How history shaped our health taxes

“History casts a long shadow,” says Paul Johnson. Just as the modern A1 largely follows the route of the old Roman road, so the current social care “mess” can be traced back to the National Assistance Act of 1946, the legislation that established the NHS and claimed to abolish the “infamously stringent” poor law (which put the poor in workhouses). However, it “didn’t quite”, since, unlike the NHS, social care remains needs and meanstested. As for the NHS, it exists in its current form because it was originally paid for by general taxation, despite evidence that other European systems, paid for through a system of social insurance, work “just as well, if not better”. Taxes also have their histories. National insurance contributions, introduced in 1911, were referred to as “the stamp” after the stamp cards that “recorded flat-rate contributions on the basis of which entitlement to flat-rate benefits were earned”. That relationship no longer exists, yet the “folk memory “lingers and it is why NI remains a “relatively popular” tax. Ultimately, however, our social care is the “unfinished business of 1946 and the direct descendant of the poor law of 1834”. And if “you want a rational system for tax, welfare and public spending, best not to start from here”.