Is the NHS surcharge just?

Not long ago the UK implemented an NHS surcharge – an extra fee that non-EEA nationals (Australia and New Zealand are also exempt) applying for leave to remain in the UK must pay. It costs £200 per year, and must be paid up front. So, for example, if you are applying for a work visa for 3 years, and you have a family of three, you must pay £1800 to cover the surcharge for you and your family (on top of other visa costs).

It is difficult to find much public discussion in the UK regarding this surcharge, outside of a few articles that recently noted that the surcharge is unlikely to do what we were told it would do – namely, benefit the NHS. (See here)

Is the surcharge a just policy? As some have pointed out, it might make sense for students, who pay nothing into the NHS. (Then again, it makes studying in the UK more expensive for such students – and this might discourage talented students from studying here.) But working people do pay into the NHS – migrants as much as UK nationals. What justifies adding a surcharge to people who already pay, or to people who will pay (given that they are applying for a work visa for a job already offered to them)?

Here is how Immigration and Security Minister James Brokenshire justified it, in a press release:

“The health surcharge will play a vital role in ensuring Britain’s most cherished public service is provided on a basis that is fair to all who use it. For generations, the British public have paid their taxes to help make the NHS what it is today – the surcharge will mean temporary migrants will also pay their way.”

An appeal to fairness, based in some way on the fact that the British public have paid taxes for generations. This doesn’t really address those migrants who do and have been paying taxes, though. So, to repeat the question: what justifies adding a surcharge to people who already pay?

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2 Responses to Is the NHS surcharge just?

  • Tom Douglas says:

    I agree, it’s difficult to see how this can be justified. Brokenshire’s idea seems to be that recent immigrants have been contributing for a shorter period of time than people born here and that this is somehow unfair. But of course, people born here have also been benefitting from NHS services for longer. If anything, the ratio of years of contribution to years of service provision is likely to be *higher* for most immigrants, since they did not benefit from service-without-contribution as children/students.

    Perhaps it’s the contribution of past generations that’s meant to create the unfairness. He may think that past generations of UK nationals contributed to the NHS’s set-up costs and that current UK nationals are effectively paying for this prior investment in the form of reduced inheritances, whereas immigrants are not. So fairness requires an extra contribution from immigrants as well. But this supposes that the NHS had a net wealth-reducing effect for previous UK generations, and I’m not sure if that’s plausible. Also, this line of reasoning would seem to support a levy on all immigrants, not just those from places other than the EU, Australia and New Zealand.

  • Raymond says:

    I think you are both making a category mistake: the policy is not an abstract exercise in rational justification but a political act responding to and perpetuating popular anti-immigrant sentiments. No doubt ‘fairness’ is not a concern of Brokenshire; the excerpt is but rhetoric.

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