[ta1243]

Vast majority of NHS expense is keeping an aging population alive. A lot of the rest of government spending (nearly 80% of my council tax for example) goes on social care for that same aging population.

The NHS spends less per capita than the US spends on medicaid. Not less per person covered, less overall.

[Earw0rm]

How do poorer countries manage to avoid getting outright bankrupted by social care? Why is it such a black hole money-pit in the UK particularly?

[lotsofpulp]

It’s a black hole money-pit everywhere. There is no return on spending money for people who will never be productive again.

The only way that kind of wealth transfer works is with a growing proportion of workers, but that has long not been the case in many developed countries.

The solution for all these countries (even the US) is to dismantle all wealth transfer to old people. It might be the only way to incentivize production of families that raise productive children. Or tell old people to expect declining quality of life (faster than it already is).

[naijaboiler]

The west is caught in a web of its own creation. We have basically incentivized the countries to get older by taxing the young to subsidize the rich.

Unfortunately, there's no easy way for democracy to correct this. older people vote and are wealthier. Both of those mean they have large political power.

[Earw0rm]

Doesn't this create a situation where the old rely on their own younger generation to support them?

And therefore inequality between older people who have families (or have families that care about them) and those that don't?

I can see this particularly being a problem for countries like the UK which has long encouraged "upwardly-mobile" people to move away from their towns of origin in pursuit of economic opportunity, leading to families being widely dispersed across a country which, despite its fairly small size, is not especially fast to travel around.

[pjc50]

Transferring away from older voters is not going to happen, other than very gradually.

[ta1243]

More workers to older people ratio

More social care from family (which is unpaid and thus is hidden in GDP figures)

Less social care

Expectation in the UK that wealthy old people should not pay for their own care and instead poorer working people should

[Earw0rm]

Are we miscounting GDP?

That is, if someone goes out for work instead of caring for relatives, not only do we count their work as GDP, we also count the person who has to stand in for them.

So that's a large increase in paid work done, but a minimal amount of extra wellbeing generated. Especially if, say, each of them now has to drive 45 minutes each way.

If, as you say, care is paid for by other people working, are there interventions - either state or individual - to reduce the need to consume it? Obviously some people are just unlucky, and live a long time in a state of total incapacity (hence the "dementia tax" rhetoric), is it possible to incentivise people to do things that mean they need less of it - by spending a greater proportion of their lifespan in good health, say?

[ta1243]

Depends on the what your goal is when counting GDP.

If I spend a day painting my garage door, and my neighbour spends a day wiring a new lightbulb, nothing is added to GDP

If I pay my neighbour to paint my garage door, and my neighbour pays me to wire a new lightbuld, that counts as GDP

Same work is done, same outcome.

> by spending a greater proportion of their lifespan in good health, say?

Might reduce the amount, on the other hand might extend lifespan and thus cost more.

[Earw0rm]

Not necessarily on that last point as it's something other than a linear relationship.

There are people aged 90 who've needed 0 years of care, and others who've needed 30.

That was kind of what I meant by greater proportion.. we're all mortal, but for me personally, the idea of being utterly dependent for a long period of my later years is, to put it mildly, not something I want. As in I would literally rather be dead. I'm not saying other people should feel the same, but that's how I feel about it.

Two, three, perhaps five years at the end? Sure, that's rather to be expected. Even then, there are huge differences in quality of life enjoyed by different eldercare residents. I had one older relative in a home for his last four years, who basically had good quality of life up until the final couple of weeks. Another who was in a home for a decade+, and had almost zero quality of life from the day she went in. Not because it was a bad home, she was just too far gone.