Paul Schnabel, head of the government’s social policy unit SCP, warns that the cost of health care is becoming unsustainable. The reason: our ageing population. The solution: use your home to pay for care. The Volkskrant interviewed him.

Titanic
Almost half of the health care budget is spent on the over 65s. This group with its greater health care needs is growing all the time. It’s a Titanic heading steadily towards an iceberg, the paper writes. The government is predicting a 100 % increase of the budget by 2040, from 20 to 40%.
This week, the health care budget is going to be the subject of discussion in parliament.
Expensive
‘Health care is labour intensive and capital intensive. Things like computers get cheaper and better over time but health care doesn’t. We’re still fighting 19th century infectious diseases and the list is only getting longer. People don’t realise how expensive health care is. We’re spending 10% on defence. Running a teaching hospital for ten months would use up the whole culture budget’, Schnabel says.
Schnabel says that, essentially, health care is care for the elderly: ’15 percent of people are over 65 and their health care needs take up 43% of the budget. The cost of care increases sharply once people are over 75 and need home care and then round the clock nursing. 1.5% is over 85. They represent 12% of the budget. More over 65s means higher overall health care costs. If this is allowed to happen the budget on education or defence could be affected.’
Solidarity
This government wants to slow down the growth of health care expenditure but even as it does so, Schnabel thinks it is inevitable that people will have to pay more for health care. ‘You can safely say that the contribution for AWBZ services like home care will go up. My mother lives in a care home and pays €1,700 a month while her neighbour who only has a pension pays much less. It’s called solidarity, mother, I tell her. These contributions could go up to €2,200. The government is not keen to mention these amounts.’
Sell home
Schnabel’s own solution to the gathering health care crisis is for people to use their homes as health care collateral. ‘Home owners could use part of the value of the house to finance health care while continuing to live in the house. We are wedded to the idea that a house should be inherited by the children, tax free. But those children will be around 60 when their parents die an won’t need the money. Moreover, part of the house was financed by the community through mortgage relief tax.’
According to Schnabel the measures may look too controversial to ever be proposed by a politician wanting to be re-elected but ‘sooner or later it will be acceptable to talk about selling your house to a bank or pension fund to finance your own care.’