"Choice and the Welfare State", by Professor Titmuss, is the third of a series of Fabian pamphlets concerned with what Professor Abel-Smith called, in the first of the series, "the ugly imbalance between private affluence and public squalor." The first two contributions showed how (in Abel- Smith's ably argued thesis) the projected and now forgotten National Plan falls far short of meeting the most elementary needs for growth in the welfare services, and how (in Peter Townsend's harrowing and definitive "Poverty, Socialism and Labour in Power") the incidence of poverty and deprivation was, far from diminishing, showing an alarming likelihood of becoming "wider instead of narrower ... during the term in office of the present Labour Government." Both are required reading for all serious socialists. This third essay is a little different in scope and significance, It consists of a brief discussion of four erronious notions, all of which have obtained a wide currency, ‘The first is that poverty can be overcome simply by economic growth, without redistribution, The second, that the "problem of discrimination and stigma" can be solved by private markets in welfare. The third, that consumer choice will be widened by reversion to market determination of standards and provision. Lastly, Professor Titmuss makes a detailed onslaught on the theory that "social services in kind, particularly medical care, have no characteristics which differentiate them from goods in the private market." Titmass shows that the assumption that growth alone would cure poverty, and, in Daniel Bell's hyper-spurious phrase, bring about the "end of ideology" into the bargain, has been decisively rebutted by American experience, "One is led to wonder", he says, "what liberal economists would have said 15 to 20 years ago had they foreknowledge of the growth in American wealth, and had they been asked to comment on the following facts for the year 1966: that one American child in four would be regarded as living in poverty, and three elderly persons in ten would also be living: in poverty .... that the U.S, would be moving towards a more unequal distribution of income, wealth and command-over-resources ..... that many grey areas would become ghettoes .... that a nationwide civil rights' challenge of expolsive magnitude would have to be faced - a challenge for freedom of choice, for the right ‘to work, for a non-rat infested home, for medical care and against stigma .... that, as a nation, the U.S. would be seriously short of doctors, scientists, teachers, social workers, welfare aids and professional workers .... and that American agencies. would be deliberately recruiting and organising the import of doctors, nurses and other categories of human capital from less affluent nations of the world," In comparing U.K. experience with this, Professor Titmuss points out that however badly we treat our immigrant doctors, at least we do not systematically recruit them from the underdeveloped countries, That may be: but it should be borne in mind that the Labour Government's measures for immigration control make it difficult for unskilled labourers to come here, whilst establishing a clear preference for trained personnel, Titmuss also uses evidence from U.S. experience to show that private markets in welfare, far from removing discrimination and stigma, fortify them, and he shows that the slogan "freedom of choice" is a hollow mockery
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Professor Titmuss Defends Welfare Principles continued in the whole area of privately imposed pension schemes agreed between employers and the insurance companies, The Government's proposals for transferability and full preservation of pension rights are still not public, Meantime, the car workers are sacked wholesale (as when BMC announced on 27th June that 6,000 employees would be sacked on 29th June) without any protection at all in this field. But it is when he comes to dissect the distinction between social services in kind, or goods in the private sector, that Titmuss scores most heavily. He takes a careful look at the Blood Transfusion services in Britain and New York. Using hitherto unpublished material, he shows how 150 separate agencies collecting blood on = commercial basis in New York completely fail to meet a chronic blood shortage, Every day operations have to be postponed, The derelicts of skid row become "professional donors", earning their livelihoods by retailing their blood at 10 to 25 aoltati or more a pint. This blood, six times more likely to be contaminated by hepatitis than that of voluritary or family donors, is pumped out of the victims, predominantly unemployed or unskilled workers, far too frequently for the good of their health. In Britain, people give blood freely, and it is distributed freely. There is enough. So much for the virtues of the market, which many more than Enoch Powell would be happy to bring home again across the Atlantic, These three Fabian pamphlets sketch out a basic argument in defence of Britain's welfare services. But it is clear that we need a fourth such pamphlet, to go over to the attack, and work out the claims which should be made by the welfare sector on areas which up to now are the sole unchallenged province of the market, Two sectors, at least, are obvious candidates: housing, which is a national disgrace, and public transport, which is the only cure for thrombosis on the roads. Free housing, free transport, will seem as necessary as free air to the people of the future. How long will Britain delay entering that future? Certainly for as long as is necessary to reverse the wholly reactionary priorities of the Wilson administration,- All three of these excellent but grim pamphlets are welcome as weapons in the struggle to do just that,