over £25 716.
Many students also study for a masters degree. The average fee for a taught, classroom-based masters (MA) is £7392 and for a laboratory-based masters (MSc) is £8167 but can be considerably higher at some prestigious universities where demand is high. Government loans of up to £10 906 are available to contribute towards fees and maintenance. These are paid back at a marginal rate of 6% for people earning over £21 000, giving a combined marginal rate of 15% for first and masters degrees.
For high earners on the 40% income tax rate, the combined marginal rate of payment out of income is 40% tax, plus 2% national insurance, plus 15% for those with undergraduate and masters loans. This gives a combined marginal rate of 57%.
Average student debt in England is higher even than in the USA, where the average is $37 000. US university courses are more expensive than in the UK, costing an average of $34 000 per year in tuition alone. But undergraduates can borrow less. They can borrow between $5500 and $12 500 per year in federal loans towards both fees and maintenance, and some private loans are also available. Most students do some paid work during their studies to make up the difference or rely on parents contributing. Parental contributions mean that students from poor families end up owing more. According to a Guardian article:
Race is a huge factor. Black students owe an average of $7400 more than white students when they graduate, the Brookings Institution found. After graduation, the debt gap continues to widen. Four years after graduation, black graduates owe an average of nearly $53 000 – nearly double that of white graduates.
Student debt looks to become one of the key issues in the 2020 US presidential election.
Pressure to cancel student fees and debt in the USA
Most of the Democratic candidates are promising to address student fees and debt. Student debt, they claim, places an unfair burden on the younger generation and makes it hard for people to buy a house, or car or other major consumer durables. This also has a dampening effect on aggregate demand.
The most radical proposal comes from Bernie Sanders. He has vowed, if elected, to abolish student fees and to cancel all undergraduate and graduate debt of all Americans. Other candidates are promising to cut fees and/or debt.
Although most politicians and commentators agree that the USA has a serious problem of student debt, there is little agreement on what, if anything, to do about it. There are already a number of ways in which student debt can be written off or reduced. For example, if you work in the public sector for more than 10 years, remaining debt will be cancelled. However, none of the existing schemes is as radical as that being proposed by many Democrats.
Criticisms of the Democrats’ plans are mainly of two types.
The first is the sheer cost. Overall debt is around $1.6tn. What is more, making student tuition free would place a huge ongoing burden on government finances. Bernie Sanders proposes introducing a financial transactions tax on stock trading. This would be similar to a Tobin tax (sometimes dubbed a ‘Robin Hood tax’) and would include a 0.5% tax on stock transactions, a 0.1% tax on bond trades and a 0.005% tax on transactions in derivatives. He argues that the public bailed out the financial sector in 2008 and that it is now the turn of the financial sector to come to the aid of students and graduates.
The other type of criticism concerns the incentive effects of the proposal. The core of the criticism is that loan forgiveness involves moral hazard.
The moral hazard of loan forgiveness
The argument is that cancelling debt, or the promise to do so, encourages people to take on more debt. Generally, moral hazard occurs when people are protected from the consequences of their actions and are thus encouraged to make riskier decisions. For example, if you are ensured against theft, you may be less careful with your belongings. As the Orange County Register article linked below states:
If the taxpayers pay the debts of everyone with outstanding student loans, how will that affect the decisions made by current students thinking about their choices for financing higher education? What’s the message? Borrow as much as you can and wait for the debt to be canceled during the next presidential primary campaign?
Not only would more students be encouraged to go to college, but they would be encouraged to apply for more costly courses if they were free.
Universities would be encouraged to exaggerate their costs to warrant higher fees charged to the government. The government (federal, state or local) would have to be very careful in auditing courses to ensure costs were genuine. Universities could end up being squeezed for finance as government may try to cut payments by claiming that courses were overpriced.
Even if fees were not abolished, cancelling debts would encourage students to take on larger debt, if that was to be cleared at some point in the future. What is more, students (or their parents) who could afford to pay, would choose to borrow the money instead.
But many countries do have free or highly subsidised higher education. Universities are given grants which are designed to reflect fair costs.
- Assess the arguments for abolishing or substantially reducing student fees.
- Assess the arguments against abolishing or substantially reducing student fees.
- Assess the arguments for writing off or substantially reducing student debt.
- Assess the arguments against writing off or substantially reducing student debt.
