Sunday, 20 January 2013

Healthcare, who should pay?

With the sweeping NHS reforms, the question of who should pay for our healthcare is being asked. Along with public health campaigns this has been fuelling the debate as to whether people who make themselves ill should pay for their healthcare. There is a compelling argument for those who believe that if your actions damage your health then you should foot the bill for the consequences. With reports suggesting that societies three greatest vices are costing 16bn/yr; smoking costs the NHS £5bn/yr, alcohol costing £6bn/yr and obesity costing another £5bn/yr. This accounts for about 15% of the £106bn budget, I have to say I do question the sources of these figures but it gives a rough idea. One of the big problems is establishing cause and effect, smoking is an interesting example where cause and effect are clearly linked but are grey around the edges. 

What do you define as smoking related disease? Is someone who tried a cigarette on holiday ten years who has now developed lung cancer classified as a problem smoker? Arguably that one cigarette may have cost them their health, but it is unlikely. So how about the person who had two then developed lung cancer, or three, or four, or a hundred, or a thousand? The question is where to draw the line, you cannot punish everyone who has ever been in the presence of cigarette smoke. 

Lets take a different tack. It is well advertised that smoking causes chronic obstructive pulmonary disease, but what many people don't know is that only 20% of smokers will develop it. This leaves 80% of people with healthy lungs. Should these healthy smokers be allowed to get away without paying for their fellow smokers suffering?

How far would you like to take this? What about those people who go jogging every day to stave off obesity? Should they be billed when they develop arthritic knees? What about people who drive cars, should they have to pay a healthcare premium on top of their existing insurance for all car drivers who are involved in collisions? At the end of the day you are going to end up charging everyone, so why not just stop blaming people and charge everyone equally? Oh wait, it's called tax, and we already have it. 

These are all mere practicalities of who to charge for the services. However, they do not get to the heart of the matter, should we make people pay for their self inflicted illness? I believe that no one should have to pay for their healthcare, even if it is self inflicted. Forget all of these arguments both for and against just stop and think for a moment, it might one day apply to you. What if it turned out that something we had been doing all these years was very bad for us and as a result our children decided that we should pay for what we had done? Not too dissimilar to what happened with smoking all those years ago. I can see the argument for charging people for the ill health they cause themselves, but to me it does not seem practical or morally correct. 

I do not have all the answers and as you can see I have a strong opinion on this issue. What do you think about it?


  1. You say that people shouldn't have to pay for their health care, but it is people like me who work hard, and pay taxes for other people to abuse by say smoking or drinking! The amount of times at university people would get so drunk that an ambulance had to be called. That is a waste of not only NHS money, but wastes the hospitals time having to treat these people who self inflicted it on themselves. So yes they should pay for this, the time and money spent on treating them, is less time and money being spent on more serious issues!

  2. ^^
    Sadly it is easy to say, but where would you draw the line? Obese people have a higher risk of heart attack, so lets make them pay. How obese? Would a BMI of 26 count? What if they are a rugby player, they then have a very high BMI?

    What if you go skiing and hurt yourself? It is your fault for putting yourself in that position, perhaps you should pay?

    Getting in a car accident? After all, it is safer to fly...

    I disagree completely. I think those who abuse their health do pay, in some ways, towards their healthcare via the high taxes on booze and cigarettes. Perhaps these could be increased, and a 'fat tax' added, but making people pay for the healthcare at the point of delivery seems like it could start down a slippery slope of giving healthcare to very few people indeed!


I look forward to hearing your thoughts and will endeavour to get back to you