Immigrant poster

Image: Joint Council for the Welfare of Immigrants.

When news was announced last week that the government was introducing a new NHS surcharge for incoming migrants, I saw several friends posting about it with the usual tutting “isn’t this terrible” comments, as though the main problem was the further plight of the poor beleaguered immigrants, the least of these in our society, etc.

Which is a point, sure.  Having an extra layer of bureaucracy and a further £150 or £200 tacked on to an already expensive and time-consuming visa application process is a hardship.  However, it misses the much more fundamental problem, which is that this policy is the thin end of the wedge that would end free-at-point-of-use NHS healthcare altogether.

This move is blatantly ideological.

If the worry were truly budgetary, the government could simply have raised the fees on visa applications. This would actually bring more money in for the NHS, since it would remove the bureaucracy costs of processing an entire separate fee, on another website, with all of the attendant costs of having human beings explain the inevitable confusion, rewrite and reformat all of their forms, and so on — compared to which, the work that would go into changing the digits of a single number, even across all of their forms, is trifling.  The government could even make exactly the same claims to garner popular support: “We’ve raised visa fees by £150 to £200, so that immigrants are making a fair contribution to their NHS care!”

That they have instead chosen to go with the more expensive option of making the new fee explicitly about paying for said care, they show that what they really care about is changing the culture and perception of the NHS, from a service that is and should be free for all users, to one that people should have to pay to use, directly rather than only through taxation.

After all, to an American, at least, £150 or £200 for two to five years of health insurance looks like an absolute bargain. And that is the point, the ultimate goal of this sort of policy change.

With all the background-privatisation, budgetary neglect, and general financial dickery the Tories have perpetrated over the last five years — continuing, let’s not forget, on the same trajectory started by Labour, who were themselves merely carrying on the Thatcher/Reagan neoliberal “consensus” that absolutely every service ought to be operated by or like a private, profit-making company — the head of the BMA has already stated worries that the next government will introduce charges for the NHS even without reference to the new charges being made to immigrants.

This does not seem quite politically feasible just yet.

On Thursday night’s leaders debate, even old-fashioned novelty racist Nigel Farage felt the need to emphasise that it ought remain free at point of use (although you could point out that the fact that that question even appears to be on the table is itself evidence of the degree of slippage that has already occurred).

But in a few years’ time, after what we can only assume will be a few more years of neoliberal austerity, with privatisation driving up costs and UKIP’s constant scaremongering about immigrants having been answered by explicitly charging immigrants to use the NHS, and everybody having got used to the idea of some people being explicitly charged for it — how will it look then?

  • This article was reposted with permission from here where it first appeared on 4th April 2015.