If the State provides your health care

Then the State will claim the right to regulate your lifestyle that leads to health care.

‘NHS must treat unhealthy lifestyles, not killer diseases’
The NHS must focus on treating unhealthy lifestyles rather than killer diseases because they place the greatest burden on doctors, according to health leaders in London.

40 comments on “If the State provides your health care

  1. It is old age which is the expense, and they all know it.

    Not much you can do about that, unless you are really Left wing.

  2. It’s hard, really, to see the objection to this. If you look at the NHS as a State run insurance scheme, it is doing exactly the same as any sensible insurance provider would do. I’m sure if I declared to my health insurance provider I’d taken up an interest in parachuting from tall buildings they’d be looking to adjust my premiums to take account of the risk. Not being able to vary the financial contributions of its subscribers, The NHS is only left with trying to manage the risk itself.
    It’s only if you see the NHS as an organ of social management, you can start objecting to how it discriminates between risks as part of that social management. For instance not discriminating against dangerous sports. But you’re accepting it has a role of social management in the first place.

  3. @BIS ‘It’s hard, really, to see the objection to this. If you look at the NHS as a State run insurance scheme, it is doing exactly the same as any sensible insurance provider would do.’

    As one who enjoys your contributions, BIS, I am surprised by this.

    Insurance is relatively transparent, governed by contract and, at least in theory, subject to competition. Most importantly, it’s (usually) voluntary.

    I can’t opt out of paying for the NGS, even though it killed my grandmother and kills thousands of other people.

    If there were no NHS, and we were all covered or not) by insurance, the different providers could offer different premiums based on a variety of factors.

    Then there would be no problem.

    As it is, the NHS is not about health, it’s about control (and employment for a client electorate).

    Of course, the strange corollary to this is that we are, currently, reasonably free to take a lot of risks and expect others to pick up the pieces.

    This is another argument against the NHS, and I say that as someone who has taken a lot of risks with his health over the years.

  4. Sooner the NHS is gone the better.

    You have a choice with insurance companies and in a real free market (as opposed to the fascist forum we actually have) said companies would have to really compete. That competition would be unlikely to be about which of them can force the most miserable lifestyle on you. An “unhealthy” lifestyle (altho’ what that is is not clear–eg nearly as much bullshit has been talked about Cholesterol as about AGW) might cost you somewhat higher premiums under a free market–not, I think, that much higher.

  5. @Interested
    I think, if you go back & read what I wrote, I’ve said exactly this. The NHS isn’t an insurance scheme. If it was, one could argue about whether the risk management was appropriate & justified. But the NHS is simply a vehicle for social control. Always was. Difficult,then, to object to it socially controlling although one can about what & why.

  6. @ BIS – I was only really quibbling with your opening pars, but I think the NHS does operate to all intents and purposes as a health insurance scheme.

    This sort of proposal is – as you say – only what health insurers would do if they found out you were parachuting.

    The difference is that the NHS will quite likely one day be ableto prohibit parachuting, wheres the insurer (absent some sort of Obama-like compulsion) can never do this.

    (I know you know this, I guess you phrased it badly.)

  7. Why do I suspect ‘treating unhealthy lifestyles’ = ‘raising sin taxes & employing more people in the NHS Scolding And Scaremongering Teams’..?

  8. @Interested
    Go to any A&E of a weekend & you’ ll see the walking (& sometimes not walking) injured being carried in from the playing fields of England. Treating sports occasioned injuries are a considerable cost to the Health Service. And there’s absolutely no reason to believe indulging in sport is a healthy activity. Yes the body requires a measure of exercise. But sports, by definition, impose requirements on the body it’s not evolved to sustain. Or you wouldn’t have winners & losers or need to train. Or get injuries. The human design answers a need for short sprints, not 26 mile marathons.
    But the medical profession, for some unaccountable reason, promote sport.

  9. @BIS

    Yes, I’ve been to A&E after sports injuries myself.

    It’s probably me, but I’m not sure of the relevance to that of the question of whether the NHS is or isn’t (effectively, and currently) a health insurer, though?

