There’s not likely to be a groundswell of enthusiasm for the old cigar-smoking beer-swilling former Chancellor Kenneth Clarke’s idea of raising more revenue for the NHS by getting ‘wealthier people’ to pay means-tested charges for GP visits and hospital care.

His plan appears even to have upset the right wing Daily Mail, which headlined their report “Middle-class families could face ‘modest’ charges to see GP and have routine ops.”

It’s strange to see a Daily Mail reporter of all people point out that:

“The two-tier idea goes against the very founding principle of the health service, in that treatment should be provided free at the point of delivery for all, whatever their means.”

The Mail article also flags up the similar idea that has recently been raised and disowned in Scotland.

But it would have also raised the hackles of some core Tory voters and Mail readers, by comparing a possible charging system … to that now paid by immigrants working in Britain!

“A …  potential way to create a two-tier NHS would be to create a special tax that the wealthy could pay to access the health service if the need arose.

“England already has a such a system in place for immigrants coming to the UK which could be used as a model. Called the immigration health surcharge, this sees anyone who immigrates to the UK to live and work charged £624 per year plus £470 per year for any dependents under the age of 18.

“… The charges end when a person leaves or becomes eligible to remain in the UK permanently and they choose to do so.  Expanding such a scheme to Britons would be highly controversial to say the least.”

What the Mail does not ask is why would we want to even consider breaching two of the key founding principles of the NHS – its universality and its provision of clinical care fee at point of use – to raise more money, when it would be so much simpler just to make the tax system fairer and more inclusive by getting the wealthiest minority of billionaires, tax dodgers and super-rich to pay their share of tax? General taxation could also benefit other public services such as education, or even increase the miserable state pension.

Given that millions of people would not, at least at first, be paying the new NHS charges, to generate any significant contribution towards the £150bn-plus NHS budget they would have to be substantial – and therefore unpopular.

Clarke uses the analogy of prescription charges, which in England offer widespread exemptions, including means-testing to allow reduced costs for those on low incomes.

But prescription charges themselves are a classic example of a stupid way to raise money for health care – by creating a barrier for the poorest accessing the health care they need. It’s such a stupid system that in Wales, Scotland and Northern Ireland their devolved governments have scrapped prescription charges leaving only the English public still lumbered with them.

At the last count prescription charges, at £9.35 per item, paid on less than 10% of all prescriptions, raised just £615m towards a drugs budget of £11.5bn (less than 5 percent). It’s a barely measurable share of around £150bn annual spending on England’s NHS: and the damage that is done by deterring people on incomes just above the threshold to pay for their prescriptions could easily outweigh that.

Why have the Tories always been so fixated on taxing illness, and levying charges on the sick, even when it’s likely to be their own core supporters? That is the triumph of ideology over common sense.

The charges would not affect the super-rich, who only come near the NHS if they need emergency treatment or complex treatment beyond the limited means of the private sector. The less wealthy may opt simply to insure against having to pay for NHS treatment – but obviously if the aim is to raise significant sums from these charges the definition of ‘wealthy’ would have to be widened to include tens of millions of “middle class” people – and the Mail fears.

So what might start as apparently getting a few fat, rich people to stump up extra cash for the NHS would swiftly degenerate into a major erosion of the principle of providing care on the basis of need.

It would potentially detach millions of people from their loyalty and affection for the NHS and push them into the arms of grasping insurance companies, who would be given a brand new chance to make profits from health – without offering any services.

It’s important to recognise that the universal principle is a strength of the NHS: intelligent richer people know that without the NHS there is no emergency care, little if any maternity care, limited cancer care, and very limited mental health care.

Keeping the wealthy reliant upon and benefitting from the NHS is crucially important.

30 years ago Ken Clarke as Health Secretary gave us the internal market system and then soon afterwards as Chancellor he saddled the NHS with the excess costs of PFI. He has done too much damage already.

This proposal is as bad as the others: he should stick to playing his jazz.


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