Nobody sets out to become an alcoholic. Nor is there a single person who wakes up and thinks: “Hell, I can see the appeal of being obese.” You choose to sink a lager, sure. You choose to eat a Big Mac. But that’s not proof of the indomitable power of human free will. If your biology is wired especially to enjoy alcohol, or fat, then it will be pulling a few strings. The brain is not too good at seeing the bigger picture, either. It is more comfortable in the short-term – a nice glass of wine – than in the long-term – the possible shattering of your health and happiness.
The need to re-state this comes after the Northern Ireland Health Minister, Edwin Poots, suggested that the NHS ought to present alcohol and drug abusers with a bill for their treatment. “The United Kingdom has a great principle of healthcare, free at the point of need,” he began. “But I think on occasions it is abused and we sometimes need to look at how we can make sure that abuse doesn’t take place.” In other words, it is a wonderful idea, but a better one would be to do the complete opposite.
If you don’t smoke, booze, jaywalk or pursue any other kind of activity that increases your chances of a trip to A&E, then perhaps you’ve earned the right to sit with Mr Poots in judgement on what kind of lifestyles merit free treatment on NHS. Otherwise, you invite the only semi-fatuous response: if we’re making drunks pay, why not skiers? Or cyclists? Or base-jumpers?
The NHS was founded, we are often called upon to remember, during a window of post-war solidarity that allowed for the creation of an essentially socialist institution. I quote Karl Marx in full awareness that, in a contemporary political debate, it’s as good as doffing your cap to Krusty the Klown: From each according to his ability (in tax), to each according to his need (in costly treatment for liver disease).
The way to slow the warned-of collapse in NHS standards is not to bring in ideas of “deserving” and “undeserving” patients. That would be a disaster on two levels. First, it would threaten the lives of thousands. Second, it would set patients against each other for the attention of a doctor and, at a time when market forces extend ever further into public life, undermine the very idea that an institution can operate on the principle of complete equality.
You don’t find many politicians these days who support the idea of raising general taxation. Before the 2015 election, the Conservatives plan to clobber Labour with the accusation that they’ll fall back on discredited “tax and spend” habits. Taxes can certainly hurt more than they help. Not here, though. We can’t support a functioning NHS on current levels of funding. Either we call on whatever reserves of solidarity exist in modern Britain and everyone coughs up a bit more – via a slight rise in National Insurance, say – or we watch as the health service retires to its sickbed.