Government is right to question state-funded health care for all

Bishop Pat Lynch is absolutely right to be concerned about whether migrants, asylum-seekers and those in great need will be able to get health care as a result of government reforms. The principles of the promotion of human dignity and the common good demand that all can access health care – and that includes migrants.

However, we should perhaps consider the wider issue. Should the state be the only financier and provider of health care? Should there be a responsibility on church institutions themselves in this regard? We share a health care system with Canada and Iceland that all other Western countries – including Catholic countries – have rejected. For example, 51 per cent of hospitals in Germany are not government-owned (and they provide much more than 51 per cent of the care) and 34 per cent in France. We do not have a health care system in which the state assists organisations that develop organically within the community, which is what Catholic Social Teaching demands. We have a health care system in which the state is dominant.

Before the war, the system was different. In 1939, charitable hospitals (the same names we know today – Great Ormond Street, St Bartholomew’s, and so on) took in 60 per cent of all patients requiring acute care, and local government provided places for many others. About 19 million people had health insurance and most of the rest of the population were members of Friendly Societies or made direct payments for their medical costs.

Less than 15 per cent relied on free services provided charitably, through the goodwill of doctors or funded by government. In the demands for reform it was that 15 per cent about which there was most concern.

But reform did not take the turn many expected. Neither did it take the turn Lord Beveridge would have hoped for. And we certainly took a different route from the Christian Democratic countries of continental Europe. Indeed, the creation of the NHS was not supported by the Catholic Church because it involved the complete compulsory nationalisation of almost all local, charitable, church and friendly society hospitals. The then-archbishop of Westminster, Cardinal Bernard Griffin, fought for and obtained exemptions, but only for the small number of Catholic hospitals. He argued that it would be a ‘sad day for England when charity became the affair of the state’.

There can be no objection in principle to people paying for health care any more than there can be an objection in principle to people paying for other things that the Catholic Church believes all need access to – food and shelter, for example. A system of provision and finance that combined mutual societies, insurance contributions, commercial entities, direct contributions, charity and church institutions, and government help where necessary and desirable, may well be more humane and serve families and the community well (the hospice movement has some of these features). That would also be a model that would enable people to obtain health care in a way that was compatible with their conscience. It is also worth noting that the thousands of friendly societies in pre-war UK, as well as the organisations that still exist today elsewhere in Europe, are often organised on the principle of reciprocity discussed with admiration by Pope Benedict XVI in Caritas in veritate.

Meanwhile, we are where we are. Bishop Lynch is right that all must have access to health care. It would also be wrong if the state monopolised the provision of health care and then pulled up the drawbridge so that some could not access a service of which the state had become the only provider. There is nothing intrinsically wrong, though, in asking migrants to pay for, or insure for, health care. However, this should not apply to those who are in no position to afford it (especially if they are asylum-seekers).

But, in the long run, perhaps we could have a less monolithic system in which Catholic hospitals and provident funds played an active part in providing health care for migrants in the same way that Catholic schools play an active part in educating their children – with or without state support, as is appropriate in the circumstances. Bishop Lynch is probably right. Certainly he is not wrong. But we need a wider debate too.

This article was originally published by The Tablet.

Academic and Research Director, IEA

Philip Booth is Senior Academic Fellow at the Institute of Economic Affairs. He is also Director of the Vinson Centre and Professor of Economics at the University of Buckingham and Professor of Finance, Public Policy and Ethics at St. Mary’s University, Twickenham. He also holds the position of (interim) Director of Catholic Mission at St. Mary’s having previously been Director of Research and Public Engagement and Dean of the Faculty of Education, Humanities and Social Sciences. From 2002-2016, Philip was Academic and Research Director (previously, Editorial and Programme Director) at the IEA. From 2002-2015 he was Professor of Insurance and Risk Management at Cass Business School. He is a Senior Research Fellow in the Centre for Federal Studies at the University of Kent and Adjunct Professor in the School of Law, University of Notre Dame, Australia. Previously, Philip Booth worked for the Bank of England as an adviser on financial stability issues and he was also Associate Dean of Cass Business School and held various other academic positions at City University. He has written widely, including a number of books, on investment, finance, social insurance and pensions as well as on the relationship between Catholic social teaching and economics. He is Deputy Editor of Economic Affairs. Philip is a Fellow of the Royal Statistical Society, a Fellow of the Institute of Actuaries and an honorary member of the Society of Actuaries of Poland. He has previously worked in the investment department of Axa Equity and Law and was been involved in a number of projects to help develop actuarial professions and actuarial, finance and investment professional teaching programmes in Central and Eastern Europe. Philip has a BA in Economics from the University of Durham and a PhD from City University.