Last week, a National Heath Service board in the United Kingdom announced it was banning surgery indefinitely for smokers and those it considered obese. This provoked a furious backlash, with some labelling the decision discriminatory. However, might they be right, and might we learn something from what they have done?
Put simply, if you don’t care about your own health, why should the government?
There are two schools of thought here. One says that the government has no right to dictate to us how we live our lives, and that banning surgery for smokers and over-weight people today will only lead to discriminating against people who put too many sugars in their coffee tomorrow. The contrary viewpoint is that the government is not the insurer of people’s bad lifestyle choices, and such policies are entirely right.
For the purposes of this discussion, let’s put to one side the treatment of those who are obese. Even if there is no such thing as a “fat gene” – and science does not know if that is so – we do know that some people put on weight more easily than others. Expecting everyone to have the same body mass index could therefore impose more onerous expectations on people with lower metabolisms than people like me who are as lean as greyhounds. There must, after all, be a place for huskies as well.
We can, however, be under no illusions about the risks people take when they smoke.
Statistical studies by the ABS show that smoking is the cause of 80 per cent of lung cancer deaths, and 20 per cent of cancer deaths overall. Moreover, it complicates surgery in most cases, and adds significantly to the cost of rehabilitation, let alone those people who lose limbs due to the effects of years of smoking.
If this is so, why should billions of dollars of public money be spent on complex treatments for diseases which are a direct consequence of people doing what they know to be bad for them?
In fact, allowing people to smoke and then receive free health care is a form of what is known as moral hazard. That is, it frees people from the consequences of bad decisions, or even encourages them to make such decisions.
The complicating factor is that governments are also making a pile of money from tobacco taxes. Figures from the Cancer Council show that total revenues from tobacco taxes, customs duty and GST amounted to $11.29 billion in 2016. The Cancer Council also estimates that, in net terms, state and federal governments make a profit from tobaccos revenues, even after deducting the cost of health care and foregone taxes.
If this is so, smokers are paying their way, and it would be morally improper for governments to deny medical treatment to smokers in Australia, while ever they receive so much revenue from tobacco products.
The addiction of successive federal governments to tobacco revenues was apparent to me when I was in Parliament, and nothing has changed in the intervening years. The reliance on tobacco taxes to plug holes in the budget, is a form of financial perfidy of which all governments should be ashamed.
If federal and state governments were fair dinkum about health, then they would progressively raise the legal age at which tobacco could be purchased by one year, every year, until it is eradicated from our society.
While people like me and many others vehemently disagree with using medical procedures to end people’s lives, it must follow that we have a moral duty to save lives wherever possible.
That extends to eradicating the cause of preventable deaths, especially from smoking related illnesses. Then, and only then, can we dictate the right to health care from a place of moral authority.
Bill O’Chee is a former National Party senator for Queensland.