A taxation revolution

Germany somehow manages to provide high-quality health and social care to its citizens.


My brother-in-law Ludwig died on Saturday 11 March, 2017. Ludwig was 62 this year, so he lived into old age for someone born with the health problems he was born with. In recent years he had severe dementia. He didn’t respond at all to anything the last few times we went to see him. He had 24-hour care in the specialist care home where he’s been for the past five years or so.


The hardest part of getting Ludwig into care was convincing his mother, who is 89 years old now, that she really would not be able to look after him herself any more. He needed a team of professional carers. She was absolutely opposed to “putting him in a home”. She said she hoped he would die before her, she was so determined that he should never be in a situation where he might suffer indignity. We’ve all heard of neglect and mistreatment of people in residential care, and of course with dementia there would be no way for him to communicate what was going on.

In the end, his siblings found Ludwig a fantastic state social insurance – and charity-funded – placement that met his particular needs, just a 20-minute drive from his mother’s house. It is a rural area of farms and small villages, so I thought Ludwig was fortunate to get a place in the nearest market town. Over the next few years, when we visited him we would go unannounced, so staff could not prepare in advance or anything. We talked to other visitors about their impressions, and spoke to other patients who were able to speak.

The carers who looked after Ludwig were wonderful. There was a high turn-over of staff – carers are the front-line infantry of the health sector – but every carer we met, seemed cheerful and dedicated. The place itself where Ludwig stayed was cosy and relaxed enough that it was easy to forget it was a fully-equipped medical facility.

I thought so many times when we went to see Ludwig: this terrific, dignified treatment is possible in Germany, and in Scandinavia too, and no doubt in other countries… why not in England? At the time Ludwig was admitted I was working in NHS hospitals and had witnessed some very different things to what I saw in Germany.

Germany somehow manages to provide high-quality health and social care to its citizens with its 80 million population, plus the million more refugees they welcomed. Britain by comparison, with 65 or so million people, and screaming “We’re full up!!” in the faces of asylum seekers, lurches from one healthcare crisis to the next. Germany, with its current centre-right Christian Democrat government, somehow manages to feel like more of a socialist country than Britain did under the most recent Labour government.

Germany somehow manages to provide high-quality health and social care to its citizens with its 80 million population, plus the million more refugees they welcomed.

There’s no secret to how to provide excellent public services. Public funding comes from taxes and voluntary contributions. Citizens and corporations must be willing to pay. I think Germans fundamentally understand that, while English people often appear to demand that they are simply entitled to things they’re not prepared to pay for. England needs a taxation revolution. High standards of publicly-funded education, healthcare, and social care – provided not-for-profit – are necessary for a functioning democracy. In practice, there’s no representation without taxation.

My brother-in-law Ludwig was born in 1955 into a society that had learnt from horrific experience how to share, co-operate and treat fellow citizens with respect and dignity: and their country prospered as a result. Ludwig was a lucky man. I hope that some coming generation of fellow English citizens will be as lucky as Ludwig.

This article was published by The Fabian Society

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