The NHS is the most emotive example of people free riding courtesy of the British taxpayer. Doctors say they are not border control officers, and they’re reluctant to ask people to confirm their identity… no doubt for free of being accused of racism. According to Full Fact, the independent fact checking body, the NHS loses £280 million a year on foreigners deliberately taking advantage of health tourism. Another £1.8 billion a year is spent on ‘normal’ foreign patients, of which only £500 million is thought to be recoverable.
The numbers do not even themselves out for Brits living abroad. There are more than twice as many EU citizens living here than Brits living in the EU. Most of those Brits identify themselves at the hospital; and the EU country claims its money back from our government whereas the same is not true the other way around. This is not acceptable; and Brexit is a perfect opportunity to sort it all out. There has to be a system where everyone coming into this country either has compulsory health insurance before they get off the plane; or their governments underwrite any health costs, as part of a visa waiver program. It’s not practical to ask hospitals to chase people halfway across the world to pay bills they probably can’t afford. But hospitals have to identify everyone using their services before or while they’re being treated, so we can check who is entitled to what.
National Entitlement Card
So, I think it’s time to introduce a National Entitlement Card that we all have to use in order to claim any public services… everything from claiming unemployment benefit to seeing your GP to using the local library. In 2006, Tony Blair tried to introduce a National Identity Card. This faltered primarily because there were big concerns about the amount of data that would be held on the register and how government agencies – and maybe others – could access and cross reference that data. David Cameron’s coalition government scrapped the idea in 2010. Well, an entitlement card is not the same as an identity card. The database need only contain basic information your name, address, nationality, national insurance number and some biometric identifying data, such as a retina scan, currently used in UK passports. It’s not necessarily a plastic card. In today’s digital world, the “card” could be a digital card, accessible via a mobile app. The same way as Paypal works.
So, even if you don’t have the card or your phone on you, say at a hospital, they can take a retina scan and match you to your records in the cloud, that way. Scotland already has a national entitlement card that coordinates services among 32 Scottish councils. It’s not the same as what I’m describing, but it shows the viability of the basic idea. The good thing about a National Entitlement Card is it will force a modernization of the welfare system because – behind the scenes – it will operate like a credit card. You walk into an A&E and get your broken arm fixed, and the hospital bills your card… say £500. That money is transferred from one pot of public money to the hospital. Consequently, it compels the state to accurately price services and account for them. Just like when you walk into a supermarket and buy a tin of beans. Tesco can tell you which brand of beans is selling in which neighborhood at what time of day. I doubt if the NHS today could tell you how many broken legs it treats on a Tuesday afternoon. This kind of data is important if you are managing any large enterprise; and you only get that data if you are tracking a flow of money. I’m a libertarian, but I cannot see any problems with having a National Entitlement Card. Logically, it’s the only way to police our welfare services in the modern world and ensure only those entitled to them, get them.