    It seems to me to be part uneconomic health insurer/part coercive arm of the State (leaning ever more to the latter) which doesn’t currently place many restrictions on what you can do – largely because of its socialist origins, the modern fear of judgmentalism, a residual fear of the demos, and because the people involved don’t seem to think very hard about economics.

    ‘But sports, by definition, impose requirements on the body it’s not evolved to sustain. Or you wouldn’t have winners & losers or need to train… The human design answers a need for short sprints, not 26 mile marathons.’

    This is clearly not correct (certainly the first bit). The body evolved to hunt and forage, and the people who hunted more would have been better hunters (or winners). Sport, I expect, replaces a need for physicaly activity that used to be found in manual labour or battle.

    As to the sprint/marathon part, some of that hunting would have involved stalking, following herds for quite some time. With admittedly absolutely no evidence for this, I’d guess that modern humans have probably de-evolved, at least superficially: that at one time we were quite comfortable with loping long distances, certainly in cooler climes or high up in Africa. Kenyans look pretty well designed for marathons to me!

    As to why doctors emphasise sport for health, my resting pulse is in the mid 50s because I walk the dog, run, cycle and lift some weights a fair bit. This is pretty obviously a health benefit. It’s possibly outweighed by the potential for joint/other injury, but I must confess I don’t know the stats. I’ve never suffered any injury in non competitive sport, though. I only do it because I like it, anyway. I don’t listen personally to what doctors say. I have friends who are doctors.

    In any case, I think, perhaps wrongly, that you’re confusing the medical profession with the NHS.

    One is a vast state bureaucracy designed in part to act a bit like a global health insurer, whereas the other is doctors and nurses.

  10. @Interested
    If the NHS was, indeed, behaving as an insurer, with its fixed premium & lifetime cover structure it would, as the Thought Gang suggested above, wet itself at the prospect of me taking up base jumping in late middle age. Parachute, failure to deploy, incidents being usually non-survivable.
    On the sports/fitness angle – you seem to fall into the usual sports enthusiast illogic. Humans did indeed evolve to do some mild hunting & general trotting about. The human arm is quite well designed for throwing a spear. It is not designed for playing 5 sets of competitive tennis & the elbow thus disintegrates. And it is, of course, the competitive nature of sport that’s the problem. We evolved brains so that we could put the least effort in for the maximum return. Hunting injuries were not a benefit. Sport encourages the maximum effort for the least return. The small margin needed to win.
    Keep walking the dog but mind on the stick throwing.

  11. BIS, just to do my stuck record impression,

    The deification of “sports” was part of the Victorian puritan system. The idea was that it would exhaust young people and thus discourage impure thoughts and actions. Hence all the sports clubs set up by churches, reformist capitalists, etc. The whole thing really was based on stopping games being fun- which is dangerous hedonism- and make them into another type of hard work which is good for the soul, etc etc. You stop the young men chasing the girls by making them chase a ball.

    As to whether the NHS was always about social control, I’m not so sure. I’m pretty convinced myself that the primary motivation for the welfare state was provision to the needy, at least from Attlee’s pronouncements on the subject. Whether you agree with that or not, I think the current obsession with lifestyle management arose out of the “New Public Health” which arose later, which was partly motivated by the “old Public Health” putting itself out of a job by being successful in largely conquering both infectious disease and inadequate diet, etc.

  12. @BIS

    ‘If the NHS was, indeed, behaving as an insurer, with its fixed premium & lifetime cover structure it would, as the Thought Gang suggested above, wet itself at the prospect of me taking up base jumping in late middle age.’

    I think we’re probably talking at cross purposes, a bit. Firstly, the NHS is prohibiting stuff – you can’t get certain treatments if you smoke, for instance. Secondly, an actual insurer wouldn’t wet itself; it would just increase the premiums. As the govt does, via tax. I haven’t gone base jumping, but I do ski (inc off piste). I get insured, and take the appropriate equipment.

    ‘On the sports/fitness angle – you seem to fall into the usual sports enthusiast illogic.’

    Not really; I said you’d have to weigh the benefits against the risks, but that I didn’t know the stats. What’s illogical about that?

    I’m not really a ‘sports enthusiast’ either – other than for myself. I want the government and other people out of my life, and I don’t much want to be in anyone else’s.

