Thursday 28 August 2008

A Cynical Calculus

'If a problem is about everything, it's about nothing'. That, believe it or not, is Tory health honcho Andrew Lansley, in the course of addressing the latest outbreak of health inequality outrage. Lansley has recently steered quite close to saying the unsayable - that people consciously choose to be unhealthy and die young, by smoking, drinking, eating badly and taking dangerous drugs. They do these things because they want to. Whenever the media pluck up the courage to do a vox pop on the streets of these enclaves of fabulous ill health, that is pretty much what the locals tell them - but of course it does not compute with the mindset that values good health and long life above all things, so it gets ignored.
In fact, we should be grateful that there are so many people out there who don't share that healthist view. By a cynical calculus (of a kind no government would care to own up to), those who drink and smoke a lot and die young not only contribute disproportionately to the exchequer, but also save other taxpayers a fortune in unpaid old age pensions. When smoking was near universal, this suited all governments just fine, as lung diseases could be relied on (generally speaking) to kick in fairly soon after retirement, ending a productive, tax-paying life before much pension had been paid. And now they want us to give up smoking, and drink and eat sensibly - ha! The more healthy the population gets, the more costly it's going to be for us all. So, carry on with your fun-loving, life-shortening ways, you hedonistic masses!


  1. All easy to agree with, bar one thing (probably an even more cynical calculus). And that's the suspicion that the ruling elite of whatever party would really like to withdraw NHS entitlement from anyone whose ailments are judged to have been brought on by their own conduct, i.e. by "smoking, drinking, eating badly and taking dangerous drugs" - or by anything else some maniacal health supremo deems beyond the pale. So, yes, these honchos can issue their verbiage. But not on the basis of an easy ride. I wish they were pinned hard to the wall about entitlement to treatment regardless of, so to speak, the merit of the case.

  2. Alternatively we might end up with a squalid, rock-bottom NHS for precisely those people, while everybody else takes care of themselves with private health insurance...
    When they set up the NHS, they genuinely believed that,once they'd mopped up the outstanding medical problems, it really would become a health service, serving a healthy poopulation, with expenditure dwindling as it became less and less necessary. As Burke said, politics 'ought to be adjusted not to human reasonings but to human nature, of which reason is but a part, and by no means the greatest part'.

  3. This is an absolutely great post, Nige. I never thought of the health dilemma in this way.

    Of course, it makes a sort of sense. Here in America, *many* in the inner cities believe crack cocaine was introduced there by the gov't to destroy the poor and keep them down (read, destroy the black people who are our huge underclass here). It sounds utterly paranoid in one way, but quite believable in another.

  4. Well just my 2 cents but if we want to call ourselves a civilized, Christian country, which broadly we are, then excluding folks from the health service on the grounds the problem is their fault is not the way to go. In some and perhaps even many cases, we don't even know enough to make such a call. It would be using moralistic mumbo-jumbo to excuse our ignorance of genetics.

    And have you checked the small print on private health insurance lately? At lot of it is becoming a complete scam. Get something that actually requires serious treatment and all sorts of exclusion clauses about chronic conditions and the like kick in.

  5. Oh I don't advocate it, Mark - just fear it might, in effect, end up that way. Lord knows they could easily refuse me treatment on all manner of grounds - same goes for most of us probably, and it is indeed a sinister (and authoritarian) trend. Though there might be some justice in levying a small charge on the drunks who swamp every A&E in the land every weekend...

  6. Interesting you mention alcohol and A&E. I was recently told (by some staffers there) that 80 per cent of the load in my local A&E is related to drink or drugs every day, not just weekends. What seems to be going on is that a lot of the "regulars" are encouraged to migrate for a while - to another health authority. So they all go down to the South Coast for the winter. Then, in April or May, they head back northwards to take what they can off the tourist trade over the summer. My hunch, if you studied this pattern, is that it may have been going on for many decades or even centuries. If Bruce Chatwin had written The Beerlines, I'd guess this would be it.

  7. My friend Jack was an ER nurse in Edinburgh before he became a folklore Ph.D. in Philadelphia. He says they didn't need a watch to know when the pubs had closed, 'cause that was when they got their vast influx of patients: Alcohol-related accidents, fighting, etc.

  8. Ah yes Susan - and in the old days in Scotland they had to drink fast as the pubs only opened from 5 to 10 (and on Sundays didn't open at all). Seems unbelievable now, though I believe some Hebridean islands are still 'dry'. The old puritan thing - abstention or excess...

  9. Scotland's pretty puritanical with booze at the moment. It's almost hysterical; they want to raise the drinking age to 21 among other things. So you'll be able to get married, get a mortgage, fight in Afghanistan but not buy booze. The only brightside is that it may be the one policy that turns Scotland against Salmond.

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