The Nobel laureate Paul Krugman has written extensively on inequality, and on zombies. Not the sort that feature in The Walking Dead, but zombie ideas, which are, according to Krugman “a proposition that has been thoroughly refuted by analysis and evidence, and should be dead — but won’t stay dead because it serves a political purpose, appeals to prejudices, or both”. Such an idea was disinterred again last week, when the British Medical Journal discussed charging people to see their GP.

One point that should – but apparently does not – kill the idea of GP charges is that we already have an example of healthcare in the UK that is not free at the point of use, that of dentistry, which illustrates some of the dangers: there are huge inequalities in oral health, with some people even resorting to “DIY dentistry”.

One of the factors sustaining advocates of GP charges is that the debate is disproportionately conducted by affluent people, who can be out of touch with the realities of everyday life.  The advocate for GP charges in the BMJ article referred to “a £10 fee, which most GPs would find acceptable”. £10 may seem like a small matter to some, but for many people that could be the difference between staying within budget and being forced into debt. This is not just something that affects a small number of people: as Oxfam point out, “36% of the UK population are just one heating bill or a broken washing machine away from hardship”.

In the UK, it is often expensive being on a low or middle income, and charges to see the GP would only make things worse. The poorest already pay a higher rate of overall taxes (45% of their income) than the richest (35%). Other examples of products with a “poverty premium” include food, fuel and finance. Healthcare definitely carries a poverty premium:  not only because £10 is a bigger proportion of the weekly budget if you have a small weekly budget, but also because there are numerous health problems that affect low income people the most. People can become trapped in a vicious cycle in which poor health affects earning power which in turn affects health. Charging to see a GP would only make the cycle more vicious.

Politicians regularly tell us that Britain must compete in a global economic race. If we want to compete in such a race we must be fit to do so, and giving people a disincentive to look after their health can’t be a good way to achieve that.  

Duncan Exley, Director