The NHS is unlikely to survive in the EU
The aim of the EU is to homogenise EU commerce into a single market, so that companies can compete for business across borders on equal terms. A variety of EU regulations stipulate that suppliers have a right to provide services, the suppliers must not be discriminated against and have a right to conduct a business. Articles 87 and 107 decree that the actions of member states must not distort competition. It is illegal if “any aid granted by a member state or through state resources in any form whatsoever which distorts or threatens to distort competition….”. In other words state owned industries cannot shield themselves from fair competition.
However many state owned industries go against these principles, particularly the NHS which is an intentional monopoly. By being by far the biggest healthcare provider in the UK it can control wages, influence the price of drugs, equipment and services. This monopoly saves the government millions. The NHS monopoly is huge, it is the fifth largest employer in the World (1.7m employees), after the US Department of Defense, the Chinese Army, Walmart and McDonalds.
Article 168(7) states that member states have control of “the management of health services and medical care” but this control is still subject to EU trade and competition laws and as the EU pursues ever closer integration competition laws are being used to override historical safeguards.
This can be clearly seen in the rail industry. Many rail industries in the EU are state owned monopolies. Article 345 states “The Treaties shall in no way prejudice the rules in Member States governing the system of property ownership”, so state owned industries should be immune from EU political interference. However the Fourth Railway Package is using EU competition laws to override article 345.
The Fourth Railway Package proposes to open up each country’s rail network to competition and to create a single European market in rail services. State-owned passenger companies will have to compete to retain the routes they currently run, probably through competitive tenders, rather like they do in the UK, and private companies will start to take over some of the privatised services.
If the article preventing EU interference with state owned industries can be pushed to one side then so can the article preventing EU interference in health services, particularly when the NHS contravenes so many of the competition laws.
The common model of EU healthcare systems allows more commercial competition than the NHS, is part state funded and part insurance funded, and has a higher mix of private to public provision. As rules are changed to create a homogenised health care system that will allow suppliers to compete across borders on equal terms, the NHS will have to fall in line with the part insurance funded model, so cannot survive in it’s present form.