Friday, June 30, 2006

Smokers' and alcoholics' health care costs

More and more doctors in the UK's NHS believe that those subjecting themselves to unnecessarily high health risks by means of smoking, drinking or eating a lot ought to cover the costs for their health care (as far as their illness is related to their lifestyle choices) themselves. The Guardian reports that 4 out of 10 NHS doctors believe smokers who need heart bypasses and alcoholics who need liver transplants should not get them free of charge through the NHS.
33% believe that procedures such as IVF should be covered by patients themselves.
Here are the details.


  1. Ok I can see this point. I would like to take it one step further. What
    about obesity? Does one have a moral obligation to remain fit? We know
    that there is a substantial amount of illness associated with obesity and
    yet there are no health care repercussions for unhealthy eating. Now for
    insurance there is. Should we adopt a similar model.

    We supersize it and the healthcare system takes the brunt of the financial
    hit for obesity. Is it time to make people accountable for their bad
    habits, including overeating?

  2. Jeez! what happened to the freedom of choice!Anyway i think you are suggesting that the Gvnt shut down all beers and cigarettes manufacturers and boy they are going to lose some serious money and Are they willing to do that? ummh i dont think so! Smokers or drinkers should not be charged if for unfortunates reasons the fall ill..cos i think the gvnt has something to do with it!

  3. Laurence McCulloughJune 30, 2006

    Brilliant! Financially punish people for their addictions on the false belief that these are "lifestyle" choices. The response to addiction (which, of course, displays variation, as do all traits) should be to recognize the irrelevance of autonomy and take a far more aggressive posture,
    experimentally (to identify populations of patients for which such intervention is promising), e.g., involuntary detoxification followed by training, etc., to avoid taking the next smoke or the next drink, supervised environments, training family members to support and intervene. Some brains should
    not be exposed to tobacco products or to alcohol, a fact that these docs irresponsibly ignore.

    There may be an element of autonomy in first exposure, but since those making this choice do so ignorant of their potential for addiction, the choice is not informed and therefore not autonomous (conditions of understanding and therefore of appreciation are not met).

    Thus, on biopsychosocial grounds, these doctors can reliably be judged to be displaying disordered intellects.

  4. Kevin Powell, MD PhD FAAPJune 30, 2006

    In dealing with children as I do, I know their choices are also not ideally
    autonomous, but many child behavior specialists still recommend holding
    children accountable in terms of the natural consequences of their actions.

    To understand the natural consequences of lifestyle, I would recommend a
    1991 work funded by the Rand Corporation, The Costs of Poor Health Habits,
    by Manning, Keeler, et al. Their work precedes the current obesity epidemic,
    but they did evaluate external costs to society of drinking, smoking, and
    sedentary lifestyles.

    For smoking, it is true that medical costs are increased, but due to earlier
    mortality, Social Security costs are decreased. If we charge smokers more
    on health insurance, justice might demand we give them a discount on Social
    Security. The net result for smoking was actually a slight decrease in cost
    to society. And that doesn't account for the much larger sin tax we now have
    on cigarettes.

    For alcohol, the major external costs are really tied up in injuries,
    disability and deaths of innocent victims of drunk driving. There were
    externalities in health care costs as well so a sin tax makes sense.

    For sedentary lifestyle, again the increased medical costs are more than
    covered by earlier mortality.

    It is not clear that externalities from obesity will mirror those of
    sedentary lifestyle, but they should be similar. There have also been major
    increases in expensive medical treatments for many health conditions since
    1991. Artificial joints, stents, and statins are now big time costs. So the
    exact balance of consequences might be worth revisiting.

    Meanwhile, since I plan on retiring about the same time as Social Security
    goes bankrupt, I must disagree with the recent movie (it is a good one) and
    say, "Thank you for smoking, just not around me."


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