There seem to be two arguments around which the EU referendum debate is revolving.
There is the trade debate, where the Remainers state that leaving the EU will mean that countries will stop doing business with the world’s fifth largest economy.
And then there is the immigration debate, where the Leavers state that this country is at the mercy of uncontrolled immigration as membership of the EU means that the UK has abolished restrictions on the number of citizens of EU countries that may arrive at our shores.
The difference between these two arguments is that the Remain argument is a prediction, the Leave argument is factually accurate. By population, London is the sixth-largest ‘French City‘ having more French people living in London than in Bordeaux, Nantes or Strasbourg. It may be racing up the league tables for other countries’ expatriates as well.
As I have written before, the pull of prosperity that is attracting this tide of immigration cannot but put strain on the NHS. It has been argued that the migrants are a net benefit to our economy, but this misses the point. The economic benefits of migration all happen after the migrant has arrived, and may take years to have a beneficial effect. However the migrant will need state services, such as health, education and housing immediately. It has also been argued that the NHS could not run without migrants. Well, these NHS workers would still come and work here if they were given priority in a points-based system
How does a government plan for the health requirements of a population when there is uncontrolled migration from the twenty seven other members of the European Union? Well, the planners will not only have to look at the current population of the United Kingdom, but also across the Europe. They will have to analyse the demographics of every country, plus the economic performance, quality of life and numerous other factors to be able to have a fighting chance of predicting the likely numbers of people that will quit those countries to come and live and work here and to use our services. This is a difficult challenge, made even harder if the planner cannot necessarily rely on the statistics put out by the other European governments. It may even be impossible.
The NHS cannot provide its services if it does not plan for them. It cannot plan for them if it cannot predict the numbers that will use them. It cannot predict the usage numbers if it has no method of knowing population growth. And there is no method of knowing population growth if there is uncontrolled immigration.
A service designed to provide one hundred per cent of the needs of a given population number will provide a lower quality of service if that number increases unexpectedly. The quality of service will decline in direct proportion to the unplanned-for population increase.
It is not possible to assemble the large pile of cash caused by the boost to the economy by migration and have it spontaneously turn into a medical professional.
The migrant arriving on our shores today needs to have the availability of a medical professional planned years before they leave their country. Indeed, we may need to start training the doctor required to attend to the migrant well before they have even made the decision to migrate.
Leaving the EU would mean that population growth would be better understood. A points system would mean that medical professionals could be fast-tracked into this country while keeping demand at a manageable level. We could still have an NHS providing a universal health service free at the point of need.
Remaining in the EU may force this to change.
There is an alternative to a health service run on the principles of statism. It is called capitalism.
Capitalism has been proved to be able to react to demand for goods and services much better than state socialism, to the point at which communist countries had to imprison their own populations and murder them if they tried to escape. However to do this, capitalism has to have a surplus of capacity. There is slack in capitalist enterprises which is there for the express purpose of catering for rises in demand to maximise market share and profits. Any loss for this slack is factored into the overall cost of providing the product or service.
For example, if the burger buns for my weekend barbecue are sold out in my branch of Aldi, I may try Tesco or Sainsbury’s instead. The aggregate of providers will always have stock in excess of aggregate demand. This promotes competition for the best offer to the consumer. The consequence is that there is a direct financial relationship between provider and consumer. There is literally a price to be paid. And this price is based on the demand, as well as the quality. Aldi would have sold out because it sells the cheapest burger buns. Tesco’s buns are available, but they cost more.
However, this kind of surplus of provision is impossible in the NHS for political reasons and because it would be too expensive. Any capacity surplus means that the service is not being run on a value-for-money basis. People will ask why some services are being unused when there are waiting times for other services. To be told that the services are there to cater for an immigration-led demand that has not materialised would be politically unacceptable. So there has to be shortages.
A contribution-based service based on compulsory health insurance would be better at managing demand as well as ensuring resources are available, as it would allow those health services a source of income other than taxation. This would require the private sector to play a greater part in the provision of health services, and would increase capacity to be able to meet unpredictable demand. Competition would mean there would be surplus, but the financial burden would be on the private sector and not the taxpayer. This is the system that is in use in France, Germany and Poland. But it does meant that people will have to start paying for health services that were previously free here for seven decades. With uncontrolled demand, a free service may be an unaffordable luxury.
This would be sold to the British public as a necessity for the improvement of health services as well as increasing their availability, but the price would be that these services would no longer be free. Keeping the NHS could be shown to be an ideological anachronism, valid in 1945 when so many people lived at subsistence levels in unimproved or bomb-damaged housing in a country verging on bankruptcy without American cash, but obsolete in the 21st century where deprivation and absolute poverty have been abolished in the UK and the national finances have been improved. Obesity is a greater problem in the UK than vitamin deficiency.
The Labour Party, campaigning on a platform to nationalise the health insurance companies, may find itself unable to do so in government as this would fall foul of EU competition law or find itself hamstrung by legal cases having to go all the way to the European Courts. So remaining in the EU may result in the partial or total privatisation of the NHS and may prevent it being renationalised. Labour may see leaving the EU as the only way to restore the NHS. But the voters may not agree. The EU may be seen as more important than the NHS. Seizing the health services would be illegal and a sign of arbitrary government.
Why is this concept not being more publicised? It is not in a pro-EU Labour’s interest to promote the consequence of uncontrolled immigration, when they trade heavily on being the ‘party of the NHS’. The Conservatives see any hint of NHS privatisation as a vote-destroyer for their party as it validates Labours oft-repeated accusations. So this may be the dirty secret of the referendum campaign. There may be a political truce over this.
Remaining in the EU may involve harmonisation of heath services to a European standard, which will result in people having to open their wallets every time they visit the doctor.
Labour voters may therefore have less than 48 hours to save the NHS, as they know and love it, by voting Leave this Thursday.
(Image: Erlebnis Europa)