- If it were decided to cancel student debt, would it be fair to pay students back for any debt they had already paid off?
- Does tackling the problem of student debt necessarily lead to a redistribution of wealth/income?
- Give some other examples of moral hazard.
- If student fees were abolished, would there be any problem of adverse selection? If so, how could this be overcome?
- Find out what the main UK parties are advocating about student fees and debt in the nations of the UK for home and non-home students. Provide a critique of each of their policies.
Firms are increasingly having to take into account the interests of a wide range of stakeholders, such as consumers, workers, the local community and society in general (see the blog, Evolving Economics). However, with many firms, the key stakeholders that influence decisions are shareholders. And because many shareholders are footloose and not committed to any one company, their main interests are short-term profit and share value. This leads to under-investment and too little innovation. It has also led to excessive pay for senior executives, which for many years has grown substantially faster than the pay of their employees. Indeed, executive pay in the UK is now, per pound of turnover, the highest in the world.
So is there an alternative model of capitalism, which better serves the interests of a wider range of stakeholders? One model is that of employee ownership. Perhaps the most famous example of this is the John Lewis Partnership, which owns both the department stores and the Waitrose chain of supermarkets. As the partnership’s site claims, ‘when you’re part of it, you put your heart into it’. Although the John Lewis Partnership is the largest in the UK, there are over 330 employee-owned businesses across the UK, with over 200 000 employee owners contributing some £30bn per year to UK GDP. Again, to quote the John Lewis site:
Businesses range from manufacturers, to community health services, to insurance brokers. Together they deliver 4% of UK GDP annually, with this contribution growing. They are united by an ethos that puts people first, involving the workforce in key decision-making and realising the potential and commitment of their employees.
A recent example of a company moving, at least partly, in this direction is BT, which has announced that that every one of its 100 000 employees will get shares worth £500 every year. Employees will need to hold their shares for at least three years before they can sell them. The aim is to motivate staff and help the company achieve a turnaround from its recent lacklustre performance, which had resulted in its laying off 13 000 of its 100 000-strong workforce.
Another recent example of a company adopting employee ownership is Richer Sounds, the retail TV and hi-fi chain. Its owner and founder, Julian Richer, announced that he had transferred 60% of his shares into a John Lewis-style trust for the chain’s 531 employees. In addition to owning 60% of the company, employees will receive £1000 for every year they have worked for the retailer. A new advisory council, made up of current staff, will advise the management board, which is taking over the running of the firm from Richer.
According to the Employee Ownership Association (EOA), a further 50 businesses are preparing to follow suit and adopt forms of employee ownership. As The Conversation article linked below states:
As a form of stakeholder capitalism, the evidence shows that employee ownership boosts employee commitment and motivation, which leads to greater innovation and productivity.
Indeed, a study of employee ownership models in the US published in April found it narrowed gender and racial wealth gaps. Surveying 200 employees from 21 companies with employee ownership plans, Joseph Blasi and his colleagues at Rutgers University found employees had significantly more wealth than the average US worker.
The researchers also found that the participatory management practices that accompanied the employee ownership schemes led to employees improving their communication skills and learning management skills, which had helped them make better financial decisions at home.
But, although employee ownership brings benefits, not only to the employees themselves, but also more widely to society, there is no simple mechanism for achieving it when shareholders are unlikely to want to relinquish their shares. Employee buyout schemes require funding; and banks are often cautious about providing such funding. What is more, there needs to be an employee trust overseeing the running of the company which takes a long-term perspective and not just that of current employees, who might otherwise be tempted to sell the company to another seeking to take it over.
- What are the main benefits of employee ownership?
- Are there any disadvantages of employee ownership and, if so, what are they?
- What are the main barriers to the adoption of employee ownership?
- What are the main recommendations from The Ownership Effect Inquiry? (See linked report above.)
- What are the findings of the responses to the employee share ownership questions in the US General Social Survey (GSS)? (See linked Global Banking & Finance Review article above.)
In 2012, the Scottish Parliament voted to introduce a minimum unit price for alcoholic drinks. The Scotch Whisky Association along with others appealed against the legislation, but on 15 November 2017 the UK Supreme Court ruled unanimously that the legislation does not breach European Union law. It is thus likely that, after consultation, a 50p minimum unit price will be introduced, making Scotland the first country in the world to introduce minimum pricing for alcohol.
