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The ethics of charging for prescriptions

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William Crawley | 10:18 UK time, Tuesday, 11 September 2012

"The health service can't afford to go on like this. Most must start paying again for their prescriptions." So says Northern Ireland's chief medical officer, Dr Michael McBride. I a wide-ranging interview in today's Belfast Telegraph, Dr McBride said anyone who can afford to pay for prescriptions should pay. He also emphasised that "there should never be any circumstance were someone is discouraged from from taking their medication because of prescription charges."

Pay attention to the moral language used by the chief medical officer: anyone who can pay "should" pay. Is Dr McBride suggesting that some people have a moral obligation to pay, even though they do not have a legal obligation to do so (at present)? Or is he making a more strategic, less ethical, point: we "need" people to pay if the NHS is to provide the services people expect?

What do you think? Do people who can afford to pay prescription charges have a moral obligation to pay? What kind of paying regime is consistent with the basic philosophy of the NHS?


  • Comment number 1.

    I thought you all were already paying for this through taxation?

  • Comment number 2.

    Open Thread


    me to mscracker,

    “...then have enough money to completely support yourself (via cash, ala their ‘anyone who can pay "should" pay’), and at least two other people, via taxes.”

    Or am I just another 21st century frontier American?

  • Comment number 3.

    I still find myself wanting to ask the pharmacist, “How much for that?” whenever I pick up a prescription; then I realise, ‘Oh, yea, it’s free.’

    The trouble is, it isn’t free - someone pays; and, as I lift the paper bag containing the medication from the counter, I think, ‘Actually, I can afford £5, or £7, and I really should (now I’m fixating on that word) contribute.’

    ‘Shoulds’ aside, payments like this, from those who can afford it, may allow other decisions to be made in other areas of the health service for the benefit of those who need it.

    One thing is clear, however we do this, the 'pot' is limited.

  • Comment number 4.

    3. PeterM,

    “ ‘Shoulds’ aside, payments like this, from those who can afford it, may allow other decisions to be made in other areas of the health service for the benefit of those who need it.”

    “from those who can afford it” Is that from those who can afford it again? Did your ‘free’ prescription come from your taxes?

    “payments like this...may allow other decisions to be made in other areas of the health service for the benefit of those who need it”

    When you make an additional payment at the counter, who makes these other decisions? The government? That’s fine with me, if you agree with the government’s ethics, and believe it doesn’t waste money.

  • Comment number 5.


    Can I begin with a question - what taxes do you pay in the States, and to what degree can you account for the spending?

  • Comment number 6.

    I think I agree with Peter's illustration that the pot eventually can become empty.
    Maybe one could ask the pharmaceutical companies whether they have a moral obligation to charge less for their products?

  • Comment number 7.

    @2. marieinaustin,
    Or,going back to an earlier theme, we could turn the whole thing over to pirates.They can capture the goods & distribute them directly to the consumers at a lowered cost, eliminating the middleman.Those who do not cooperate can walk the plank.
    Much more efficient.

  • Comment number 8.

    Perhaps a distinction should be made between medication which must be taken every day for what is left of your life, and medication which acts quickly and (we hope) permanently; e.g. a course of antibiotics.

  • Comment number 9.

    Since I was 16, I’ve known the pot(s) was not bottomless. I’m sorry other people haven’t known this. Maybe they were luckier than I was.

    So I was writing a response…ready to sing my personally- and fiscally-conservative and ethical praises. But it’s too personal, and in the end, I can’t win this argument. (I don’t think any of us can/will.) No matter what I do or where I give, I will be called stingy. Sorry, I get too stressed out for this topic, and I shouldn’t have started it.

    You’ve got the NHS there, and you can make additional payments for prescriptions at the counter? Good.

  • Comment number 10.

    I think I've written this before, but just 25 years ago, our country dr. charged $5.00 per visit, including medications.(A few yrs. earlier the cost of an office visit had been $3.00.) This was for plain old, every day,walk-in patients.
    I could take a sick child in there & come out with a shopping bag full of medications, literally.And a $5.00 charge.
    His waiting room was always full-go figure-& he made a decent living before retiring.

  • Comment number 11.


    The 'pot' comment was a straightforward fact - no more; 'whatever we do' (in this case in relation to government spending) we have choices to make.

    The question was a straightforward question; I don't know the set up in the U.S.

    Sing away, I've no personal gripe to make.

  • Comment number 12.

    Oh, choir of angels. I don’t know anything about the country. I assume he lived in the house where he was born on the second story landing and road his neighbor’s horse to work, his medical degree was paid for by tossing hay, his children were schooled by his wife in a one-room school building, and they went to college on grants that somehow I contributed to. In 1987 everyone wore bonnets, including the men. And upon retiring in 1988, his living became indecent.

