In 2016, Britain voted to leave the EU by the narrowest of margins. One of the main factors was immigration, which comes first or second in the list of reasons for voting leave, depending on who you ask. Membership of the EU was a marginal issue for years, until campaigners began to highlight the connection with immigration.
We can peel back another layer by asking why people oppose EU immigration, something that various polls have done. The main reason is that people see immigration as putting pressure on public services, particularly the benefits system and the National Health Service. The NHS is very important to us, regularly mentioned as the top political concern for voters. And many perceive immigration as bad for the NHS.
We could debate whether or not that concern is legitimate or not*, but it’s a bit late for that. The point is that many people voted to leave the EU because of immigration, and the main concern about immigration is the effect on the NHS. The NHS is hugely valued and we want to protect it.
It is therefore a horrible irony that Brexit presents a huge threat to the NHS. Why? Because many of the people in charge of implementing Brexit have different priorities from those who voted for it. Talk about immigration and sovereignty might come up on the campaign trail, but the dominant political philosophy in the hard Brexit camp is one of free markets, low taxes and small government. In such a context, the NHS is a burden and ripe for privatisation.
Once Britain leaves the EU, we will have to negotiate our own trade deals. We will do so as a junior partner, with countries such as China or the US in a strong position. If the US wants access to the NHS, it will ask for it and we may not have much of a choice. We will need that trade deal more than America does.
This is an open secret. The Initiative for Free Trade published a report on US-UK trade, co-written by Brexit architect Daniel Hannan, that suggested “health services are an area where both sides would benefit from openness to foreign competition”.
With President Trump in town this week and talking up trade deals, Theresa May has said the NHS will not be part of talks, but the US ambassador thinks they will be. Donald Trump has previously warned that he wants the NHS to pay higher drug prices, and will use trade talks to put ‘American patients first’.
Over the next couple of years we may find mounting pressure from the US to open the NHS to overseas competition. Depending on the outcome of the Conservative leadership election, there may be a prime minister who is happy to cooperate with that agenda, or one who is willing to push back. That decision will be made by Conservative party members and is out of our hands.
In trying to protect the NHS from immigrants, Britain may end up handing it to corporate interests instead.
*EU migrants tend to be younger and therefore use NHS services less than British citizens. They pay taxes, and Britain recoups costs from other countries in the EU for the healthcare it provides to their citizens.