Modernisation, Solidarity and Care in Europe the Sociologist’s Tale

Abstract

In today’s affluent Western European societies most people take full-fledged health and social care for granted. They are free from fear of the dire poverty that was for a long time the consequence of unemployment, ill health, or old age. The adequate provision of care by the welfare state has become so self-evident for them, that it has become an idée reçue. Yet newspapers report daily on the negative effects of bottlenecks in our systems of health and social care and on health and care costs that get out of hand. With almost the same frequency, ideas and policy proposals are presented that claim to provide remedies for such malfunctioning or overspending. Some plans propose only financial solutions to the problems at hand. These plans take either of two forms; on the one hand there are those who worry chiefly about the quality of care and brush aside cost objections. They want to increase the budget for care by raising taxes and levies or, by making individual co-payments compulsory. On the other hand there are those for whom increasing costs are subject to constant concern. They want to cut costs and at the same time make efficiency improvements, so that the level of care provision can be kept at the same level or even raised. Others, neither believes in the willingness of governments and people to pay more and more for health and social care, nor do they have enough faith in substantial cost reduction in combination with efficiency improvements. They deem rationing measures necessary or propose that the sick, the disabled, and the elderly queue up in anticipation of cure and care. In the face of such plans for reconstructing the existing collective risk-sharing arrangements, full-fledged health and social care provisions are in danger of losing their self-evidence.