Also on health...

... but back in the usual hemisphere that I get upset about, I read this By Minette Marrin:

A tax on junk food will help offset those looming NHS cuts.

Give me fucking strength...

Debt means cuts. There is no way around this obvious fact of life. If you have run up serious debt on jam yesterday, there will be no jam today nor any jam tomorrow, for many tomorrows to come. You will have to spend more of your income on debt and less (if any at all) on jam. Vast public debt such as ours means huge public-services cuts.

Okay, sounds reasonable, go on.

Yet most politicians seem either unwilling or unable to talk about it like responsible adults.

Yeah, also true. And?

There will, for instance, have to be cuts in the National Health Service, no matter what they pretend. Last week the NHS Confederation predicted an enormous shortfall in NHS funding starting in 2011 – the equivalent of a cut of £8-£10 billion. The government is trying to get out of admitting this, but failing. The Tories have admitted something of the sort but are backtracking. All that’s clear is that the golden years of NHS spending are over.

No shit, Sherlock. There's some more stuff about how NHS spending under Labour is up but productivity is down, but let's just cut to the chase, shall we?

I think what’s needed now is a quick fix or two – something simple and fast-working, something even a health secretary with attention deficit disorder can understand.

The most obvious, I realise, has to do with preventing chronic illness in the first place. Until last week I had always thought this fell into the category of bossy government intrusion – wasting squillions on telling people how many potatoes to eat and on useless quangos. To me the phrase “public health” had come to mean “public nuisance”.

You're not the only one, but "until last week" you thought it was bossy government intrusion and a nuisance? Hmmm, not looking good for individual freedom.

However, my mind was changed... the main burden upon the NHS comes from chronic diseases – cardiovascular disease, lung disease, diabetes and cancers – which, apart from causing drawn-out suffering and death, are hugely expensive to treat. All these conditions are often caused or made worse by smoking, inactivity and a bad diet.

Oh fuck. I knew it. Another fucking dose of fucking health nazism. Strength Through Joy.

I am sick of people talking about health education and “lifestyle choices”. What’s clearly needed, contrary to everything I’ve always thought, is a little compulsion. Our NHS and our economy cannot take the consequences of poor lifestyle cho

Well I'm sick and fucking tired of revolting authoritarian cunts telling me how to live my fucking life and how to treat my fucking body, and I despair whenever I hear that someone who has recognized this nannying for what it it is in the past has gone over to the enemy. As for the NHS being unable to afford these lifestyle choices, Minette, has it not occurred to you that the fact that so many people expect the NHS to sort out their bad decisions might perhaps be the fault of the NHS itself? Mr Fatfuck of 20 Rothman's Terrace expects the NHS to sort out his smoker's cough and dodgy ticker for free because that's the whole point of the NHS, and because politicians of both sides keep wittering on about the NHS being free at the point of need. Mr Fatfuck therefore has absolutely zero incentive to change his lifestyle, and Minette Marrin and others with similar opinions must be vaguely aware of that or they wouldn't be advocating "a little compulsion". But if Mr Fatfuck had to pay his medical costs himself, or more realistically via insurance premiums weighted according to the risks the insurer assigns to his lifestyle, he might well choose a healthy lifestyle voluntarily. Of course, Mr Fatfuck in turn is aware that he's already paid for any NHS treatment he needs through his taxes, though of course he's really overpaid or underpaid since the chances of any individual's NI contributions covering exactly the amount of medical care they need are pretty remote. That's by the by, the point is that there is no incentive for Mr Fatfuck to get health insurance, which in turn means the incentive of market driven risk related costs persuading Mr Fatfuck to change is lost.

Second, the polluter must pay, as the Greens always say. The polluters who manufacture junk food of all kinds should be forced to label it, like cigarette packets, with simple information about calories. And the food itself, the pollutant, should be made extremely expensive, by high taxes, so that those who are polluting their own bodies would have a powerful incentive to stop.

Unnecessary, complicated and intrusive for both companies and individuals. An equally powerful incentive could be achieved if, as I said above, the Mr Fatfucks of the world chose private health insurance. The only obstacle is that there is currently a disincentive for them to bother - the "freebie" NHS. Now if Mr Fatfuck paid less tax in return for having private health insurance he'd have a powerful incentive to stop whatever unhealthy habits he had - every pound he can reduce his premium by is a pound he has to spend on something else. So, pulling a few numbers out of the air, say his tax bill goes down by fifty quid a week but as a fat smoker who thinks exercise involves green faced children with rotating heads his health insurance is about £40. So he's tempted to do it because it save him a tenner a week, but it is only a tenner. However, already he's not the NHS's problem anymore, on top of which he might start asking about how he can reduce his premium and save money. Perhaps he'll be told that it's a fiver less for losing weight, another ten if he gives up smoking and five more for taking up jogging - half his costs, which were already 20% lower than being a fat bugger waiting around for the NHS to fix anything that goes wrong as a result of his unhealthy lifestyle, and that's before any savings from the change of lifestyle itself. Now obviously those numbers might not be that realistic but a free and competitive health insurance market should keep premiums down anyway, so the tax reduction need only be enough to tempt even unhealthy people off the state and into the insurance market to begin with. Large enough to feel noticeable after likely insurance costs basically. After that the incentives of the market take over by rewarding healthier lifestyles with lower premiums.

Your suggestion, Minette, unpleasant and authoritarian as it is, does have the financial incentive of not spending money on overtaxed unhealthy living. But that's the only incentive it offers, and we know from the numbers of smokers still around or the level of alcohol abuse - both heavily taxed - how effective that's likely to be. You want to reduce the drain on the NHS to cope with the inevitable cuts that in the near future some politician, spineless though they might ordinarily be, will be forced by circumstance to bring in, and you want to use people's wallets to do it. Fine, but surely you'll achieve more by getting people to want to opt out of the NHS altogether. Give them a reason to take responsibility not only for their health but their healthcare, and not only can you expect healthier people but the cuts you foresee will come about as a natural result of the NHS doing less. In fact it might not do all that much less since a lot of treatment funded by health insurance will probably happen in NHS hospitals anyway, just with an insurer picking up the bill.

Not everyone will want to do this of course. Some might be ideologically wedded to the idea of the "free at the point of need"* NHS and others might simply fear the market and the possibility of variable costs (though I don't know how that can be a greater fear than the variable amount forcefully taken from them by the government, or indeed the variable quantity and quality of NHS health provision - the "postcode lottery" - as things are now). And of course others will simply be unable to afford to opt out of the NHS because they're already on the breadline as it is and pay such a small amount of tax any reduction wouldn't cover premiums.** For them the NHS and how they pay for it can remain pretty much as is, but if I was one of them looking at friends or family enjoying their extra disposable income from the savings on their healthcare costs, which incidentally can only benefit the economy as a whole and as such will provide a little extra VAT etc to the Treasury, I'd be very tempted to follow suit.



* Translation - paid for on an ongoing basis regardless of any need.
** No idea how many this would be but there'd certainly be some, though given that the British poor are overtaxed anyway it might not be as many as we'd first think. Just say you raised the tax threshold a bit anyway to slacken the jaws of the poverty trap, because it's too damn low by far at the moment, but raised it a lot for those who bought private health insurance. What effect might that have?