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WSWS : News & Analysis : Europe : Britain

Labour Government set to ration healthcare

By Jean Shaul
30 September, 1998

The Blair Labour Government has seized on the launch of so-called "life style" drugs, Viagra and Xenical, which combat impotency and obesity, respectively, to establish the principle of rationing treatment and drugs in the National Health Service.

Frank Dobson, Secretary of State for Health, told doctors not to begin prescribing Viagra, even though it had been approved for use by European regulatory authorities. Only the day before, his department had agreed with the manufacturers, Pfizer, to set the price of the drug at £4.84 per tablet. Pfizer's opening bid for Viagra was £10 per tablet.

It is thought that one in ten men suffer from impotency. This could mean a £50-£100 million bill for the NHS if Viagra were available on prescription.

Dobson has so far only delayed the introduction of Viagra while the government considers ways of restricting eligibility. But he has made clear his intention is to limit its availability on the NHS by rigorously screening potential recipients and laying down a nationally applicable set of instructions to doctors. He justified this with jibes about "men flaunting their potency at discos".

As a result Viagra is being effectively rationed on the basis of cost. It will be available only to those who can afford hugely inflated charges in the private sector. In so doing, the government has created a veritable gold mine for the private healthcare corporations. There are already reports of private medical centres, conveniently located at railway stations, charging £120-150 for the initial consultation and £15 per tablet. This is the equivalent of imposing a charge of £1,680 for couples having sex twice a week over a one-year period.

The Department of Health is also "considering the potential impact of the anti-obesity drug, Xenical, on the NHS. Guidance will be issued to the health authorities if the findings suggest this is necessary." Xenical is not a slimming drug. It is used for those at risk of premature death through diabetes, coronary heart disease, strokes or obesity-related cancers. Doctors at present have few options for helping obese people lose weight.

Figures as high as £400 million have been quoted as the bill for treating patients if Xenical proves popular. About 8.5 million, or 15 percent of the British population, are thought to be very overweight and to have health problems as a result. But Roche, the manufacturer, said that it did not expect that more than 5 percent of those with a serious medical condition would get the drug.

Drugs like Viagra and Xenical are required to treat conditions that are created by the "free market". Food and drink corporations, some of the largest and most powerful businesses in the world, manufacture and sell products that are injurious to health and contain little nutritional value. The widespread use of chemicals known to be hazardous, increasing pollution and intensive livestock rearing practices dependent upon drugs have led to reduced fertility and increasing impotence.

A National Institute for Clinical Excellence (Nice) is to be set up. One of its tasks will be to devise a method of rationing drugs. It will scrutinise new treatments and drugs likely to be popular, like Viagra and Xenical, to assess their cost effectiveness against other drugs and forms of treatment, estimate their value to the NHS, and decide who should get them.

At present doctors make decisions about how to treat their patients on clinical, not financial, grounds. All that is set to change under the arrangements announced in last year's White Paper on the NHS. Doctors will have to meet all the costs of their patients' care, including community health services, care in the community, drugs, acute care hospital treatment and the cost of running their own surgeries from a capped allocation they will receive from the state. So in future, doctors' choice of treatments will be financially driven. This will lead to a system of rationing by price, a surge in private health insurance and the wholesale closure of wards and hospitals. Decent health care will be placed beyond the reach of millions of workers and their families.

Despite the fact that the NHS's £6.3 billion drugs bill has been rising at about 10 percent a year and accounts for 13 percent of total costs, it is still well below the European average. Moreover, the government is largely responsible for the high cost of drugs because of its sycophantic relationship with the drug companies. The government's very secretive Pharmaceutical Price Regulation Scheme (PPRS) sets prices so as to allow a massive 20 percent rate of return on drugs sold to the NHS.