January 02, 2008

The NHS and lifestyle choice

Matt Sinclair thinks that the NHS reduces the sphere of private accountability to a minimum because all risk is pooled together in one pot. If your healthcare is not something which costs me any money, I don't feel interested, in Matt's view as to whether you smoke or not or take drugs or not or do whatever you wish to do. If your healthcare is something that costs me money, then in a Millite sense (that any action which is other regarding we should have the ability to regulate) I have the right to regulate your conduct. Its a worthy argument- I think though that its wrong- partly because it overestimates the actual strength of the Millite position on liberty.

Let me explain with the use of a couple of empirical points:

a. It is true that the age of healthcare has been the age of increased regulation of what we put into our bodies- opium in the form of laudanum was legal in the nineteenth century but isn't today. But there isn't much evidence to connect the fact that drugs are illegal with the survival of the NHS. Those who support the NHS and support drug legalisation today often overlap. Whereas those who want to privatise the NHS and support drugs being illegal often overlap as well. Homosexuality is not under threat from those worried about STDs, its under threat from those worried about the Bible. The 'yuck' factor and not the abstract Millite argument is what really motivates bans. Look at the distinction between the discussions about banning fatty food and stressful jobs- there is a discussion in the one case for aesthetic reasons, there isn't in the other because an overworked lawyer is more attractive than a fat slob.

b. Matt misunderstands wilfully Mill's argument and consequently misinterprets the zone of Mill's freedom. Mill's concept of freedom is very tricky to understand- but if it were as Matt suggests inclusive of all actions that affected others in any way, the area of free rights would be tiny. Afterall all our actions in some ways effect others- even actions taken in complete privacy- a choice of job afterall effects others sometimes more than a choice of lifestyle does (even in a system with an NHS). This brings me to another point, what Matt neglects is that of course other regarding actions don't require a state to be other regarding- my health has more profound implications for many than those required to pay for it. It has ramifications for my family and for my friends (including Matt) which go far beyond its ramifications for the state. Matt states that public healthcare makes everyone's health a 'public good'- sorry my friend actually everyone's health is a 'public good' whether you have a healthcare system or not.

c. Matt's preferred solution is that,

individuals, rather than taxpayers, are paying for their health insurance it should be possible to allow adjustments in their premiums for healthy behaviours.
His preferred solution though creates many other problems. Genes matter as much as environmental factors- would Matt accept a system in which companies were allowed access to our genetic code and set different premiums based on that for various people, sometimes prohibitive premiums. What about such premiums actively discouraging people for example from performing various important jobs- take for example those who volunteer to be part of the royal lifeboat association (something that involves them in great risk for a real public good and for free)- that would incur them a higher premium is that fair- the same thing might be said about special constables. The concept of splitting the insurance pool for healthcare could take us down some very dodgy paths.

Healthcare isn't an easy issue- but splitting up the insurance pool doesn't seem to me to be a good way forward in tackling it. Nor does a strict adherance to a particular concept of Mill's argument for liberty. Matt Sinclair is one of the most intelligent bloggers on the right and raises an interesting issue- but I don't think he manages to provide a good answer to his question nor to frame his question in an appropriate way.


Matthew Sinclair said...

I've responded to this over on my blog.