Should we be charging for “self-inflicted” diseases on the NHS? (NHBPM 28)

From an article in the Huffington Post0, amongst others, it appears that there are now calls for those requiring NHS care for alcohol, tobacco and obesity related issues to be required to pay for that care.

On the face of it it does sound like a reasonable thing, for those burdening the economy with diseases that were somewhat self-inflicted, to have to pay from their own pocket instead during these hard times. However, I have three issues with this.

1- It’s cruel, and goes against all that the NHS should (and did once) stand for.

2- Where do you draw the line between what is a self-inflicted issue and what isn’t? For example, if you live with a smoker and develop lung cancer, but you don’t smoke yourself, is that self-inflicted because you chose to live with a smoker? Or if you develop lung cancer because you lived in a building with asbestos, is that self inflicted because you could have commissioned a report checking for the presence of asbestos, but you didn’t? And what level of smoking would be regarded as causing the self-inflected – it just takes one mutation in one cell to cause cancer. Does a single puff of a cigarette at the age of 16 count you among the damned? I mean, it could have caused that mutation – so could a random free radical in the air.
Where to draw the line doesn’t even need to be considered, however, now that I have come to reason #3.

3- Are they actually burdening the NHS?

Let’s investigate that a little.

The NHS is funded by taxes; and alcohol, tobacco and fast food all carry a higher tax burden. Each cigarette sold in the UK earns the government 26p1. That means if you started buying cigarettes at 172 and smoked around the average of 13 cigarettes per day3, the government would be receiving in tax from you:
£3.38 a day (or)
£23.66 a week (or)
£1233.70 a year (or)
£66,663.74 by the time you were 71 – the average age for a diagnosis of lung cancer4.
With the average full cost of cancer treatment being only £35,000, the government has made almost double that off you in taxes already.

In a more general sense, the cost to the NHS due to smoking is estimated at £5.2bn a year3,5, whilst the treasury is taking in a whopping great £11-12bn6 in tobacco tax. Smokers have already paid their NHS costs – twice over.

Again, for alcohol, the UK government receives around £9 billion in taxation 7, whereas costs to the NHS are merely £2.7bn8 – a gain of over £6bn from alcohol consumption. Of course, alcohol also causes other issues; the estimate for the cost from anti-social behaviour is £7.3bn. Luckily for us all, such offences can already be punished by fines – but I sadly couldn’t find statistics on the income generated by this.

I also couldn’t find information on the revenue generated from junk food – but people existing off takeaways are likewise paying extra tax for it in the form of VAT, now at 20%. I don’t know how much, however, and am waiting on an FOI request to tell me. Regardless, obesity only costs 5.1bn9 to the NHS per year, which is already dwarfed by the £12-13bn we have spare from alcohol and tobacco, so I think we can offer the overweight a little lenience in this matter.

It would seem from the facts that the smokers and alcohol imbibers are paying for the non-smokers and teetotalers! So, following the happy conservative logic, surely they should be calling for non-smokers and non-drinkers to pay more for their use of the NHS, since they clearly aren’t pulling their weight!

0http://www.huffingtonpost.co.uk/2012/11/27/nhs-should-charge-smoking-obesity-alcohol-tory_n_2196343.html
1http://www.thisismoney.co.uk/money/news/article-1716621/Each-cigarette-earns-the-State-26p-in-tax.html
2According to the NHS, 1/3 of smokers started before 16, and 2/3 before 183, so 17 seems a good example age to choose.
3http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/Statistics%20on%20Smoking%202012/stats_smok_eng_2102_rep.pdf
4http://www.lungcancer.org/reading/about.php
5Although these figures are from 2005-6, they appear to be the most current available
6http://www.the-tma.org.uk/tma-publications-research/facts-figures/tax-revenue-from-tobacco/
7http://www.hmrc.gov.uk/research/alcohol-consumption-uk.pdf
8http://www.ic.nhs.uk/webfiles/publications/alcohol10/Statistics_on_Alcohol_England_2010.pdf
9http://www.dh.gov.uk/health/category/policy-areas/public-health/obesity-healthy-living/

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