    I do have a slight vested interest, in that I am a net contributor to the NHS, but I’d prefer to abolish the NHS.

    ‘Humans did indeed evolve to do some mild hunting & general trotting about. The human arm is quite well designed for throwing a spear. It is not designed for playing 5 sets of competitive tennis & the elbow thus disintegrates.’

    You’re moving the posts a bit here. You talked about there being ‘absolutely no reason to believe indulging in sport is a healthy activity’, when I gave you one – my resting pulse.

    Set against that are some injuries that some people suffer. I played competitive rugby and cricket for 20 years and suffered one broken finger, one concussion, two broken noses and had stitches three or four times. On the other hand, I didn’t injure myself doing Saturday DIY.

    None of which says I agree that it’s any business of doctors to tell me what exercise to take, or when.

    As for the human arm not being designed for tennis, true. It also wasn’t designed for bricklaying, typing, needlework, or playing cards. I’m not sure what your point is?
    And I know people who are still playing tennis into their 70s, with entirely non-disintegrated elbows.

    ‘We evolved brains so that we could put the least effort in for the maximum return.’

    Yes – but you surely recognise the benefit (return) that other people see in the sports they enjoy?

    ‘Hunting injuries were not a benefit.’

    No, they were a risk – as are injuries playing (say) rugby. This is not in dispute – it’s just that you’re saying there’s no corresponding benefit.

    ‘Sport encourages the maximum effort for the least return. The small margin needed to win.’

    At the highest level, maybe, and among some wannabes. But for most people, sport’s just an afternoon out with the chaps, and then a few beers in the pub afterwards. Maximum effort? Never seen it!

    ‘Keep walking the dog but mind on the stick throwing.’

    My shoulder’s gone (bowling)!

  13. Don’t forget the compulsory archery, Ian. In furtherance of killing the French. A prospect, in view of my previous marital condition, I’m less than neutral on. But yes. The notion that pain is its own reward. Like opera.
    The NHS was more “from each…to each….” How much social management do you want for your inflated away shilling?

  14. This is very much a feature, not a bug. Go on any lefty forum and they are positively delighted that the NHS provides them with this stick they can use to browbeat the population.

  15. @ Interested

    “Secondly, an actual insurer wouldn’t wet itself; it would just increase the premiums.”

    No, it wouldn’t. If the insurer was, akin to the NHS, obliged to cover you for your whole life, then it would lower premiums to people engaging in life-shortening activities. They’d send out free cigs at Christmas, and have daily prize draws to win a waterskiing holiday in Syria.

    The biggest lie from the ‘Public Health’ industry is that they are trying to save the NHS money. It’s unadultered bullshit designed to justify their own salaries and to appeal to the simplistic thinking of, well, nearly everyone. Dead people are cheaper than live ones, and the younger they’re dead, the better. An insurance company unburdened by ‘ethics’ would recognise this and ‘incentivise’ accordingly.

  16. A few years ago, the NHS tried to calculate the impact of lifestyle on life-time health care costs. It appeared that the total for a ‘healthy’ lifestyle is higher than for unhealthier ones (smoking, being obese). The total cost is a good measure (not pound-for-pound) of the burden put on docters.
    A research institute in the Netherlands did a similar calculation (on a different population) and came up with similar numbers. As far as I remember, your (and my) friendly host mentioned this.

  17. @ bis
    ” The human design answers a need for short sprints, not 26 mile marathons.”
    Completely wrong. Short sprints involve anaerobic exercise with exceptional strains on muscles and joints. Marathons are run as aerobic exercise with no exceptional strains. The mortality rate in the London Marathon is lower than the weighted mean mortality rate for men of that balance of age-groups [yes, I had someone argue about this, but I eventually demonstrated this was true even though I had started only by saying this applied to the period when I had first done the analysis].
    The cost of sports injuries to NHS is non-zero, but relatively small, partly because those with sports injuries are pressurised to pay for private sports physiotherapists because the NHS runs an unstated policy of making you wait three months. It is vastly lower and ,even without that delay policy, would be lower than the cost to the NHS of abolishing sport. Gentle exercise such as golf (FYI I don’t play golf, so I am not talking my own book on this one), reduce sickness and mortality rates,
    There is an evolution theory which holds that early humans hunted game before arrows were invented by running down antelopes who were much faster over sprint distances but would tire more quickly so our distant ancestors caught them up after ten or twenty miles and hit them with a flint or whatever (uncut diamond would be best :-) ) and dragged the meat back to camp. Sorry, I can’t remember the reference but if I wrote down every reference my study would be waist-deep in paper instead of just knee-deep.