  • Comment number 13.

    @12. marieinaustin,
    Actually our dr.was a WWII refugee from Germany & lived in a fairly modern home near his office.I know his children did go to college, but I am not sure by what means.
    I think he must have retired his family practise in 1986, because my son born in '87 had to go to another, less competent & more expensive, doctor for his check up after he was born.
    In addition, we had an older dentist-born locally, not from Europe-who refused to charge anything for treatment.He said he'd made enough money & just appreciated taking care of his neighbors. His office was attached to his farmhouse & you could watch his cattle graze outside the window.
    No bonnets-except on my babies...

  • Comment number 14.

    (It seems he could afford to misspell ‘rode.’)

    Well, if he had already made his money, then it was very nice of him but less significant that he charged $5 at the end of his career in 1986. Only a small choir of angels is needed here. Sorry, I don’t understand that story. It isn’t even about inflation.

  • Comment number 15.

    @14., marieinaustin,
    I think our doctor charged no more than $3.00 to $5.00 a visit for his entire practise as a physician.He didn't come to the US with any money so he must have supported himself that way. Perhaps he didn't have to deal with malpractise insurance & such? Folks where we lived didn't sue doctors they way they do elsewhere.
    I read an article on the BBC or CNN site not too long ago about a similar, older doctor who charged very little. I guess it can still be done.

  • Comment number 16.

    I'm sure Dr Mc Bride was talking at the policy level, not suggesting individuals should simply start sending in donations to the Department of Health. It is perfectly moral to accept what you are entitled to, particularly when you pay tax. You shouldn't be made to feel guilty for it. If the government and the legislature wants to change entitlements, that's a matter for them. And then you start to pay. Unless what they do is immoral and in breach of fundamental human rights - like Obamacare of the 1967 Abortion Act

  • Comment number 17.

    "If the government and the legislature wants to change entitlements, that's a matter for them. And then you start to pay."

    But if we need to pay, then it's still reasonable to ask who can pay, as part of the decision making process.

  • Comment number 18.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 19.



    Pastor Philip mentioned en passant the cultivation of a beard. No photographic evidence as yet.


  • Comment number 20.

    It is unethical language. As stated in the entry, ‘should’ denotes duty or obligation. Paying taxes is an obligation. Almsgiving is a choice, and imo not even a moral obligation. Unless the NHS wants to make extra payments mandatory, Dr McBride should have said ‘can’ or even ‘need to/there is a need.’

    “Most must start paying….” ‘Must’ implies probability. When they make more/higher payments a legal obligation, unethical language will no longer be needed.

  • Comment number 21.

    Off-topic, but this is the only available thread.

    Four (alternative) gospels.

    No, I have not yet read it. Maybe Santa will bring me a copy...


  • Comment number 22.

    Scotch Git

    What is on-topic round here anymore?

    Interesting article. May I ask, I've been meaning to, have you a Jewish background? Secular? Religious?

    My first thought, did Philip Pullman beat her to it?

    Second, we read, "Most ought to have got over the shock discovery...", well, yea, but it wasn't a shock, we knew already.

    Then, "By turning this incredibly well-known story on its head, Alderman brilliantly places the beginnings of the world’s most successful religion against the chaotic background of an occupied country."

    But if you turned it back round again (off it's head, so to speak) isn't it still told against the chaotic background of an occupied country?

    Getting back to Judaism, would you be entirely happy if the same treatment was given to, say, Abraham, David or Moses? It's not that I'm offended by the 'alternative Jesus figures', I'm not at all, but what about other national figures, how would you feel about that? Interestingly Christians wouldn't particularly want to 'play about' with those histories either.

    And here's this 'critical perspective' thing again, "“Storytellers know”, writes Alderman, “that every story is at least partly a lie.” "

    Emmm, would those be 'known lies', 'unknown lies', 'untrue lies', or 'true lies' ?:-)

    Oh, and this, gotta love this, "Alderman writes acutely about Iehuda’s loss of faith in Yehoshuah" Now, shouldn't Iehuda be booked to speak at an up-coming Emergent Conference? They do 'after-dinner' (or should that be 'after-supper') speaking too.

    Can someone please answer this, I'm a Christian, I'm expected to be interested in the Jesus character, what's this endless preoccupation with the 'not the son of god'. Like, who are these 'pirate stories/gospels' for?

  • Comment number 23.


    Any chance of another Open Thread?

  • Comment number 24.

    On Judaism I notice Andrew Marr has been going around telling people the Jews invented monotheism after the end of the exile. Who knew? And he didn't even mention the lost tribe's boat trip to North America.

    On a related subject, but not actually related (to either prescription charges or Judaism), William's documentary on the Ulster Covenant was rather good.

