Since the start of the National Health Service, British doctors have taken pride in working in a service whose core principles include health care as a basic human right and a universal service for all based on clinical need, not ability to pay.1 Yet the reality is different: destitute failed asylum seekers are being refused hospital treatment and being hounded by debt collectors if they have received emergency treatment.2 A recent report from the Refugee Council catalogues people with potentially fatal conditions, such as bowel cancer, diabetes, and renal failure, who are being refused free treatment but cannot afford to pay or have become too intimidated to seek treatment. It concludes that people will, if they have not already, die as a result. More, however, is at stake in the NHS than a 58 year tradition as the first ever national medical service based exclusively on clinical need.