  18. @ TTG
    NO
    The largest cost to the NHS of healthcare for males comes in the last year of your life, whatever age you die. [OK, averages - not if you are run over and dead before the ambulance arrives.]
    If you die very, very slowly then it it will cost more; if you are chronically unhealthy due to obesity, asthma, whatever, it will cost more. Smoking *does* cost more for those who suffer chronic disease as a result – but not for those who, like my great-aunt (still gardening enthusiastically and, when necessary, wielding an 8lb hammer into her 80s) had no ill-health as a result.

  19. john77,

    > There is an evolution theory which holds that early humans hunted game before arrows were invented by running down antelopes who were much faster over sprint distances but would tire more quickly so our distant ancestors caught them up after ten or twenty miles and hit them with a flint or whatever

    This was even demonstrated rather well in the final episode of The Life Of Mammals, by someone from an African tribe who still know how to do it.

    > Short sprints involve anaerobic exercise with exceptional strains on muscles and joints. Marathons are run as aerobic exercise with no exceptional strains.

    Would it not be correct to say that Bloke In Spain’s real error here is to talk about “the human design”? Humans have a number of different designs. As has often been noted, West Africans excel at sprinting, East Africans excel at distance running, and Europeans beat them both at swimming. I know I’m not designed for distance running. My breathing has never been able to handle it.

  20. john77: it was I who disagreed with you about marathon risk.

    I reckon that humans are designed to run 20 miles but not 26, which is perhaps why the marathon distance is attractive to people who like a challenge.

  21. @john77
    If humans had evolved for long distance running they probably would have evolved rather more legs. Actually the body plan is a bit of a compromise. It can do long runs or short sprints or swim or climb. It drives cars rather better than any of them.
    Which is the point. There’s no virtue in doing any more exercise than is required to remain healthy. Ask any cat.

  22. “NHS must treat unhealthy lifestyles”

    Actually I agree with this, if that’s what actually happens.

    But what actually happens is that the powers that be identify the “causes” of “unhealthy lifestyles” and ban, tax or restrict them, inflicting a collective punishment on those who do not have “unhealthy lifestyles”.

    The NHS is too weak and irresponsible to address the person with the “lifestyle” directly, they give them a wide berth, the last thing any disinterested government organisation wants to do is deal with real people as individuals, that’s takes far too much time, money and resources.

  23. @ PaulB
    Sorry, I had forgotten that because it was an awful lot of blogs ago but there must have been two occasions because I seem to remember having to do a complete summary of all deaths in the London Marathon from the start until the then latest to demonstrate that mortality was in fact below average.
    I have since found the 0.17% to which you had referred which is for male non-smokers who have passed an insurance company’s medical examination – average human mortality is nearly 10 times that.

  24. I am guessing few people around here grew up in the countryside. Because this behaviour is immediately recognisable. A good farmer doesn’t want his livestock to become ill before their time.

    We have sold our freedom and independence for a mess of pottage. In return the state treats us like they own us. Which I suppose they do in a way.

  25. @john77
    Can never understand why youz get so enthusiastic about marathon entrant fatality statistics. Fit person who has trained for event is less likely to croak doing marathon than cross section of whole population couch surfing. Wow! (Yet it’s exactly he first sort of activity regularly kills Army recruits. Oh well…)
    The appropriate comparison would be fit fit bloke running marathon against fit bloke watching event on TV.

  26. john77: pardon? That mortality rate isn’t plausible.

    There are a bit less than 1400 deaths a year among 50-year-old men in the UK. There are about 870,000 50-year-olds, say 430,000 50-year-old men, so the death rate is about 0.32%. It’s about 0.15% for 40-year-old men.

    If life expectancy is 80, then the average mortality rate across all age groups is 1.25%. But it’s heavily concentrated among the very young and old.