    I appreciate that Marr's history aims to cover a few more years, but still!


    Like, who are these 'pirate stories/gospels' for?

    Buccaneers and preening birds.

  • Comment number 25.

  • Comment number 26.



    My adoptive parents (may they rest in peace) were Irish Protestants. (Church of Ireland). They raised the question of whether I wanted to trace my biological mother several times, but I did not do so until after their deaths.

    To do so earlier would, I feel, have been disrespectful. Afterwards it felt like unfinished business.

    As for Abraham or Moses being given the same treatment, I'd be surprised if they hadn't already. Joseph Heller's God Knows did not spare the blushes of King David, and I enjoyed it very much.

    Can't comment on the Philip Pullman book, as I haven't read it.

    The book has been written by a Jew about a Jew. That she does not share your belief in Jesus' divinity is understandable.

    I found this recording of a review. Listen from 13 minutes in, lasts almost 9 minutes.

  • Comment number 27.

    Scotch Git

    Thanks for the recording link.

    It’s not specifically Naomi Alderman’s type of writing which bothers me, it’s the fawning and beard-stroking of the ‘cool not to be a christian anymore’ crowd which I find tiresome.

    They don’t believe in Jesus anymore? OK... passé... feng shui... but they should get over themselves, the rest of us already have.

    People are shocked that the Jesus story is Jewish history? Really? People are shocked at the myriad of politics, religion, violence in Jesus’ day? Apocalyp-a-tastic! We always thought of Caiaphas as a baddy? Really? People never noticed a human dimension (Mary etc.) in the story? Really? People never saw a ‘Marxist critical perspective’ in the Jesus story before? People never saw doubt in the text before? They thought Jesus was a long-blond-haired Victorian?

    As for ‘sparing blushes’, the biblical text is hardly guilty of that either.

    Each and every one of these rewritings are presented as new, notable, risqué... it’s like sniggering in the back row of an SU meeting.

  • Comment number 28.

    While we are using this only open threrad on W&T to go off -topic, I might as well join in.

    The butler did it! Though it seems he may get off lightly, given that he says he stole the documents to expose various forms of corruption within the Vatican. It is in the Vatican's interest to go easy on him and keeping him from spilling everything he knows, rather than throwing the book at him and antagonising him to the point where he'll tell everything to any paper or tv station.


  • Comment number 29.

    And in another Catholic church related story, in Germany they are clamping down on those not paying extra income tax to the church, threatening deny the sacraments those who don't.


  • Comment number 30.

    And one story for one of the blog's Catholic regulars, rather than a Catholicism related story. :)
    A story might actually be slightly related to this thread on money and medicine.

    mscracker, some time go you posted being divided on science, saying it sometimes does amazing things, while in other cases, e.g. in case of the pharmaceutical industry, profit motives distort and poising the science into something rather dark. There was an article in the Guardian that is somewhat likely to send chills down your spine. Even if it were to prove a bit sensationalist and exaggerated, if things are half as bad as described in the story, it still looks pretty bad.


  • Comment number 31.

    Might the outrage in the muslim world be worth its own thread here, Will? Here is a Brit who managed to get worked up pretty badly about it himself in response, though he sticks to having an angry rant about it on YouTube, rather than causing death and destruction due to his outrage.


    Instead of getting angry about it, I think I might prefer ridicule in reply. :D

    [Unsuitable URL removed by Moderator]


  • Comment number 32.

    And what thread on W&T would be complete without some attention to creationist shenanigans? It seems the creationist victory at the Giant's Causeway visitors centre has been mostly undone.


  • Comment number 33.

    And finally for this morning, it is good to see that with Greece's economy about to fall off a cliff, the authorities there have their priorities right. When your have such urgent, humongous problems on your hands, of course the first thing on your mind is to lock up some Pastafarian (blessed be His Noodly Appendages) for blasphemy.



    And I see that the image on The Onion website linked to in post 31 was a bit too much for the moderator. Even though no one was killed because of the image (hint hint, Google.......?). :D

  • Comment number 34.

    I know I tried this before and couldn't get a hearing, but maybe people will listen to Michael Ruse:


  • Comment number 35.

    @30. PeterKlaver ,
    Thank you for the Guardian link.Very good article. Appreciate it. It reminds me again of the old saying that "figures don't lie but liars can figure."
    Here's a book I found a while back in the library.Not only may data be intentionally skewed in studies, but drug trials are often carried out in third world countries where informed consent is an issue.

    White Coat, Black Hat: Adventures on the Dark Side of Medicine
    Carl Elliot (Author)


    My daddy attended a UK osteopathic school many years ago.He didn't complete his training, but learned enough to pass on a healthy skepticism of mainstream medicine.

  • Comment number 36.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 37.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 38.

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