A truly repellent piece by Cristina Odone in the Telegraph in which she argues for NHS-rationing by liefestyle and wealth. That’s not quite how she puts it, for sure, but her suggestion that (middle-class) pensioners are losing out to (lower-class) fat people and that something should be bloody done about this is the kind of classist call for healthcare rationing that well, let her make her case herself…

[A]ge comes to us all, and is not the result of  lifestyle choices. There are plenty of conditions, though, that are the direct result of bad habits, poor diet, and the wrong choices [Sic]. These conditions range from obesity and diabetes to smoking-related diseases like emphesema. If a 20-stone, 30-something woman comes into hospital with a bad diabetic attack, does she deserve to be at the front of the queue or the back? She has chosen to stuff her face with Mars bars and Coke, and is now suffering the consequences of her choice. She cannot claim ignorance of the dangers of her diet: the Government has carpet-bombed us with health advice, from schools to GP practices. Class no longer regulates access to healthy living: everyone who can watch the telly, let alone read the magazines, knows that a high-fat diet will make you look bad and feel worse.

Does the obese 30-something lay claim to NHS services and a hospital bed when this means thousands of others will have to do without?

The septuagenarian who develops breast cancer has done nothing wrong – except grow old. The NHS has to consider that there are deserving cases and undeserving ones. Age should not be a barrier to optimum care; but bad habits should be.

Is this view repellent and revolting? Yes, it is. Why is it revolting and repellent? Because it demands that the state spend more time adjudicating your healthcare needs on the basis of lifestyle contributions to your healthcare needs than on those actual needs themselves. It is an invitation to yet more government interference in everything you eat, drink or smoke. It makes the state your fitness advisor. And not just your fitness advisor but your fitness commandant. Do as we say or get to the back of the queue.

This is one of the criticisms American opponents of government-run healthcare often make. It is not an unfair criticism, though of course wholly-private insurance based systems also discriminate against people who fail to observe the pieties of received wisdom of best lifestyle-practice.

This brings me to a libertarian defence of the NHS:  it may not be an efficient system or, by international standards, an especially marvellous one, but it is for the price we pay for it a just about decent-enough system. It is neither great nor awful but somewhere inbetween and at least it does not ration by ability to pay. Nevertheless, it also has this within it: the poor pay enough for it as it is. And it should protect us from government, odd though that must seem and is.

Remember: per capita spending on the NHS is roughly £2,000 a year. A 20-a-day smoker pays roughly £2,500 a year in tobacco duty alone. Those that drink will pay more on top of that. These are the arguments for these taxes: make those whose lifestyle-choices we dislike pay for the costs of all of this. Nevermind that, over a lifetime, smokers and drinkers actually cost the NHS less than non-drinkers and non-smokers. As we move towards a war on sweet or salty food – and move we will, I am afraid – the fat will pay their way too.

And, if you agree with this, that’s fine. It will not stop the public health racket from calling for ever-more punitive measures to be levied on those people unwise enough to make lifestyle choices of which they disapprove (an ever-extending list of choices, incidentally) but it is at least semi-plausible to send "signals" (even if they are unsupported by revenues/expenditure data) to discourage this sort of dreadful chavish behaviour.

Nevertheless, this is the point of the NHS. Treatment according to need not some trumped-up definition of moral-worth. A nationwide, compulsory insurance-pool may be an inefficient means of delivering healthcare but it should have the benefit of affording it according to need not lifestyle. That is why it is designed as a universal insurance pool and why those who make choices of which the state (foolishly) disapproves tend to pay more, albeit usually indirectly. In a better world the universalism would be a protection from the health-police. You know, like careless drivers, careless livers (in every sense) already pay more.

Cristina Odone differs and appears to be some kind of lifestyle-martinet better suited to a role as a Commissar of Health in one of those countries that used to have Commissars of Health. That said, she’s probably well-suited to a job advising this government on how they can mandate (or "further encourage") lifestyle choices.

Privileging near-death, non-smoking, teetotal pensioners seems about as fiscally-reckless a notion as you could hope for. Should the old be treated better by nurses (salt of the earth!)? Sure they should. Are the old automatically more deserving than the non-old? Not necessarily. At least drinkers and smokers tend to die pretty quickly and relatively cheaply. Heroes to the last wheeze.

PS: Last Ms Odone was heard of in these parts was when she complained about how expensive it is to send her kids to Westminster School. Feel free to edit her Wikipedia entry,

 

Tags: Booze, Britain, NHS, Smoking