The expectation(s) of solidarity: Matters of justice, responsibility and identity in the reconstruction of the health care system

We analyse solidarity as a mixture of social justice on the one hand and a set of cultural values and ascriptions on the other hand. The latter defines the relevant sense of belonging together in a society. From a short analysis of the early stages of the Dutch welfare state, we conclude that social responsibility was originally based in religious and political associations. In the heyday of the welfare state, institutions such as sick funds, hospitals or nursing homes became financed collectively entirely and became accessible to people of all denominations. Solidarity was transformed in a more general category, related to the status of Dutch citizenship. Responsibility was transformed to collective responsibility. Financial pressures on the Welfare State have resulted in a debate on choices in health care and in a number of system reforms, so far relatively small. In the surrounding discourse, justice was linked to private responsibility. Both from government officials and from participants in the societal debate, moralistic overtones could be heard concerning the threat of overburdening of the health care system by citizens. In this paper, we develop a concept of reflexive solidarity that links elements of social justice to conceptualisations of responsibility that address policy makers and health care institutions as well as citizens, in their role of care receivers. A short analysis of the phenomenon of personal budgets in care services should prove that our concept of reflexive solidarity is not empty. Linked to, but beyond the concept of justice, issues of social responsibility can be addressed without moralistic overtones.