Old age, as the ancient joke goes, is better than the alternative. But old age also comes with a hefty price tag. As we grow older, many of us will need help with basic tasks such as washing, dressing and cooking. And since more of us are living longer thanks to medical advances and improved health, this social care bill is getting steadily larger.
For more than a decade, politicians have been wrestling with the question of whether individuals or taxpayers should bear these costs. Andrew Dilnot, a respected economist who was asked to look into the issue by the Coalition, has come up with a fair answer. In his report, published yesterday, he proposes a greater contribution from both the state and individuals.
At present anyone with savings or assets (including property) worth more than £23,250 is entitled to means-tested state assistance for their social care needs. But anyone with wealth above this level is left to fend for themselves. Dilnot proposes to raise the threshold for assistance to £100,000, which would result in tens of thousands more people qualifying for help.
He also advocates a £35,000 cap on the amount that any individual should have to pay, over their lifetime, for social care. Any costs above that level would be met by the state. The attraction of such a cap is that it would provide individuals with clarity about the potential costs of their infirm old age. This should encourage people to save and also prompt the development of an insurance market for future social care costs.
So far, so generous. The sting in the tail is that the costs of accommodation in a care home, as opposed to the physical assistance, are not included in Dilnot's £35,000 cap. For "bed and board" Dilnot proposes a separate cap of £10,000 a year. Those who need residential care for many years could still, therefore, face substantial bills over a lifetime. But just as the state needs to pay more, so do individuals. What Dilnot suggests is as fair a way of sharing the burden as has yet been put forward. So what are the prospects for Dilnot's recommendations being enacted? There is always a danger that political parties will play politics with this hugely sensitive subject, as the Conservatives did before the last election when they cynically accused Labour of planning a "death tax" to pay for their own proposed reforms. But the offer of cross-party talks from the Labour leader, Ed Miliband, yesterday suggests that such a fate could be avoided this time.
A greater immediate obstacle is the projected £1.7bn annual cost of the reforms. The Government was less than enthusiastic in its reception for the Dilnot report yesterday. The suspicion is that that the Chancellor, George Osborne, whose obsession is eliminating the deficit, would like to kick social care reform to the far side of the next general election. That would be the wrong decision. When it comes to social care, reasons can always be found to put off the difficult day of reform. But each year of delay puts the system under greater strain and adds to the uncertainty of the frail elderly. The time for reform is not four years down the line but today.