Health is a right, not a reward for being born in the right place

Forget the inaccurate, hate-filled xenophobia - here's why we should treat migrants without extra charge.

Alex Langford
31 December 2013

Don’t let the Daily Mail fool you. The vast majority of migrants work hard and pay tax. On average, they actually put 34% more into our economy than they take out, roughly £22 billion a year – compared with native Britons who contribute 11% less than the amount they take out. They fill vital holes in our workforce including, ironically, more than 4,500 nursing positions each year. Recent immigrants are 21% less likely to be receiving benefits than native Britons, and because they tend to be young and fit (and less well linked in with GPs) they access healthcare less frequently.

True “health tourism” – people who visit the UK only to access free medical care – doesn’t cost us £2 billion a year. It costs us £70 million. As documented by The New Statesman amongst others earlier this year, that’s only 0.06% of the NHS budget. Jeremy Hunt’s transparent bending of that statistic made him look rather foolish in October, but I wouldn’t be surpised if he tried it on again. Smoking and alcohol, by the way, cost the NHS at least £3 billion a year each, and the recently abandoned NHS computer system has cost £10 billion so far – 140 times more than a year of health tourism.

So we’re not facing an oncoming army of begging, scrounging low-lives. We’re facing an influx of largely skilled people who are keen to work and contribute, with a smaller cohort of refugees. Of course, there will be exceptions – as indeed there are with “native” British people – but we’re thinking of making laws for a population here.

So if the reality that they mostly pay tax, work hard and cost fairly little isn’t enough to convince you – why else should we treat immigrants without extra charge?

Health is an inalienable human right. I’m not ashamed to say that I think healthcare should be free at the point of delivery, as Nye Bevan said. It shouldn’t matter if you’re rich or poor, if you’re black or white, if you’ve been here your whole life or for five minutes. We even treat murderers, thieves and rapists without a second thought because withholding healthcare is a punishment that no crime deserves, let alone the simple fact of having the wrong passport.

If someone is in the UK legally, it becomes our duty to ensure they receive this most basic human right using the fair methods we already have in place – taxation according to income and provision according to need. If we aren’t comfortable with that, we shouldn’t allow the person in.

If they are residing in the country illegally, proper legal proceedings should begin and healthcare should be given freely during this time. This is a civilised country that doesn’t make people choose between their health and a large debt, and I’m proud of it. Simply because other countries make their citizens pay for the misfortune of becoming ill doesn’t mean we should do the same when they arrive here.

Charging them would rip our society to pieces. Like we’ve already mentioned, a large proportion of people who live in Britain are migrants. To tell them that they can come over here, work to keep this country economically active and raise their families, but still have to pay extra to remain healthy, would force a racial divide through society which would be catastrophic.

Either we’re happy to let them in and treat them as equals, or we don’t let them in at all. There should be no half-measure of letting someone in but denying them fair healthcare.

Imagining checking to see how “entitled” someone is to something as essential as healthcare conjures up deeply unsettling feelings in me.

It’s for our own good. Not just simple things like vaccinating migrants against diseases that could become epidemics and kill a lot of British people, like TB and measles. If you don’t treat people early, they get sicker – sick to the point where you can’t deny them help because they’re on death’s door. And that costs way more. Some will go to unscrupulous back-street quacks, and dealing with the complications of that will make things even trickier. Refusing to treat drug addiction will lead to increased crime and unemployment. Not surprisingly, healthy people work more and pay more tax.

Even people who don’t pay tax contribute in ways that aren’t immediately obvious. Tourists buy items high in tax like petrol, alcohol and cigarettes as well as ploughing their foreign money into hotels and restaurants. Students pay thousands of pounds in tutition fees.

Charging them would be a bureaucratic nightmare and cost a lot of money. We would need an entirely new database to check and re-check immigration statuses (and we know how slick our governments have been with bringing in new IT). The database would need to link in with a system of ID cards, which would need to be applied for and distributed. Everyone would need an ID card, including UK citizens to tell us apart. Staff would need to be hired to design and implement this system and manage payments at a local and central level. It would cost far, far more than it would save, especially as if we decided to charge only those who weren’t contributing, we’d be targeting the very people who are least likely to be able to pay anyway. Faced with a choice between spending money on treating people or on building a system to stop them being treated, I’d go with the former.

Charging them would be the first stop to privatisation. First we’d make migrants pay, then another seemingly less deserving portion of society, then another. Until healthcare is entirely paid for in addition to our taxes, with the excess ending up in the pockets of someone already far richer than you or I. We must keep a completely zero-tolerance policy on this.

So that’s my opinion on the matter. The act of letting someone into this country, as a working person, tourist or refugee, should be an acknowledgement of our duty to provide that person with healthcare costing no more than the contribution that is expected from ourselves. If someone is here illegally, we should care for them humanely until the matter can be resolved, because health is a right, not a reward for being born in the right place or having enough money to afford it.

I am a doctor. I am trained to keep people healthy, not judge who should be.


This article is cross-posted from The Psychiatry SHO with thanks.

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