Following the money

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He might twist and turn a little on the issue, but there’s no real doubt that Farage wants to move from an NHS funded out of taxes to one funded more by insurance. He knows, though, that the NHS ideal of services being free at the point at which they are required is popular, and he’s obviously finding it difficult to find a form of words which means that would still be true as well as meaning that those who can afford to pay for insurance will do so. 

It isn’t just a Farage thing, either. There are plenty of Tories as well as an increasing number of Labour politicians who seem to be thinking along similar lines, with they key phrase always being about ‘those who can afford to…’. A system of health care based on the most well-off paying more than the poorest sounds hard to argue against – but what advocates of such an approach want us to forget is that that’s exactly what we have now. Health care is free for all, funded by tax and National Insurance, and those who earn the most pay the most. In principle, there’s no necessary difference between the two models. In principle, it shouldn’t matter which model we use, so why are they so keen to change?

Ultimately, there are several reasons, none of which they are particularly explicit about.

The first two are purely ideological: they have an almost pathological hatred of taxation, the state, and the whole idea that the state should be doing anything. Handing over the NHS to the management of a network of private providers and private insurance companies is, in their eyes, axiomatically better. That leads us on to the second reason, which is almost a corollary: they believe that all economic activity (and whilst ‘economic activity’ isn’t the first description of the NHS which springs to mind for many of us, the NHS is actually a significant part of the UK economy) should be profit-generating.

There are also two probable consequences of an insurance-based system along the lines that they are suggesting. They are both features rather than bugs. The first is that the target group for paying more is rather larger than the wealthy few who might be more easily targeted by a more progressive tax system. What might be called the ‘middle earners’ are the ones who would end up paying more. They might be ‘able’ to afford it, although it is always and inevitably the case that people paying more for one thing end up with less disposable income to spend on other things. That is the price they would pay for having a more reliable and available health service. The second is that we would end up with a two-tier health system. The UK, allegedly, cannot afford to improve the NHS for all, but a system of private providers available only to those paying for insurance would provide a better service than the residual NHS which would continue to exist to serve those who could not afford, or choose not, to pay for insurance. It is, after all, that belief that they will get a better or faster service that drives many to pay for private insurance currently.

The ‘winners’ from the alternative system would be those owning the shares in the companies guaranteed to make a handsome profit; there is a group in the middle who would lose financially but probably gain in terms of an improved service; the ‘losers’ will be those who are thrown back on an inadequate public NHS, getting a second-class service – typically, the poorest and the lowest earners. It’s obvious why the first of those three groups would see this as being in their personal interest. They will be a reliable source of donations for any party promoting such a policy. Those in the second group would have to weigh up the pros and cons rather more carefully; some would favour it, others less so. But the target electoral group for Farage and his gang is actually the third group. His reluctance to spell things out starts to look entirely rational.