Introduction

I keep in my desk drawer the National Health Service cards issued in l967 to me, my wife and our son, who was one-and-a-half years old during the time we were living in Britain. I keep them in full knowledge of the fact that for years they have been completely useless. As to why they are useless and why they cannot be turned in for a new set of cards – which I am guessing are now made out of plastic – I strongly suspect that many readers have already figured out the answer, which is that, because I am an American citizen, my family and I are no longer eligible for NHS services.

What does this foible of mine have to do with the subject of this chapter? The answer is that this little anecdote illustrates an almost chemically pure instance of the ‘sea change’ brought about by the Thatcher government and its successors. That is, one did not always have to be a citizen of Britain in order to receive some of the services of the welfare state – and in the case of the NHS, the crown jewel of the welfare state to boot. Nor was this generous coverage some kind of policy oversight or unanticipated consequence. Aneurin Bevan had it put in intentionally. This in turn is of more than merely antiquarian interest, since it has become a virtual axiom in recent scholarly writing on the subject that the extension of citizenship and the creation of the welfare state everywhere meant – and had to mean – the inclusion of some people and the exclusion of many others. As a broad generalisation, this is perhaps sustainable. But Bevan’s intentional extension of NHS coverage to non-citizens of Britain stands on the face of it as an unambiguous counter example, unless one wishes to make the logically costly gambit of arguing that it is an ‘exception that proves the rule’ – costly because it is by no means clear that the exception ever proves the rule.

So why do I still keep the cards? My tendencies toward ‘packratism’ and common-garden-variety nostalgia – which no doubt are real enough – take us only so far.