Scotland's free prescriptions
What with so much else going on today, you may have missed a potentially significant moment in the history of the kingdom.
No, not the latest defection among courtiers of the dusky despot of Tripoli, nor even Prince William's upper-class decision not to wear (is this one actually the Daily Mail's 1 April spoof?) a wedding ring.
What caught my eye was Scotland's switch to free prescriptions for all its patients, on the very day when England's rate goes up 20p to £7.40 a pop. Wales and Northern Ireland have already gone free, so the contrast within the British NHS
family is now a sharp one.Does it matter on a day when Julian Glover is exploring separatist Catalonia's latest spat with the central Spanish power in Madrid and the happily independent Irish are being clobbered (again) by the European Union?
In one sense, no. If you have a devolved system of government that reflects ancient historic patterns – and Belfast was a self-governing province for most of the 20th century, Scotland a separate kingdom until 1707 – then elected reps are going to make different decisions.
Good. In time, the rest of us benefit from seeing whether other people's experiments and choices work better than our own.
For that reason, America's 50 states are sometimes called laboratories of democracy. And competition between Europe's warring states through most of the modern era is widely thought to be a major factor in giving Europe the edge over more homogenous entities such as imperial China.
On the other hand, is it smart to bribe the Scottish middle class with its own money – a consistent feature of Scottish National party policy since it took power in Holyrood in the May 2007 elections? And does it help to improve health outcomes in the three Celtic regions?
With the latest Scottish elections due on 5 May – Scots voters' chance to weigh up Alex Salmond's four-year rule and the alternatives – both those questions are more problematical.
In England, as the BBC reminded us this morning, 90% of scrips are free too because children, the unemployed and the over-60s (me included) don't pay – and they are the ones who take the most pills. I take five a day to treat hereditary high blood pressure (hypertension) and related symptoms. They work very well. So far.
But about half the population in England do pay the £7.40 for their penicillin – or buy a quarterly or annual pre-paid certificate (PPC) for about £100 if the sums make sense for them – a policy that raises about £400m a year for the NHS (did I hear "pays for 15,000 nurses"?) as well as dampens demand a bit, as pricing policies are designed to do.
This is known as co-payment and exists across an ever-increasing range of public services in most advanced industrial (do I mean post-industrial?) countries. In Australia, they charge to see the GP. In some places, patients pay "hotel charges" to cover hospital costs.
In Britain, co-payments cover more and more of the cost of higher education instead of letting the taxpayer carry most of the strain.
And, though no one describes it in these terms, all the rackets councils now use to sting motorists are a form of user co-payment, from parking tickets and residents' permits to aggressive fines for minor breaches of road practice. You don't have a car? Then you don't pay.
The Scottish executive – whoops, I mean government – has produced all sorts of interesting paperwork to suggest that free scrips contribute to health and wellbeing because they encourage people to go to the doc and get their medicine – better than becoming seriously ill.
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