Immigration, the NHS and the law of unintended consequences

In the days of the British Raj, the Colonial authorities in India were concerned by the number of residents dying from the venomous bite of the cobra.  In order to reduce the number, the authorities introduced a bounty on the body of a dead cobra; for killing a cobra you could receive a reward.  Cobras were killed in large quantities by people seeking payment of the bounty.  In the first instance, the number of deaths from cobra bites increased, as people hunting the cobras were bitten in the process of their capture.  Eventually however, the number of cobras fell and so the number of innocent (i.e. non-hunting induced) deaths fell.

As the cobras became scarcer, so did the ability of the cobra hunters to earn a living from the bounty; fewer cobras meant fewer snakes on whose death a reward could be claimed.  Entrepreneurial Indians began breeding cobras in order to provide an ongoing supply of snakes upon which the bounty could be claimed.  The authorities soon identified that while the number of deaths from cobra bites had diminished, the number of snakes being killed was increasing, as the farmed cobras entered the market.  They soon identified the root cause of the continued rise in snake numbers and brought the bounty to an end.  The abandonment of the policy of paying the bounty left the snake breeders with a worthless supply of venomous snakes.  Rather than run the risk of suffering a fatal bite whilst attempting to destroy their worthless stock, the breeders simply released the snakes into the wild, where they bit more humans.

The unintended consequence of the Colonial authority’s policy to reduce the number of cobra related deaths was to increase the population of cobras and increase the number of deaths from their bites.

It seems almost inevitable that any Government action to influence the economy or society has its own unintended consequence.

The founding of the National Health Service in 1948 by the Labour Government of Clement Attlee is no different.  The NHS was designed specifically as an investment in the British workforce.  By improving the health of the working population, so the theory went, the labour force would become more productive.  reducing absenteeism through ill health would increase output.  The increases in output and productivity would lead to economic growth from which the NHS could be funded.  By improving the health of the economically active, economic activity would be increased.

Unfortunately, the economic advantage of the NHS has not materialised and that is due to an unintended consequence.  Whilst the ideal of the NHS was to improve the efficiency of the labour force, it was never intended to be a resource solely for people of working age.  But as the NHS stopped people from dying prematurely from diphtheria or smallpox and improved the health of the nation, so the population began to live longer.  But what the NHS is unable to do is to prevent human beings from mortal.  So as preventable and curable illnesses were made part of history, people began dying in greater numbers from cancer, heart disease and strokes.  These are the illnesses more prevalent in the elderly than the young.  They are generally illnesses caused by lifestyle, so the longer a person lives, the more likely they are to encounter such an illness.  The result is that the NHS now spends its money on research for cures for illnesses that were much rarer at the time of its inception.  Its resources are no longer spent on improving the health of the economically active, but on keeping the economically inactive alive.

This has a severe repercussion for the economy, as the economically inactive in the population are supported by the economically active.  So the longer the economically inactive live, the more the economically active have to provide for them.  At the same time as mortality rates have fallen, so have birth rates.  This has the consequence of meaning that a greater proportion of the population are inactive.  Since the foundation of the NHS in 1948, the proportion of the British population at pensionable age has increased from 10% to just below 20%.  This of course places an extra burden on the shrinking economically active proportion of the economy.

Given that in the United Kingdom, life expectancy at birth rates are now at over 80 years and rising rapidly, the proportion of the population that are no longer of working age is likely to rise much more rapidly from its current position over the coming decades.  If this pattern continues unchecked, then the United Kingdom will find itself in a position of slow and perpetual economic stagnation.  As the percentage of economically inactive residents increase, so do the costs of supporting them and providing them with health services.  This burden falls on a diminishing number of economically active workers.  The costs are rising inexorably and ability of the workers to meet them are diminishing.  The position is not sustainable.

There are only one solution to this predicament, which is that we have as a nation to increase the proportion of us that are economically active.  There are a number of ways that we can achieve this, but none of them are likely to be politically or socially acceptable.

We could:

(i) increase the state retirement age so that people remain economically active for longer.  This is being undertaken to an extent already with the increases in retirement age rising from 65 to 68 over the coming years. and it is likely to continue further.  But this potentially endangers the health of those being asked to work longer in order to support those who have already retired at potential earlier ages.  This can realistically only be achieved over a long period, which given the rapid rise in life expectency will probably be insufficient to provide a solution by itself.

(ii) introduce a harsher regime in determining the standard of health care offered to the economically inactive.    Whilst this is possible, it is of dubious morality.  We could offer palliative care to the inactive who become unwell, rather than helping them to recover from their illnesses.  But rationing healthcare on the basis of a patient’s future benefit to the economy, while disregarding their past contributions does not just cold and calculating, but inhumane too.  The provision of healthcare would have ceased to be on the basis of the individuals need, but on their ability to pay through productive post recuperative work.

(iii) promote higher birth rates, but this too is fraught with difficulty.  The birth rates in the UK have fallen as living standards have risen.  The population has voted with their prophylactics and they do not want more children.  Families with large numbers of children are seen as somehow wanton, especially if they do not have the means to provide a standard of living to those children, that parents of smaller families are able to provide.  Heaven forbid that the state should provide financial benefits to low income families that might encourage them to have more children.  you can almost imagine the Daily Mail headlines already.  It is taken as read, that when a middle class couple have children, they cannot reasonably be expected to pay for their education, so the state provides this for free.  They cannot be expected to pay for private healthcare, so the state provides this for free.  Whilst raising their children, they cannot be expected to look after their elderly and inform parents too, so the state provides assistance.  These provisions are provided irrespective of the number of children the middle class family creates.  But if an employed couple have a child that they cannot afford to clothe and feed?  Well that is down to their own fecundity and fecklessness.

There would appear to be only one possible solution, but that solution will cause the readers of the Daily Mail to splutter over their cornflakes.

(iv) import people of working age from overseas.  This has several advantages.  Firstly people wishing to migrate generally have a better work ethic.  Someone willing to travel thousands of miles to find a better life for themselves is showing some gumption.  Secondly, many immigrants come fully educated and trained, so reducing the cost on our economy.  Thirdly, they are generally in the age group 20 to 35, which means they place a much lower burden on our health services.  They contribute more to the economy in taxes than they use in services.  Fourthly, their children are frequently multi lingual, meaning that as adults they are a much more flexible and valuable resource.

In two week’s time the nation votes on whether to remain inside the European Union.  Those wishing to leave the EU in order to reduce immigration are condemning the nation to a slow but certain stagnation.  On the BBC1 One Show earlier in the week, retired residents of Clacton complained that immigration was stretching their health service provisions to breaking point.  It seems almost comical that in an area where immigrants constitute less than 2% of the population, representatives of the 20% of the population who are pensioners can blame the migrants for overusing the health services.

The argument, especially from the older generation is that the United Kingdom is overcrowded.  We are a full island.  When we joined the EEC in 1973, our population was about 55 million.  It is now about 66 million, so it has increased by about 20%.  Over the same period the world population has doubled from 4 billion to 8 billion.  The UK population has increased at a much slower rate than the rest of the world.

It is not the EU that has lead to our increased numbers of recent migrants, though it has facilitated it.  It is the National Health Service and our desire to be immortal.


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