    I strongly agree with your underlying argument that exercise is good for your health, and I think the very slight risks of marathon running are for me worth taking. But, sorry, your headline claim doesn’t hold up.

  27. @PaulB

    ‘I reckon that humans are designed to run 20 miles but not 26, which is perhaps why the marathon distance is attractive to people who like a challenge.’

    No – the marathon is run over that distance for quasi historical reasons.

    Most people, me among them, would find 20 miles (running, not walking) a serious challenge; most people would find two miles a fair challenge.

    I’d accept that ultra runners are really pushing the envelope, mind you.

    @TTG

    I said: “Secondly, an actual insurer wouldn’t wet itself; it would just increase the premiums.”

    You said: No, it wouldn’t.

    And yet, strangely, they do?

    Try getting quotes for with and without smoking, just as one for-instance.

    They don’t want you dying young, they want you dying old, and paying premiums for many, many years. It’s very obvious when you think about it.

  28. @ PaulB
    You (like 99.9% of the population) seem not to understand that you cannot simply take the reciprocal of life expectancy at birth to get the *current* mean mortality rate. [If I was arguing about mortality of marathon runners I ought to have stated that we need to exclude those in the general population under 17, but that's my fault not yours]. If you read the note about the pension scheme deficit in a company’s report and accounts you will see different life expectancies for current pensioners and those retiring in twenty years time. We can only measure life expectancy at birth for those born before the twentieth century The current life expectancy at birth of nearly 80 for men and for women is a guesstimate based on projections of future improvements in mortality.
    What one needs is a weighted average of the life expectancies from age 17 (but because I omitted that point I’ll use from birth) of marathon runners from 1980 to 2013 so I as a first approximation I am taking the unweighted ONS numbers* for those born 1945 to 1980 (marathon runners are older than sprinters and I *started* running marathons at 37) which gives me 67.9 and average mortality of 1.47%. If I excluded under-17s, the life expectancy would be about 52 and mortality rate 1.9%
    Mortality rates *used* to be very concentrated among the very old and young but infant mortality has dropped like a stone in the last few decades so that baby deaths are now treated as news, Mortality rates for males aged 35-39 are now higher than for those under 5 and mortality rates for all ages from 18 upwards are higher than for all ages from 1 to 17. http://www.ons.gov.uk/ons/dcp171776_292196.pdf
    The £billions thrown at the NHS have actually done something useful which is to slash infant mortality rates.
    *Yes, of course, these are just guesses but they are not *my* guesses so assumed, for the purposes of argument, to unbiased and reasonable

  29. @ bloke in spain
    The argument is whether sport is a net cost to the NHS so I am using the toughest run undertaken by any significant number of people as an extreme case [yes, fell running or the "Tough Guy" is tougher but the numbers partaking are relatively insignificant]. If we can demonstrate that the strains on the heart of a marathon runner are less than those of a couch potato, it follows that half-marathons, ten miles, 10k races and fun runs can be taken, a fortiori, as net beneficial to the health of the runner.
    Your comparison is totally wrong, like equating Google’s gross revenue to its pre-tax profit. The benefit of training and light exercise far outweighs the cost but how many people do *you* know who take part in months of training in order to sit on a sofa watching the London Marathon?

  30. john77: I have no idea what calculation you are doing there. In 2011 a British man had to be 69 before his mortality rate reached 1.9%. Are you saying that the typical marathon runner is a 69-year-old man?

    I’d be happy to take this discussion off-line if you’d like to reach a reasoned conclusion together.

    Interested: I know the history of the marathon distance. But the history doesn’t explain why that particular distance has become so popular. I suggest that it’s because it’s far enough to be really hard, however fit you are.

  31. @ PaulB
    No. I am not saying the average marathon runner is 69. I *was* saying that the average mortality rate for all men over 17 is around 1.9% p.a. (in fact it is slightly higher than 1/52 but the equation is too complicate to write in blog-text), which was a short-cut because my post was over 6 inches long.

  32. 2011 is not 1981 or any of the intervening years and 108 (17 + 1/1.09%) is not the median age at death. If it was all DB pension schemes and the UK state would be bankrupt. I shall look at your data.

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