As we saw in a previous blog, Alcohol minimum price, the aim is to prevent the sale of really cheap drinks in supermarkets and other outlets. For example, three-litre bottles of strong cider can be sold for as little as £3.59. Sometimes supermarkets offer multibuys which are heavily discounted. The idea of minimum pricing is to stop these practices without affecting ‘normal’ prices. For example, the legislation will not affect prices in pubs, which are already more than 50p per unit of alcohol.
The following table shows how much prices would rise for various types of drink when compared to current cheap supermarket prices. The biggest percentage effect is for cheap, strong cider and beer.
||Units of alcohol
||New minimum price
|Cheap strong cider
|Cheap beer/lager (normal)
||4 × 440ml
|Cheap beer/lager (strong)
||4 × 500ml
|Cheap strong spirits
The hope is that by preventing the sale of really cheap drinks in supermarkets, people will no longer be encouraged to ‘pre-load’, so that when they go out for the evening they are already drunk. It would also help to reduce the number of alcoholics amongst the poor.
But this raises the question of equity. By targeting cheap drink, the policy is likely to hit the poor hardest. The question is whether this will simply lead to alcoholics on low incomes cutting down on other things, such as food and clothing for themselves and their children.
How successful, then, will such a policy be in cutting down drunkenness and the associated anti-social behaviour in many Scottish towns and cities, especially on Friday and Saturday nights? This will depend on the price elasticity of demand.
Videos and podcasts
Scotland first country to introduce minimum alcohol price Channel 4 News, Fatima Manji (15/11/17)
The story of how Scotland brought in minimum pricing on alcoh The Scotsman, Ross McCafferty (15/11/17)
Supreme Court rejects challenge against plans for minimum alcohol pricing in Scotland ITV News, Peter Smith (15/11/17)
Scotland getting the all-clear for minimum alcohol pricing as judges reject appeal Heart Scotland News, Connor Gillies (15/11/17)
Alcohol minimum unit pricing to go ahead Scottish Government: news (15/11/17)
Scottish alcohol price survey 2016 Alcohol Focus Scotland (2016)
Minimum pricing Alcohol Focus Scotland (2017)
Supreme Court backs Scottish minimum alcohol pricing BBC News (15/11/17)
Supreme Court backs Scottish minimum alcohol pricing plans Out-Law.com (15/11/17)
Go-ahead for minimum alcohol pricing British Medical Association (BMA), Jennifer Trueland (15/11/17)
Expert reaction to UK supreme court ruling that the Scottish government can set a minimum price for alcohol, rejecting a challenge by the Scotch Whisky Association Science Media Centre (15/11/17)
Scotland to become first country with minimum price for alcohol sales Independent, Alex Matthews-King (15/11/17)
Scotland leading the world over minimum alcohol price ITV News (15/11/17)
Campaigners urge minimum alcohol price in England after Scottish ruling The Guardian, Severin Carrell (15/11/17)
Scottish ‘booze cruises’ to England predicted as minimum pricing introduced The Telegraph, Olivia Rudgard (15/11/17)
- Draw a diagram to illustrate the effect of a minimum price per unit of alcohol on (a) cheap cider; (b) good quality wine.
- What would be the likely effects of a 50p per unit minimum price on the pub trade?
- How is the price elasticity of demand for alcoholic drinks relevant to determining the success of minimum pricing?
- What determines the price elasticity of demand for cheap alcoholic drinks?
- Compare the effects on alcohol consumption of imposing a minimum unit price of alcohol with raising the duty on alcoholic drinks. What are the revenue implications of the two policies for the government?
- What externalities are involved in the consumption of alcohol? How could a socially efficient price for alcohol be determined?
- Could alcohol consumption be described as a ‘de-merit good’? Explain.
- Other than high minimum prices and taxation, what other policies could be used to (a) tackle binge drinking; (b) tackle the problem of alcoholism?
- What will determine the number of people travelling from Scotland to England to buy cheaper alcoholic drinks?
A number of famous Business Schools in the UK and US such as MIT Sloan, NYU Stern and Imperial College have launched new programmes in business analytics. These courses have been nicknamed ‘Big Data finishing school’. Why might qualifications in this area be highly valued by firms?
