In Place of Fear

An extract from the fifth chapter, In Place of Fear, of Nye Bevan’s book of essays, published in 1952, has been circulating on the internet. I’m taking the liberty of posting it here because it addresses directly (and more cogently than modern politicians seem to be able to manage) the importance of the “civilising principle” behind the National Health Service – that nobody should be denied medical assistance because they can’t afford it. As Bevan himself puts it:

Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide. But private charity and endowment, although inescapably essential at one time, cannot meet the cost of all this. If the job is to be done, the state must accept financial responsibility.

Part of this essay could have been written in 2013 rather than 1952, in response to government proposals that “foreigners” or “migrants” (or, as I prefer to call them, “people”) should be denied treatment on the NHS unless they can prove their entitlement. Bevan deals with this suggestion very well, but I think there is a point that he missed. Even if you accept that foreign visitors should be denied access to the NHS on grounds that they don’t contribute by taxation (which of course they do as soon as they buy anything that attracts VAT or earn wages in the UK), then logically you should also ban the unemployed, students, etc from access to free health care. I like to think that as a nation we wouldn’t countenance this, so why do pick out foreign visitors in this way? The answer is, of course, pure xenophobia – the lowest common denominator of British politics now as it was then..

Here is the nub of Bevan’s argument about visitors:

One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together. The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of £399,000,000, the total cost of the Health Service. It is not difficult to arrive at an approximate estimate. All we have to do is look up the number of visitors to Great Britain during one year and assume they would make the same use of the Health Service as a similar number of Britishers. Divide the total cost of the Service by the population and you get the answer. I had the estimate taken out and it amounted to about £200,000 a year. Obviously this is an overestimate because people who go for holidays are not likely to need a doctor’s attention as much as others. However, there it is. for what it is worth and you will see it does not justify the fuss that has been made about it.

The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine.

The numbers quoted above are very interesting. The current NHS budget for England is just a shade under £100 billion (c.f. £400 million in the 50s). The estimated current cost to the NHS of treating visitors is (possibly) as high £500 million, ie around 0.5% of the total budget. That’s a larger proportion (by about a factor 10) than in the 50s, presumably because international travel is far easier nowadays, but since migrant workers contribute a net £25 billion to the UK economy it’s hardly excessive. Indeed, the NHS itself could not function at all without the thousands of doctors and nurses who come from other countries to work in it. Neither would our university system, as a matter of fact.

It’s about time some of our politicians had the guts to stand up against the growing tide of foreigner-bashing. The one problem this country has with immigration is that there isn’t enough of it.

Anyway, my New Year message to any potential visitors to these shores, whether they be Bulgarians or Romanians or any other citizens of this planet, is a great big Welcome. And if you get ill while you’re here we’ll look after you. Because we’re like that. At least, I hope we are.

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