The reasons for
substantially increasing current spending on the NHS and social care
are obvious. Here is some data. The first is from the OECD on UK spending
on health over a long period as a share of GDP (source).
This reveals an
important truth which talk of ‘protecting the NHS’ is
deliberately designed to ignore: health spending increases as a share
of total GDP over time. The two noticeable points beyond that are the
increase in spending under Labour, and the slight decrease in
spending under the Coalition government.
One area of health
spending that has been particularly hit in the recent past has been
spending on social care by local authorities (source).
It is in areas like
this that I get so frustrated with TV journalism. I have seen
countless segments or interviews on what is causing the current
crisis in the NHS and health care, but I do not remember ever seeing
graphs like this. Is there an unwritten understanding in the TV
networks that people cannot read graphs?
The outlook for the
next five years for total health spending is further falls relative
to total GDP (source).
The red bars are the
projected growth in GDP, and the blue bars the projected growth in
health spending. Unless something is done the current crisis in
social care and the NHS will get worse and worse.
This increase in
spending should be permanent and financed by a permanent increase in taxes. As such a specific tax funded
increase in spending would be popular,
it seems sensible to do it that way. Given the current crisis in the NHS, if this is not done in the
budget we either have to downgrade our assessment of the morality of
our current rulers still further,
or assume they really do have an ulterior motive in running the NHS into the ground.
What would be the
macroeconomic effect of such a policy change? You might expect a permanent
tax financed increase in spending to have no effect. Taxes would rise
by an equal amount to the extra government spending, and knowing this
was permanent consumers would reduce their spending by the full
amount of the tax cut. So private spending falls to offset additional
public spending.
There are two
reasons for thinking that would not be the full story. First,
consumers initially appear
not to fully adjust consumption to a tax change, even when that tax
change is perceived as permanent. This is quite rational if they hold
precautionary savings, and wish these savings to adjust to be a constant share of post-tax
income. As a result there might be a short term boost to activity
from a tax financed spending increase. This could be amplified, of
course, if the tax increase was delayed for a year or two. As
interest rates are still at their lower bound, such a boost to
activity would be welcome.
Second, spending on
health care is likely to be less import intensive than the private
consumption spending it replaces. This would give a permanent boost
to GDP and permanently reduce the current account deficit. Now both
these effects might lead to an offsetting exchange rate appreciation, but the consequent reduction in inflation and
boost to real incomes that this appreciation brings would not be
unwelcome given the impact of Brexit.
Three final points
that I hope are obvious. First these beneficial macro effects are
incidental in the sense they are not required to justify the spending
increase. The case for additional spending on health care financed by
higher taxes is overwhelming on its own terms. Second, this is
additional to the large increase in public investment, financed by
borrowing, that should be underway right now. The changes in this
direction in the Autumn Statement were
an order of magnitude too small. Third, the second biggest threat to
the NHS right now after lack of money are staff shortages. As an important source of staff is the EU, the government seems to be doing everything
it can
to make things more difficult.