The Tory plan to charge migrants for NHS treatment has rightly come under fire for a couple of reasons: that it’s directed at an invented non-issue because it will probably cost more money than it will save, and because it will change the doctor-patient relation in an insidious way by asking doctors to police their patients. However I haven’t seen anyone has highlighted the possibility that the charges are part of the NHS privatisation agenda.
The single fig-leaf that the Tories used to disguise their massive privatisation of the NHS was that it would remain “free at the point of use”. Even though you could be treated by a private healthcare provider, commissioned by a GP consortium run as a business, they claim that because this is all being done with taxpayers money and you don’t have to pay anything upfront it’s OK, and not really privatisation at all.
This plan changes that – for the first time patients will not get their treatment free at the point of use. A charging system and the infrastructure and bureaucracy for it will need to be built into the NHS – every site of treatment will also need to incorporate a cashier. All patients will need to be divided into the deserving, who will get free care, and the undeserving, who will have to pay.
Can you see where this is going? Once all of this is in place, it will be very simple for future governments to widen the circle of the undeserving and shrink the circle of the deserving. I wouldn’t expect anything before the next election, but I bet in the next parliament some Tory think-tanks start talking about widening charges for easy targets: the long-term unemployed, binge drinkers, drug users or the morbidly obese. We could then see something of this sort in the Tory manifesto for 2020. After that, it would be a feasible step to a full-scale reorganisation where only people who have paid enough national insurance get free healthcare, turning it into actual nationalised health insurance. Obviously this health insurance system could then be privatised with no meaningful public opposition, just like the Royal Mail is being now.
The Lansley reforms were the end of the NHS as a publicly owned universal provider of healthcare, and were clearly intended to see it incrementally phased out from providing healthcare at all. The charges for immigrants are the end of the right to free healthcare for all British residents. What I’ve described above are a series of politically feasible steps to get completely get rid of the NHS in our lifetimes. It’s speculation, but it’s important to see that the first two steps are the most politically difficult – destroying the founding principles of the NHS.
One of these steps has already happened, the other is being put forward as government policy RIGHT NOW in a way that will make it very difficult to oppose. In fact it probably has significant public support, because it’s bashing immigrants. What I’m describing is a long game, with plausible deniability at every stage for the politicians implementing it. However, if you think that some people in the Tory party don’t imagine precisely this as a long-term political goal, you’re an idiot. If you don’t think that the Tory party is capable of this, you’ve not been paying attention.