There's been a call in Australia to have smokers removed from waiting lists (yes, they have waiting lists over there) for elective surgery.
Denying operations is justified for specific conditions, argues Professor Matthew Peters from the Concord Repatriation General Hospital in Australia.
Professor Peters says that smoking up to the time of any surgery increases cardiac and pulmonary complications, impairs tissue healing, and is associated with more infections.
These effects increase the costs of care and also mean less opportunity to treat other patients, he writes. In health care systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will therefore deliver greater clinical benefit to individuals and the community.
This is, of course, a logical result of making everyone's health everyone else's business because the Aussies (and the Brits and the Canucks) now have to pay for everyone else's health care. When our lives become dependent on the good will of others, it can only result in less freedom -- this time smokers go first. There are a few, however, who see this as unjustified discrimination.
Cost arguments are made to support the discriminatory non-treatment of smokers. But why focus our cost saving concerns on smokers? Patients are not required to visit fitness clubs, lose 25 pounds, or take drugs to lower blood pressure before surgery. And many non-smokers cost society large sums of money in health care because of activities they choose to take part in.
Discriminating against smokers has become an acceptable norm, he writes. It is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant. Depriving smokers of surgery that would clearly enhance their wellbeing is not just wrong -- it is mean, he concludes.
Societies that decide that their welfare is best protected by banding together under government's protection will always pick on sub-groups that fall out of favor. They may, as in this case, have health habits the majority doesn't like or they may hold beliefs the majority (or the party in power) doesn't approve of. It's inevitable.
In China, for decades, couples with more than one child were hounded, penalized and even imprisoned. In many Muslim countries, women who find love independently can be buried and stoned. And let's not forget the homosexuals. If God's word weren't enough to condemn them, then their unhealthy sexual practices were.
I'm scared to death of national health insurance. It gives the controllers in society just one more reason to dictate how we live our lives. After all, it's not just my money -- it's yours, too. And don't think that you're so clean-living that they won't eventually find something they don't like about you or your children or your parents or your friends.
If, for example, you're pro-choice, then when your health care is paid for by my tax dollars, what's to stop me from insisting that I shouldn't have to pay for your daughter's abortion. Today it's a moral debate. Down the road, I've got a personal financial stake in your personal decision, there's a lot to be said for liberty.
After all, I'm pro-life. I approve of government policies that prevent taxpayer support for abortion. Trust me when I tell you I'd approve of government health insurance denying coverage to your "immoral" practice." Your disapproval of smoking is my horror of killing a baby and if I get a chance to stop you, I will.
When I need that life-saving surgery, you know -- the one where they open you up from stem to stern -- I'll drink and smoke right up to the minute they wheel me in. And it shouldn't be your financial concern at all. I'm happy to pay my insurance premiums myself and would feel guilty as hell if any of you had to help me foot the bill.
And as long as it's me paying the Doctor, then he shouldn't worry over my personal failings any more than my mechanic who, faced with the dismaying prospect of tuning up the poorly-maintained ol' F150, might deny me an air filter change just because I hadn't replaced the old one since Clinton was president. Health care must not be turned into a transcendent right, it's a service we buy from trained professionals who compete for our business.
Let's try and figure out how we can keep health care a personal decision in the United States. As bad as it may seem, it isn't the problem it's presented as. We can fix the system and still maintain our freedom to buy health care much as we buy our food or our F150 tune-ups -- no one else need care. If we do that, we can still debate our differences, we just won't impose them by majority rule of the day.
And that, I fear, is where we're heading.