The Nationalistic Health Service

Matthew and I are having a jolly good conversation about Healthcare. It's raised a rather fundamental problem I have with the NHS, and thought it worth mentioning in a seperate post.

The NHS fosters Nationalism.

Personally, I think healthcare provision tied to personal policies (as opposed to a socialized system) is equitable. It is fair, since we're not subsidizing the behaviour of others, and fair to the poor, since it'll be cheaper and of higher quality. This last point may sound a little sweeping, but rests on the assumptions that money will be spent more wisely, and that there'd be greater rewards for innovation. Hence a system of price being tied to usage.

Some people overestimate the number of poor, destitute, and ignorant citizens, and claim that a socialized system is the only way to ensure provision for all. Rather than a price tied to usage, they therefore advocate a system of income redistribution.

Of course the socialized system will inevitabley create the very people it's supposed to help, because when usage isn't tied to price people will overconsume. Smoking, alcoholism, obesity and countless other dangerous conditions are subsidized by the NHS, creating the very type of person the lefties claim that need an NHS! It's a vicious circle, and poor logic.

Hopefully a gradual system where private insurance makes the NHS unsustainable will help the vulnerable. But lets be clear about where they came from, and who's funding them.

So, I accept that the vulnerable exist, and hope Matthew accepts that subsidizing unhealthy behaviour might not be the best way to reduce their number.

But my question to Matthew is this: If you think the NHS is valid on the grounds that it redistributes income (and the gains from this function outweigh the gains from a system where the user pays), why should we only be helping British people?

Before I get accused of living in an Ivory Tower, and not understanding real poverty in Britain, let me make one small point: no English person has had greater experience of deprived social conditions, combined with exposure to good economics than me.*

There are no people currently living in England who face worse standards of healthcare and lower opportunties to prosper than the vast majority of the African continent. Although incapacity is a serious issue, if you are an English citizen capable of action, then you can afford to live a nutritious life.

This is not true in other countries, where deprivity is absolute, and not relative. The problem is not that some people have less than others, it's that they have nothing. So if the NHS is to be judged fondly on account of it's redictribution of income, then instead of redistributing from middle-class to working-class, why not take from the rich, and give to the poor?

To argue for a British NHS, (and the NHS is a service for British citizens), implies that "we" have a responsibility to help those living among us that doesn't extend to foreigners. Surely income redistribution would be higher if we introduced a private health insurance program in this country, maintained the same level of taxation, and sent the money raised to fund hospitals in the developing world?

I geniunely believe that private insurance is a better model to deliver affordable healthcare to the poor. But if you disagree, why should we value the lives of relatively wealthy British people above the lives of desperately poor Africans? Surely the only reason is that "we're British" - i.e. nationalism.

The point I wish to make is this. If redistribution is your goal, then why should we be redistributing to British people? Personally, I can foresee prosperity without social transfers. But if we have to have social transfers, then at least have the integrity to think in global, humanist terms.

---

* I don't mean to divert attention to arguing this point... my basis is having worked for over a year in one of the poorest constituencies in the UK; and been taught economics at graduate level in a department with multiple Nobel Prize winners, with Mises on the syllabus. If you know of anyone else who can make this claim, i'll withdraw it.

Comments

[Thomas Conolly]

But if you disagree, why should we value the lives of relatively wealthy British people above the lives of desperately poor Africans? Surely the only reason is that "we're British" - i.e. nationalism.

I'm not sure that this is true. Is it perhaps the case that the NHS is not in place to provide service for the British, but rather for those 'living in Britain', and this seems to be a little different. As a British citizen living in Japan, i had to pay for private medical treatment, but a Japanese national at a British university could presumably visit their nearest A&E free of charge.
The point being (though it may be based on false information) that people support each other not because they share the same nationality but because they have to share a country and hence lives affect each other and circumstances intertwine. The health of those living amoung us, british or not, may have a direct influence on our own lives that the health of an African may not. So the rationale behind a national health service seems more about the useful aspects of helping those we live rather than with than any instictive 'nationalism'.

[TC]

2nd paragraph, line 9 - I meant 'among', not 'amoung'
line 11 - should read 'may not have'
line 12 - 'live with' or 'live among', your choice readers!

Is there a way to edit comments?

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