Employees who have the skills to collect and process Big Data might help firms to successfully implement a pricing strategy that approaches first-degree price discrimination.
First-degree price discrimination is where the seller of a product is able to charge each consumer the maximum price he or she is prepared to pay for each unit of the product. Successfully implementing this type of pricing strategy could enable a firm to make more revenue. It might also lead to an increase in economic efficiency. However, the strategy might be opposed on equity grounds.
In reality, perfect price discrimination is more of a theoretical benchmark than a viable pricing strategy. Discovering the maximum amount each of its customers is willing to pay is an impossible task for a firm.
It may be possible for some sellers to implement a person-specific pricing strategy that approaches first-degree price discrimination. Firms may not be able to charge each customer the maximum amount they are willing to pay but they may be able to charge different prices that reflect customers’ different valuations of the product.
How could a firm go about predicting how much each of its customers is willing to pay? Traditionally smaller sellers might try to ‘size up’ a customer through individual observation and negotiation. The clothes people wear, the cars they drive and their ethnicity/nationality might indicate something about their income. Second-hand car dealers and stall-holders often haggle with customers in an attempt to personalise pricing. The starting point of these negotiations will often be influenced by the visual observations made by the seller.
The problem with this approach is that observation and negotiation is a time-consuming process. The extra costs involved might be greater than the extra revenue generated. This might be especially true for firms that sell a large volume of products. Just imagine how long it would take to shop at a supermarket if each customer had to haggle with a member of staff over each item in their supermarket trolley!! There is also the problem of designing compensation contracts for sales staff that provide appropriate incentives.
However the rise of e-commerce may lead to a very different trading environment. Whenever people use their smart phones, laptops and tablets to purchase goods, they are providing huge amounts of information (perhaps unconsciously) to the seller. This is known as Big Data. If this information can be effectively collected and processed then it could be used by the seller to predict different customers’ willingness to pay.
Some of this Big Data provides information similar to that observed by sellers in traditional off-line transactions. However, instead of visual clues observed by a salesperson, the firm is able to collect and process far greater quantities of information from the devices that people use.
For example, the Internet Protocol (IP) address could be used to identify the geographical location of the customer: i.e. do they live in a relatively affluent or socially deprived area? The operating system and browser might also indicate something about a buyer’s income and willingness to pay. The travel website, Orbitz, found that Apple users were 40 per cent more likely to book four or five star hotel rooms than customers who used Windows.
Perhaps the most controversial element to Big Data is the large amount of individual-level information that exists about the behaviour of customers. In particular, browsing histories can be used to find out (a) what types of goods people have viewed (b) how long they typically spend on-line and (c) their previous purchase history. This behavioural information might accurately predict price sensitivity and was never available in off-line transactions.
Interestingly, there has been very little evidence to date that firms are implementing personalised pricing on the internet. One possible explanation is that effective techniques to process the mass of available information have not been fully developed. This would help to explain the growth in business analytics courses offered by universities. PricewaterhouseCoopers recently announced its aim to recruit one thousand more data scientists over the next two years.
Another possible explanation is that firms fear a backlash from customers who are deeply opposed to this type of pricing. In a widely cited survey of consumers, 91% of the respondents believed that first-degree price discrimination was unfair.
Big data is coming for your purchase history – to charge you more money The Guardian, Anna Bernasek and DT Mongan (29/5/15)
Big data is an economic justice issue, not just a Privacy Problem The Huffington Post, Nathan Newman (16/5/15)
MIT’s $75,000 Big Data finishing school (and its many rivals) Financial Times, Adam Jones (20/3/16)
The Government’s consumer data watchdog New York Times, Natasha Singer (23/5/2015)
The economics of big data and differential pricing The Whitehouse blog, Jason Furman, Tim Simcoe (6/2/2015)
- Explain the difference between first- and third-degree price discrimination.
- Using an appropriate diagram, explain why perfect price discrimination might result in an economically more efficient outcome than uniform pricing.
- Draw a diagram to illustrate how a policy of first-degree price discrimination could lead to greater revenue but lower profits for a firm.
- Why would it be so difficult for a firm to discover the maximum amount each of its customers was willing to pay?
- Explain how the large amount of information on the individual behaviour of customers (so-called Big Data) could be used to predict differences in their willingness to pay.
- What factors might prevent a firm from successfully implementing a policy of personalised pricing?