Sunday, 2 December 2012

Portugal and the welfare state, step 1

A recent article in the Financial Times (Portugal grapples with cost of welfare state) addressed recent statements by the prime minister on the reforms in the public sector.
The starting point was the statement a couple of weeks by the minister of finance on the (apparent) difference between what people want to pay in taxes and the welfare state benefits they want.
The discussion on the role and size of the state and how it is funded (and not the components of the welfare state) is a much needed debate in Portugal. But it cannot be done until February or March if it is  supposed to include the views and desires of the Portuguese population and if its to go beyond cut expenditures across the board.
The challenge for the discussion is how to be cut in terms of what the Government does - not only the always-mentioned quest for efficiency in Government provision of services but also which ones are to be provided by the Government.
This goes beyond knowing which charges people should pay when using Government services. And forces the need for clarification of concepts and roles of Government spending. One the more common errors of perception, which is also present in the financial times article, is people saying they could afford to pay more for health care at point of use - meaning usually that people accept income-based payments at the point of use. Fine. But the mistake is that such charges are usually a very small portion of total funding required, user charges account for less then 2% of total funding needs in the National Health Service. Increasing user charges to cover say 20% would probably lead most people to complain about it. Even the largest single user charge, use of emergency room in central hospitals, is about 10% (or less) of average cost of such episode - this is 20€ user charge mentioned in the FT article. The second aspect of this mistake is conceptual - redistribution  should mainly be done at the funding level, not at the point of use. If there is some correlation between income and need of health care (use), then payments at the point of use according to income may help, but they also destroy the insurance value of protection against uncertainty of health care expenditures. And this role is neglected (wrongly) in most popular statements.
From other areas we are likely to face good arguments for Government intervention, meaning that a careful discussion needs to be made.
Recognizing the importance of this discussion the prime minister said that a baseline proposal for cuts will be provided by February but changes are possible until the Summer, before the next budget proposal is built. This is reasonable. Sets a default situation, and then it is up to the political forces and to society to improve on it. Being too assertive at this stage will not allow for a proper discussion. Let's hope the Portuguese people can do it.

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