New Year, Old Problems

It is a new year and as always, I have been inundated with well meaning text messages and emails saying things like “have a great new year” and a fair few saying the optimistic “I hope 2008 is an even better year for you” – not that anything went wrong in 2007 (at least for me). In the same manner, the TV has all manner of pundits going on about how great the new year will be and generally around this time of year there is a lot of optimism. We seem to assume that as the world gets older, we all get wiser and, collectively, things will get better.

Personally, I think it is crap.

As Heather alluded to in a previous post, we (*) are not getting wiser. If anything, our culture is undoing every “good” that our forefathers fought and died for. Problems which previous generations thought were “solved” have returned and it seems that the entire world is racing back to the mythical version of the dark ages(**) as fast as it can. In fact, it seems we are trying to invent a society which would be frowned upon by feudal serfs as too harsh and cruel.

It is with this at the back of my mind, that I was far from shocked to read today’s Guardian newspaper:

Smokers could be required to quit in exchange for NHS rights

People could be expected to lose weight and give up smoking in exchange for rights to healthcare to be enshrined in a new NHS constitution, Gordon Brown will signal today.

In case you get the wrong idea, I am rabidly anti-smoking and, if I had the power, it would be banned in all public spaces (open and enclosed) and smokers would only be allowed to smoke in little cages with no air escapes.

However, this strikes me as being insane. It is plain wrong and undermines the basis of the National Health Service.

In the UK we have an admittedly flawed national health service but even at its worst it is better than pretty much every other one in the world. The NHS provides care for all, not worrying about the sick being rich or poor, not worrying who is fortunate enough to have a job which comes with health care or is fortunate enough to be able to afford to treat their illness. Sickness, disease and infirmity affect everyone and (with a few exceptions) doesn’t care about the victims social status or income.

It seems our society is trying to lose this fantastic service. There are repeated talking heads on the TV news saying how “we” (the public) shouldn’t have to pay for the treatment of people who are suffering what are often described as self inflicted illness (cancer in smokers, diabetes in the obese etc). However, the problem covers more than the two currently acceptable bugbears of our society.

It is easy, and almost required, for “health experts” to vilify and demonise those who smoke or are overweight (***) – especially at this time of year – and it is also a seductive point that people who smoke or are overweight may cost the NHS more than people who don’t/aren’t. Leaving aside the argument as to if this is even true, the principle is flawed.

The Health Service is there to help care for, treat, heal (etc) the sick. People end up in hospitals for all manner of reasons and trying to deny them access to services based on what is largely a value judgement on their lifestyle is foolhardy. Today we may think of denying smokers who refuse to quit treatment for infections (reduced immune defence) or cancers, and we may think of denying the obese surgery (or pretty much anything) until they lose weight. Why stop with those two groups? When the NHS saves fortunes by this simple limitation of service, it will have its budget cut and have to seek more cost cutting moves.

Why not refuse to treat people who play sports for any related injury? Physiotherapy costs a fortune and easily as many “sporty” people are undergoing it – sprains, tennis elbow, hamstring injuries etc are all the result of a pass-time they have chosen to take part in so why should we [the public] fund their treatment?

If that is too harsh, what about people who drive too fast? If they have an accident why should we [the public] pay for their ambulance and hospital time? Not just people who drive too fast but people who are just crap drivers! The ultimate in self inflicted injury – they are too ignorant to learn to drive well so we shouldn’t treat them at public expense.

This is great. We can include people who injure themselves through incorrect lifting techniques (they should have known better), people who catch STIs from unsafe sex (they should have known better), people who travel abroad and catch illnesses (you get the idea…)

Where do we draw the line? What reasonable criteria is there to deny a “National” service to one segment of society? A valid counter argument is that everyone funds the NHS by their tax payments. Can people who are “refused” a treatment refuse to pay for it?

Equally worrying, this is another example of how an ostensibly socialist government seems happy to encourage a two-tier society. Rich people will not be affected by this, so in reality only the poor serfs are at risk. What happens when the great unwashed, overweight, chain smokers catch the Black Death is anyone’s guess…

Before I rant too much, it seems the newspapers (and TV news) might have got carried away over this. From the BBC website:

Patients with unhealthy lifestyles would not be penalised under a proposed NHS constitution, the government says.

Those offered medical guidance would be encouraged to act in a “responsible” way, health minister Ann Keen said.

Ok, not really reassuring given the governments ability with doublespeak, especially when read in conjunction with this:

A constitution would set out patients’ “rights and responsibilities”, Prime Minister Gordon Brown said.

Interesting choice of words, Mr Brown… Heading back to the Guardian, the article finishes with:

[about NHS reform] And I believe they will transform the experience of the NHS for millions of people in this country.

Does this imply their experience will transform into losing an NHS?

I was googling for some relevant examples to use about this and I came across a quote (attributed to Hitler ) which seems relevant even if its provenance is dubious:

The best way to take control over a people and control them utterly is to take a little of their freedom at a time, to erode

rights by a thousand tiny and almost imperceptible reductions. In this way the people will not see those rights and freedoms being removed until past the point at which these changes cannot be reversed – Adolf Hitler (****)

Seems a good description of modern society. Would the people of the early 1950’s think we have “progressed” towards the Utopia they hoped the post war years would bring, or are we in fact sliding back to the horrors of the Victorians?

(*) I use this to mean the UK for certain and the US as a probable – the rest of the west is possibly included but I make no general comment as to the rest of the glob.

(**) Before I get shouted at, I am aware the “dark ages” were not as filled with ignorance, suspicion and horrors as my school history class used to pretend. I am also aware that the Dark Ages only really applies to the west, but that is where I live so it is where I assume the whole world lives… I am not alone in this mindset…

(***) Have you seen the Prime Minister?

(****) I have tried, but I have been unable to even slightly verify this is an actual Adolf quote. It seems to be used a lot by right-wingers who want to rubbish the government and may be a form of Godwins Law. Oh, dear Thor, I am turning into a Right Wing Express reader… Strike me down now!