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POLICY: No smoking in England By Dr. Eric Novack

In Matthew’s homeland, the National Health Service controls the vast majority of healthcare services available.  Resources are limited—but the government is in control.

In the interest of safety (or is it savings?) restrictions have been placed on joint replacements for people with a body mass index of >30. This would effectively preclude half of all US adults from total hip and knee replacements.

But now a new announcement: No surgery if you smoke.

While smoking is clearly bad for you, should it disqualify you from surgery?
If  smoking and obesity, why not junk food? Or inadequate exercise? Or any other habit / activity that is deemed not ‘for the public good”?   

Maybe we will tax ‘unhealthy’ behaviors and earmark that money for entirely unrelated specific budget items?
                  Oh, yeah, we already do.
                  This passed in 2006 in Arizona…

As we think about healthcare reform, preserving and expanding liberty ought to be first and foremost on our minds.

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7 replies »

  1. Just so, Peter. To hold liberty as the highest public good leads precicely to “you’re free not to be able to afford it”. And if we hold liberty as the highest public good, the results of other people’s bad behavior does not cost all of us — it costs only the individuals who choose individually and on an ad hoc basis to bear the cost. This may well be nobody.
    t

  2. Well Tom, the results of other peoples bad behavior costs all of us. The question I guess is how do we pay for bad behavior and how do we change bad behavior. Insurance companies raise your rates when you engage in bad behavior that results in higher costs for them and the other insured, Catholic or Calvinist.
    “you’re free to buy it or not” for health insurance could just as well be – you’re free not to be able to afford it or not.

  3. > Is it liberty to allow insurance companies
    > to charge more for higher risk people?
    Yes. Of course. Liberty is a two-way street. I’m free to set a price, and you’re free to buy or not.
    > Isn’t a tax on bad behavior the same as
    > higher insurance for higher risk?
    Depends on how the tax money is used. In Canada your case is easier to make. Here its not so clear. Canada (and indeed England & Europe) is, in its heart of hearts and whether it likes it or not, Catholic. Our “public” or “popular” morals tend towards Calvinism.
    Here, Congress tends to think people who engage in bad behavior are bad and deserve the bad consequences of their behavior, which serve as a warning to others. Just as good behavior should have its reward, so bad behavior also. In this system, a Sin Tax is meant to discourage the bad behavior, and will not necessarily be used to mitigate the temporal consequences experienced by the sinner. And so there is no correspondence between a Sin Tax and an Insurance Premium.
    t

  4. Eric, did you even read the article, or are you intensionally trying to mislead us?
    From the aricle:
    “Smokers are to be denied operations on the Health Service unless they give up cigarettes for at least FOUR WEEKS BEFOREHAND.” Not quit, just stop. 4 weeks!
    Four weeks, boy that’s a hardship – not! It also said non-stoppers would get surgery but MAY would wait longer. Wow, what a draconian measure – save me,save me!
    So Eric is it “liberty” to have the freedom to squander scarce resources? I guess you also think it’s “liberty” to be able to pollute.
    “While smoking is clearly bad for you, should it disqualify you from surgery?”
    I’m not sure Eric, I guess it depends. Should we give lung transplants to smokers who’s habit caused the lose of their lungs and who will continue to smoke after? Should we do hip transplants on obese people where the chance of success due to their weight is remote? Should we do liver transplants on alcoholics? Tough ethical questions. Even Barry Carol wants “Qualy Metrics” to determine cost effectivness of healthcare procedures.
    “If smoking and obesity, why not junk food? Or inadequate exercise? Or any other habit / activity that is deemed not ‘for the public good”?
    We tax cigarettes and alcohol why not junk food and ebesity? Is it liberty to allow insurance companies to charge more for higher risk people? Isn’t a tax on bad behavior the same as higher insurance for higher risk? Should young teenage drivers pay more for car insurance?
    As for the cigarette tax for the AZ program I don’t think it’s totally unrelated.
    “to fund voluntary early health screenings and education programs for children zero to five years old throughout our state.”
    Tell me if you think the program is worth while. Then tell me how you would fund it. I agree that the general fund use of specific taxes is wrong but that’s because no body wants to be taxed, so the politicians have to play this game of rob the easiest peter to pay paul to give the illusion they are not raising taxes. “Mr. Politician give me something for nothing.”
    You’re not realy interested in cutting health costs or your perverse definition of liberty without responsibility, you just want to profit from waste and inefficiency.

  5. “While smoking is clearly bad for you, should it disqualify you from surgery? If smoking and obesity, why not junk food? Or inadequate exercise? Or any other habit / activity that is deemed not ‘for the public good”? ”
    Of course. And to make it fair, I still say just execute every tenth person. Excepting politicians and doctors of course.

  6. > As we think about healthcare reform,
    > preserving and expanding liberty ought
    > to be first and foremost on our minds.
    No. As we think about healthcare reform, preserving and expanding human solidarity ought to be first and foremost on our minds. Solidarity makes claims on liberty.
    t

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