The type of health service on offer in a united Ireland will have massive influence on whether the public in Northern Ireland would vote for unity in a referendum. Some 50 per cent of Northerners are more likely to vote for unity if a united Ireland adopted the type of health system used in the UK, and only 3 per cent would be less likely to do so – with a resulting net score of +47.
This “NHS effect” is greater than the effect of telling people that they would be £3,500 better off in a united Ireland: 46 per cent of Northerners would be more likely, and 3 per cent less likely, to vote for unity in this economic scenario, a net score of +43.
And, importantly, there is an equally strong effect, in a negative direction, of the idea of a united Ireland adopting the health system used in the South. Under this condition 7 per cent of the public in the North would be more likely to support unification, but 45 per cent would be less likely (a net score of -38), which is not far short of the negative economic effect of being worse off by £3,500 (net -48).
For the Southern public being better or worse off by €4,000 has a substantial effect on the likelihood of voting for unity – similar to the effect for Northerners. But the type of health service would have a smaller effect on the voting intentions of the Southern public in a unification referendum. Southerners are slightly more attracted to Irish unity if that involves UK-style socialised medicine (net score of +15) while the prospect of having the Southern health system has no effect (net score of +1).
The upshot is that the possible impacts on household finances of unification have large and similar effects, North and South, but only in the North does health-service type strongly affect voting intention.
Adopting the Southern health system would be a massive turn-off for Northerners, and to a similar extent for Catholics and Protestants.
There are policy implications. Advocates of Irish unification must either propose extending (an improved version of) the Northern system to the South or instead oversee visible improvements in the existing HSE-run system to reduce the comparative attractiveness of the NHS model.
Unionists, by contrast, will do well to advertise the merits of the NHS and the financial charges in the South (as one of our focus group participants said: “Well obviously we get it free and down there doesn’t - what is it, £50 to go see a doctor and then so much for a prescription afterwards?”). They will recognise that their regional model is not currently performing well and should be grateful that public knowledge in the North of greater longevity and better health outcomes in the South is not more widespread.
There are also differences between North and South on the subject of violence. The southern public, which has experienced little political violence in nearly a century, is much more likely than its northern counterpart to shy away from voting for unity when the prospect of loyalist violence is raised: 42 per cent are less likely, and 18 per cent more likely to vote for unity (net score of -24). Northerners are more immune to the influence of such violence (net score of -7), and this is particularly the case for Catholics (net score +2).
We also asked, in a separate battery of questions, our respondents to indicate what they think are the issues that voters should know about to make informed decisions before any referendums. Respondents were invited to indicate the two most important issues from a list of five.
Again economics emerges as highly important, both North and South: 57 per cent of Southerners and 61 per cent of Northerners pick knowing “how a united Ireland would affect the economy” as one of their top two priorities. And, in line with our discussion above, the issue of the health service in a united Ireland is a much greater priority for the public in the North (60 per cent) than in the South (24 per cent).
North-South asymmetry on the issue of peace and violence also emerges clearly. For two-thirds of Southerners “whether a united Ireland would be peaceful” is a priority, but that is so for just under two-fifths of Northerners. Of less importance than these material and security concerns, perhaps surprisingly, are the protection of minorities, freedoms of expression, and political institutions. The responses from Protestants and Catholics to these questions were almost identical.
There are difficult challenges ahead for advocates of Irish unification. They must credibly persuade Northerners that not only will they be economically better off in a united Ireland, but that a united Ireland will operate an effective NHS-style health system. They must also persuade Southerners that any threats of loyalist violence prompted by the possibility of Irish unity can be successfully managed.
As for unionists, the NHS, which the Ulster Unionist Party famously opposed, is their hidden strength –so long as the Northern public idealises it. Tactically too they are well-advised to hew to the line that the North would be too expensive for the South – even if that claim has been out of date for two decades, and even though it hardly speaks well of the Northern economy under the union.