After the big “Brexit” vote last week, I wondered how leaving the European Union would affect British health care. Of course the opinions and prognostications on this have been just as hysterical and hyperventilated as the larger discussion, not to mention confusing as hell. One leading “Leave” advocate worried that remaining in the EU would invite US corporate penetration into the UK, and would be a backdoor approach to privatizing the NHS. Pro-Brexits also claim a £700 million annual loss due to “medical tourism” from EU migrants getting uncompensated UK health care. “Leave” advocates claimed that exiting the EU would free up £8 billion for the NHS, presumably by escaping excess mandates limiting already strained resources.
According to Denis Campbell, health policy editor for The Guardian, leaving the EU will be bad for British health. The Institute of Fiscal Studies predicted that upon bolting the EU, Britain would have to cut services and/or raise taxes. The Labour Party claimed that leaving the EU would result in a £10.5 billion annual shortfall, equivalently the loss of 1,000 nurses and 155 doctors. Similar warnings have been given by the London School of Economics and the Economist Intelligence Unit (EIU). The EIU has also predicted “substantial” health care problems post-Brexit:
- An “uncertain future” for the 10,000 NHS doctors and other health professionals who come from EU countries.
- Loss of access for Britain’s pharmaceutical industry to the “EU centralized drug authorization pathway”. “Britain would also no longer have any influence over the European Medicines Agency, the regulator that approves drugs for use within the EU. Medical research could be hit too, because Britain currently gains disproportionately from current funding streams.”
- The Faculty of Public Health claimed that EU membership has allowed British involvement in cleaner air and water projects, and pan-European joint efforts combating “threats to health that cross national borders, such as antibiotic resistance and combating pandemics.”
The FPH also stated that EU membership has protected:
- Occupational health; food/medicinal/medical device safety.” (Of course, the UK had their own versions of these protections long before joining the EU)
- “Generous maternity and paternity leave, guaranteed holidays, the 48-hour working time directive; equal rights for part-time workers and protection against unfair dismissal. All are powerful social determinants of health from which UK citizens have benefited.”
Uh-huh. There might be some merit to the pro-EU arguments on cohesive research and reducing obstacles for health care workers and public health projects. But the EU advocates tip their hand when they throw in the whole grocery cart of social policies and lump them together as part of health care. This is a trap similar to the U.S. experience, wherein any initiative for more big government compassion can use health care as the vector with which to infect the discussion.
Further down in this laborious article, we learn that The Guardian fears a worsening shortage of social care workers, lamenting “tens of thousands of care workers packing their bags and heading home to other EU states.” Apparently it’s tough to hire low-wage workers for home care, and EU migrants willing to work for less helped fill those vacancies. Social care employers are say they are unable to pay above the recently increased minimum wage, due to below-cost fees paid by the government for home care. Sound familiar?
Modern health care has been corporatized and bureaucratized worldwide. A key feature of this collectivization is the use of physicians as pawns, to frighten uncooperative citizens with their absence, and to engage in social engineering under the rationale of “health.” Taken to its extreme, it is logical to argue that doctors should be held accountable for whether their patients have safe homes, walk the dog daily, eat well, or take their pills on time. Over here we call those quality metrics. For purposes of this blog, I don’t care per se about the Brexit outcome, and I’m not preaching politics. But when maternity leave, holiday pay, and hiring/firing laws are described as “health” topics, this subordinates health care workers to those larger social aims whether they like it or not. That is a trap any authentic physician should want to exit