I read there is a debate about the way the UK asks recently arrived workers to pay a charge for use of the NHS. Some say as they have recently arrived it is sensible to ask them to pay some extra money for all the established facilities and staff on payroll they get access to. Others say they are paying taxes like the rest of us, so maybe that covers it.
This issue is a small part of a much wider question – how much does it cost the host country to accommodate and support new migrant workers? In most of the analyses undertaken people just look at the revenue costs and tax coming in. We need to look at the capital costs as well.
The EU once seemed to give us an answer. When they were looking at the way a few countries in the EU seemed to end up with a large share of the total economic migrants into the area, they suggested that countries not taking their share should have to pay Euro 250,000 for each one going somewhere else up to an appropriate quota for them. This apparently large sum was a capital cost, and presumably reflects the fact that each new migrant needs a home, and capacity in public services.
When a country has pretty full employment and a housing shortage, each new arrival means the need to build a new home, to provide additional classroom capacity in schools, extra surgery and hospital space for health provision, more roadspace and train capacity and so on. In the case of the UK accepting around 250,000 extra people every year it is not possible to squeeze them all in to the homes, schools and surgeries already built, so there is a capital cost in provision.
The argument about the NHS annual charge is a smaller number than this question of the set up costs for new migrants. It is perhaps this bigger issue which needs more of our attention, especially given the difficult politics of speeding up housebuilding and expanding schools.