As a GP working in London, it is not uncommon for me to hear people say they can’t afford prescription charges, or that they don’t have the money to buy their medication until they get paid at the end of the month. Some drugs are so expensive they are wholly out of people’s reach. “But if this is such an effective treatment, why isn’t it available free on the NHS?”, patients ask me.
I often struggle to respond. No one should be denied care on account of their ability to pay for treatment. Yet this is now a daily reality for many people, due to the creeping privatisation of our healthcare system by successive governments.
And, as a recent report by Channel 4’s Dispatches has shown – the programme revealed that US pharmaceutical companies have already been discussing raising drug prices in the event of a US/UK trade deal post-Brexit – denial of treatment on the NHS looks set to get a whole lot worse.
If we want to know how bad things can be, we only have to look over to the United States. US citizens currently pay far more for medication produced by US pharmaceutical corporations than the price currently agreed for UK citizens through negotiations with the NHS – with devastating consequences. When the price of insulin medication was tripled in 2017, thousands of patients lost access to the drug, leading to multiple deaths. The high cost of drugs is one reason why US health outcomes are so dire.
President Trump has stated that he’s unhappy about this disparity between what we in the UK pay for drugs and what US citizens pay. But, unsurprisingly, the US president’s answer to American patients dying from an inability to afford overpriced medications is for us to pay the same artificially inflated prices too.
The US pharmaceutical industry is intent on making this happen. In the last two years alone they have collectively spent over half a billion dollars on lobbying ministers – and it appears to be working. In addition to the six official meetings between senior UK civil servants and their US counterparts, there have been five meetings behind closed doors with representatives of US pharmaceutical corporations to discuss drug pricing. And the one-sided outcomes of trade negotiations between the US and other countries thus far – such as Canada, Mexico and Korea – should serve as a warning signal to us all, with major consequences for our health and that of our loved ones.
And how do the numbers tot up? Dr Andrew Hill from Liverpool University told Dispatches that if the NHS were to pay US prices for all medicines, our annual drugs bill would rise from £18bn to £45bn – a third of the current total NHS budget. These additional healthcare costs would inevitably be passed down to patients, with the further expansion of NHS charging and the establishment of a two-tier healthcare system, in which patients who cannot afford the price of treatment go without.
In order to conceal all of this, civil servants in the Department of Trade have been instructed not to use phrases such as “drug pricing” in NHS discussions, but to use terms like “valuing innovation” instead. So when Conservative ministers give assurances that “the NHS” and “drug pricing” are not part of post-Brexit trade deal negotiations – as they have been frantically doing in response to these revelations – they cannot be taken seriously. Their recent opposition to a Labour motion that would have kept the NHS off the table in post-Brexit trade deals only adds to the case against them.
But it doesn’t have to be this way. Progressive reform of the dysfunctional relationship between the state and the pharmaceutical industry is possible. But it requires the vision and political will to prioritise public health over private profit.
Labour recently announced plans to scrap prescription charges in England, bringing policy in line with Scotland, Wales and Northern Ireland. They have also announced plans to create a publicly owned drugs manufacturer, to supply cheaper medicines to the NHS. As a doctor, I welcome these plans that will put an end to difficult conversations with patients about whether they can afford to pay for their health.
Do we want Americanised healthcare, decided upon secretly, with the NHS on the table? Or do we prefer socialised healthcare, decided upon locally, by working people with a seat at the table? Choose wisely in the upcoming general election, because our health and the fate of our most beloved institution depend upon it.
• Ameen Kamlana is a GP in east London and an NHS activist