How can UBI be designed for health impact?

Because UBI has been advanced most keenly by economists, trials have often been designed specifically with effects on economic outcome variables, such as employment, consumption and growth in mind (see Kangas, et al. 2019). However, designing schemes to achieve health and wellbeing impact requires a different set of considerations. This part of the project creates draft legislation for three possible UBI schemes by completing the following tasks:

First, we determine sensible minima of payment to promote health impact. We examine the epidemiological literature relating to conditional and unconditional transfer schemes to establish the effect of payments of different sizes and regularities on the determinants of health. We consider the Joseph Rowntree Foundation’s Minimum Income Standard (MIS) and the Living Wage’s calculations to determine a ‘basic’ level and evaluate the different UK welfare configurations that may lead toward that income.

Second, we examine means of satisfying additional needs faced by virtue of disability, age and access to housing (Hirsch 2019, 4). These needs are affected by UBI’s replacing conditional welfare schemes (DPAC 2019, 9), such as Universal Credit. Stewart Lansley (SL) and Howard Reed (HR) have already assessed additional payments by age and housing within their Tax Transfer Model (TTM). These are examined further within the costing framework we produce in answering whether UBI is affordable.

It is essential that disabled people have a prominent role in the project because: 1) they are often subject to particular health needs and effects in relation to social policy (Johnson & Spring 2018); 2) Scope found that disabled adults face additional costs of £583 per month to have the same standard of living as their non-disabled peers (John, Thomas & Touchet 2019); 3) they are key stakeholders of any welfare policy, comprising approximately 21% of the population in 2018/19 (Department for Work and Pensions 2020, Table 4.2); 4) there is significant intersectionality between disabled people, people with long-term and multiple health conditions (including stress-related conditions (Rhode 2012)), people with lower socioeconomic status (SES) and older people (Activity Alliance and IFF Research 2020, 118-123) and 5) they have the necessary lived experience by which to develop appropriate policy responses.

We examine three options: retention of separate needs-based benefits (Lansley and Reed 2019, 10; Stirling and Arnold 2019); supplementation within a UBI transfer (Standing 2019, 36) and replacement with goods and services, as in Labour’s (2019) proposal for a Social Care Service. Developing these options requires concern for arbitrary discrimination in assessment (see Pybus, et al. 2019), harm caused to disabled people by conditionality (Johnson & Spring 2018), perverse incentives for health-diminishing behaviour in needs-based allocations (Johnson, Degerman and Geyer 2019) and the importance of autonomy to wellbeing (see Nussbaum 1999; Disability Rights UK 2014). We review the existing disability rights literature on ‘good practice’ approaches to satisfying additional needs to develop possible formulations for a UK context. We conduct a mixed methods study involving disabled people and disabled people’s organisations. Building on previous work for Activity Alliance (Johnson & Spring 2018) and with Daniel Nettle (Johnson & Nettle 2020), we design a survey eliciting quantitative and qualitative data in consultation with representatives of disabled people’s organisations. This survey is used to refine further the three specific (retention, supplementation and replacement) schemes and inform further stages of the study. These options are presented for consultation in the form of semi-structured interviews with partners. Finally, we facilitate four online focus groups, with alternative accessible options if requested, using an ORID (‘Objective’, ‘Reflective’, ‘Interpretive’, and ‘Decisional’) method with groups of 8 disabled people controlled for age, ethnicity, gender, SES and impairment type. The findings are used to refine the three options further and identify a preference. This informs design of three possible UBI schemes: i) a starter scheme that would supplement existing benefits and would not require additional funding; ii) an intermediate scheme that would reform existing needs-based benefits and require additional funding; iii) a ‘big bang’ scheme grounded in the MIS that would replace all benefits. The findings are examined in consultation with project partners. These inform calculations in answering whether UBI is affordable.

Third, having already argued that UBI for public health may serve controversially as an arm of moral perfectionism (Johnson & Johnson 2020), given its commitment to perfecting objective human qualities, we consider how people’s health needs for income ought to be weighed against other social interests. This work in ethics examines perfectionist and capabilities approaches to upholding different socio-economic interests around UBI, considering, in particular, conditions attached to receipt, such as those suggested by Atkinson (1996, 68-9), which include ‘participation in the labour market, including through entrepreneurship, education, training, voluntary work or caring’.

Fourth, we consider ethical and legal issues related to the policy, presenting institutionalisations for each of the schemes within specific UK conditions. The final two tasks inform our assessment of whether UBI is politically viable.