27 May 2014

The slippery slope fallacy and charging for NHS prescriptions

The slippery slope fallacy is a way of ridiculing an argument that says, “If we allow A to happen then Z will eventually happen too, therefore A should not happen.” The typical example is, “If we allow same-sex couples to marry, then eventually we'll be allowing people to marry their parents or their pets.”

To be fair, it is only a fallacy if no evidence is presented to support the theory that, if A happens, then Z will happen too. So the typical example above is a fallacy because there is no real evidence that people want to marry their parents or their pets. On the other hand, if there is evidence to support the contention, it is a reasonable concern, not a logical fallacy.  An example is charging for NHS prescriptions.

Prescription medicines were free of charge when the NHS was set up in 1948. In 1952 the Conservatives brought in a charge of one shilling (5p) per prescription and in 1965 Labour abolished it. In 1968 Labour reintroduced charges and set them at two shillings and sixpence (12.5p) per item, not per prescription, but with exemptions for the old, the young, people on benefit, and people with chronic disabilities such as diabetes. Since then, prescription charges have gradually increased, with the rise getting steeper over time.

A review at politics.co.uk states: on "decimalisation" in 1971 the charge was 20p per item, where it remained until 1979, when the new Thatcher government increased it to 45p, then twice in 1980, to 70p and then to £1. It has gone up every subsequent year since 1982. During the mid-1980s it rose by about 20p a year and in the early 1990s this accelerated to 25p per year. When Labour came to power in 1997, the annual rise went down to 10p, which brought the cost up to £5.65. In April 2012 it went up from £7.40 to £7.65 and in April 2014 it went up to £8.05 per item. 

Throughout the period the proportion of people who actually have to pay for their prescriptions has always been relatively low at about 20% of the population.

Still, while people on low incomes are exempt from prescription charges, charges can be exorbitant for those who are just above the poverty line. Someone who is sick or disabled and in the “assessment phase” of employment and support allowance (ESA) and who has a tiny extra income (for example, a small occupational pension or some income from savings), which brings their total income up to £80 a week, would be classed as having too much income to get free prescriptions, which means that each item would cost them about 10% of their weekly income.

In conclusion, those who have argued all along that NHS prescription charges would undermine the founding principles of the NHS and cause unaffordable health costs for certain groups in society have been vindicated by history. Those who argue now that the Tory coalition government’s plans under the Health and Social Care Bill are going to lead to privatisation of the NHS by stealth are in the similar position of having the evidence of history on their side.

This blog piece was sparked off by the ‘slippery slope’ comment on Saving the NHS for the Common Good, a YouTube video by greenpartyew, which I recommend.


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