My water bill contains the suggestion that I have a meter installed so that I can pay for the water I use.  This, is states, is “fairer”.

I am reminded of a scene in Anne Fine’s novel “Taking the Devil’s Advice” in which children are squabbling over how to share a cake and their father suggests using age as the criterion.  This seems reasonable to the children and to be based upon something quantifiable and objective, so they consent – whereupon, with three adults in the room, the young children end up with tiny slivers. And in tears.  “Fairness” is a not a simple concept.  It may be easy to define in the abstract but it is fiendishly difficult to employ.  Different matrices produce very different results.

The suggestion that we should each pay for what we use sounds eminently reasonable.   “Paying your own way” sounds great.  Putting in as much as you take out from life.  That feels proportionate and fair.  But how can we quantify this? What matrix can we use?  On some important scales, many of us are already recipients of so much more than we can ever give back:  our circumstances accidentally surround us with plenitude.  I am surrounded by luxury, none of which is of my own doing.    The luxury of having kind, committed, loving parents.  Of having a good education, a free higher education.  Of shortsightedness being a problem easily dealt with.  Of plentiful food and water.  Of good hygiene.  Of birth control.  Of relative political stability.   Upon what metric can you start to compute the value of all these comforting, supportive, lucky circumstances – many an accident of when and where I was born and which create circumstances which make it easier,  make it possible, for me to work, to engage in society, to contribute?  How can I possibly pretend to “pay my own way” having been born already in debt, as it were, to this degree?  My life is already grossly unfair.

Good health is one of the greatest luxuries.  I strongly believe that paying for health and social care cannot, and must not, be linked to individual use, either at point of delivery or over a lifetime. Indeed, there is a simple paradox:  the need for healthcare is – generally – inverse to the immediate ability to pay for it.  As individuals, if we are lucky (that word again) and live largely healthy lives, that means our times of greatest medical need have been when we were very young, and will be when we are very old: precisely those times when we are contributing least financially.

However rich they may be, no-one wants to pay for their own healthcare, simply because no-one wants to need it.  No-one wants to be ill.  Being ill is painful, frightening, stressful, miserable.  We would pay to avoid it. And we certainly don’t want to be worried about paying for it during the times when do need it.   I wish we could just see it like that.  I wish the politicians would present it like that:  celebrate paying the taxes for our NHS because when we are paying for it, we are not using it.    We are healthy enough to be working.  Paying more towards healthcare than you ever actually use?  Of course it’s unfair.  And we should rejoice, we should be so grateful, if we suffer from that unfairness:  it’s a sign of an undeservedly, lucky, healthy life.  Priceless health.