'The charges problem boils down to a classic dilemma of democratic politics in a market-orientated society'

Now that Mrs White and I have reached an age where we are starting to get our taxes back from the NHS we recently made a visit each to our local London teaching hospital, the one I call Charing St Guy's, on the same day. Wow!

I went by bus with my free pass (hurrah!), but Mrs White had a minor op and needed collecting in the car. But where to park on this crowded urban site?

I took a punt on Charing St Guy's double yellow lines and dragged the wife out of the ward by her hair ahead of the yellow line police. Well done, Mike.

I thought of the incident when reading the Commons health select committee's new report on an old problem: NHS charges, which as you probably know yield a hefty£1bn a year towards health secretary Patricia Hewitt's budget pot, less than half of it from prescription charges which fewer than 50 per cent of people pay - and pay on only 11 per cent of scrips.

Kevin Barron's committee has produced a fascinating report, not least because lay people like me can understand every word of this thorny issue and the simple dilemmas it has posed since charges were first introduced to help pay for the Korean War in 1951. The row brought down Clem Attlee's mighty Labour government.

Mr Barron, a Labour MP, tells me that it is parking charges which get people most angry, if his constituency mail bag is any guide, and I am sure it is.

In England - oh those grasping English - rates range from 30p to£4 an hour: you can pay up to£30 a day.

What the problem boils down to is a classic dilemma of democratic politics in a market-oriented society - indeed all societies.

Dangerous imposition?

Is charging for any aspect of public services, especially one so central as health, an unfair and dangerous imposition on the poor? Or is it the only way to achieve an effective allocation of scarce economic goods without waste or excess demand, not least by the feckless poor who are as careless of the NHS's money as they are of their own health?

The answer to both options is, of course, 'Er, yes.' Hence the dilemma.

The Barron report, agreed unanimously after evidence from experts and two visits, to Wales (where charges are being abolished) and Sweden (where they are not), confirms that everywhere in the world all forms of charges inhibit people from going to the doctors, dentist or pharmacist.

Not to mention travelling, by both public and private transport, to visit friends and family in hospital. At issue is the cost of the bus as well as the car park.

This report reminds us all how hard life is on the poor and made me remember how my mum couldn't visit me in hospital in Truro for six weeks in 1950. She was also having my baby sister at the time, which I can now see won't have helped.

But how to resolve the conundrum? The committee doesn't, any more than its last inquiry did in 1994. It has good ideas and buck-passes them by telling ministers to stage a 'major review.' It would include the extent to which charges - 'co-payments' in New Labour-speak - reduce 'frivolous' demand. But it does make some short-term proposals to address acute unfairness, like an extension of the hospital travel costs scheme and a cap on weekly car park charges. Oh yes, and better publicity for ideas like the prescription season ticket which I no longer need because it's FREE too!

One eye opener for me was the hospital bedside phone racket. Incoming calls are charged up to 49p a minute and the phone firms pile on pressure to ban mobiles on the ward, the rascals.

Not having spent more than an hour at a time on an NHS bed since 1950 I wouldn't know, but Mrs White says you can use the mobile if you're crafty.

But like several dilemmas in this report it strikes me that the service is still catching up on the high-tech front.

We should surely soon be able to offer patients phones, TV, broadband internet access all down the same fibre optic pipe that the doctors will be using to access their medical records. Or is that too optimistic?

Michael White is assistant editor (politics) ofThe Guardian .

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