Wednesday, 9 February 2011

More Big Problems

Rather than a reply in the comments section of the Big Problems post, it seemed easier and probably more effective to write a continuation. I know I'm not very good at replying to comments, something at which I intend to improve, but just so you know, I read and appreciate them all! Well, except the spam ones wanting to sell me watches, bank accounts in the Far East and prescription drugs...

It's a difficult issue to tackle, because I genuinely believe that there's no one simple solution, much like a large number of issues within health care. Luckily, I'm not big, brave, clever or well paid enough to make these decisions, but as they do impact me directly, I see no reason why I shouldn't have my say.

Paying for health care has always been, and will continue to be a contentious issue in these shores. In North America this argument, to a certain extent, is incongruous with reality, as the vast majority pay into an insurance scheme and receive their health care dependant on if and what they've paid. However, on both sides of the Atlantic - times, they are a changin'...

As far as taxing foods that are bad for us, and those taxes going directly to health care, well, in truth, that already happens. There's no VAT (purchase tax) on food that isn't considered a luxury. Fruit and vegetables are tax free. Chocolate isn't. Simple. Putting up tax in a way that would make these luxuries only affordable to the upper echelons, will only mean that we have very fat rich people. Well, maybe not. But the question remains of how much of a nanny state do we want to live in? Do we want a government scheme by which you must clock in the exact number of calories you've consumed every day? The idea is impossible to manage, and is the antithesis of living in a land where we are free to make our own choices. And as Fee said, taxing cigarettes and alcohol more and more every year, seems to have done nothing to reduce the overall number of smokers and drunks.

Girliebob made a fantastic point. We can't judge whether a person's worthy of an ambulance just because they're overweight. She's paid umpteen years worth of income tax and national insurance into the system with no obvious return from health care, and should be no less entitled than the young mum next door who's feeding three kids on state benefits, despite having paid in nothing. Irrefutable logic.

A private message I received also questioned the charging of patients who self-harm. More often than not, self harm is caused by mental health issues, whether short-term, temporary issues, acute moments of madness if you will, or some who are chronically ill, clinically depressed, and on a downwards spiral that society struggles to understand and accept. Do these people, those who take blades to their arms, those who genuinely attempt suicide, deliberately overdose on drugs, also deserve to be charged when using the health care system? I'd find it very difficult to justify that these people should be charged, despite the fact that these injuries are self inflicted.

Charging for medical services does occur,  even in the UK. We have to pay for prescriptions (certainly in England and Scotland, although the Welsh get them, errr, scot free), we pay at least part for dental care, even under the NHS, and I suspect that more charges are coming. Minty mentioned frequent callers and also questioned at what point on the overweight scale would we start charging. They're good points, and I wish I had the answers. But then, I'd be a politician and have to make them up, so I think I'll stick to what I hope I'm good at.

I've said it before. The NHS is the victim of its own success, and we're all going to have to get used to the idea that the free ride is well and truly over, at least to some extent. I still don't have the answers, but the questions are fascinating, and the discussions you all prompt are even more so.

I'll leave you with yet another point to ponder.

What about the smoker who improves their life by giving up the cigarettes, but then puts on the weight because of it?


Anonymous said...

Unfortunately, Scotland doesn't have universal free prescriptions quite yet :(.

Anonymous said...

Wales does!

Anonymous said...

Scottish people still have to pay prescription charges. Only free if individuals meet certain criterion.

Oneunder said...

Where do you draw the line?
I am a career smoker who complains about having to lift some of our heavy patients off the floor when their only problem is that they are too heavy to get up on their own.
I complain that “if they are too heavy to walk how do they get the food too or from the fridge?”
So let’s charge smokers “they are doing it to themselves”, too heavy, let’s charge. Drunk, charge. I have been to more than one person who had died by aspirating on their own vomit due to drink.
What about sport? Break a leg playing football, should we charge? It would not have happened if they had not taken the risk by playing sport. To take it further, what about the risks of driving, child birth?
If you create a line where are you going to place it?

InsomniacMedic said...

To the 3 Anonymi - Corrected the post! Thanks all...

Rhiannon said...

Well it is statistically evident that people who are in the overweight range of the BMI actually live longer than those in in the normal range. Also obese but physically active people tend to have better longterm health outcomes than those who are slim and sedentary. And given that only a 5-10% weight loss in considered realistic and sustainable for most people which generally doesn't bump one down to a normal bmi how can we in good conscience tax the fat?

Sorry for the run-on sentence! I can reference my sources if you wish ^_^

Girliebob said...

I've been thinking again (dangerous I know) but I don't think taxing the fat people, or the unhealthy food, is going to solve anything.

When I was at school, and I'll admit that I'm 43 now so it was a while back, we had cookery lessons. Proper 'take some fresh ingredients and turn it into a meal' type cookery lessons. A friend of mine has just taken early retirement from her job as a cookery teacher, because she was so frustrated that for years she hasn't been allowed to actually teach the kids to cook something.

So rather than taxing the unhealthy food, isn't education a more long term option? How many of the youngsters coming out of school these days actually know HOW to cook things that don't come in a packet with instructions to take it out of the box and put it in the oven?

Anonymous said...

interesting points being made about possible charges, but as someone else posted, where can you possibly draw the line?
The charity worker who comes home and has caught malaria? should we refuse them care or charge them, because they volunteered to go out there?
The elderly man who tried to lift his spouse when she collapsed rather than waiting for assistance, and as a result gave himself a hernia? I mean, he could have just waited.
What about women who choose to have children? no one has forced them, but pregnancy and childbirth can be very dangerous, so should we say "sorry love, thats a lifestyle choice, you need to pay for that care"?
I think it could be argued that a very large % of illnesses could in some way be at least partly self inflicted, so should we be assessing each persons lifestyle choice and charging them accordingly?

Anonymous said...

I've read both the posts, and the comments on them, and I think some very interesting points are raised. I think in the end, I have to agree with all of those who talk about drawing the line. One point you made in the first article was about extreme sportsmen. When does a sport become extreme? My insurance company considers horse riding to be an 'extreme sport', however in the 17 years I've been riding, I have never needed the assistance of an ambulance and have only twice required non-emergency x-rays on the NHS (one because a sprained ankle took forever to heal, the other to check the healing on an elbow I broke overseas). Equally hill walking - most sensible people would consider hiking relatively safe as long as you have the right equipment - yet any rescue will cost a small fortune in police and ambulance time, and in certain circumstances a slip or fall can result in injuries you would normally equate to an 'extreme' sport.

And what about genetic problems? Do we say that carriers of the BRCA1 gene shouldn't reproduce lest they pass it to their daughters? Do we prevent couples from marrying if they both carry certain recessive genes?

And as someone mentioned, what about driving? Do we force people to pay for the medical treatment in accidents they cause?

Michelle said...

All good points. Also what about the person who has a health condition, and the drugs used to trest it, eg steroids, cause the person to gain weight. Should we then charge them?

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