Storms of protest have greeted recent ‘leaks’ that NHS trusts plan to shoo existing smokers and fatties off waiting lists, and ban new and returning entrants until they have done time in a get fit quick boot camp. Herr citizens who fail to comply vill be sent down ze salt mine, and the key (but not their matches and crisps) thrown away.
These variants of health fascism are in fact nothing new. IDS style poor law conservatism always reckons those who have fallen on hard times have somehow managed to pull a fast one, and health fascism is the natural sibling of poor law conservatism. Those who cannot work will not get benefits; and those who will not fix their habits will not get NHS health care. Scattered amongst the protest comments on blogs and in the media is more than enough serves-the-bastards-right why-should-we-pay-for-their-healthcare invective to make Dr No’s toes curl.
The health fascist’s arguments invariably rest on a double barrelled litany of righteous indignation. By the first barrel – bang! – gaspers and fatties have by lifestyle choice caused their illness, and thus are culpable, and so punishable; and by the second barrel – bang! – why should the righteous pay for the sins of the sick? Low-life scumbags! Bang-bang!
Now, as it happens, the righteous are unwittingly enclosed in an unseen glasshouse. With very few notable exceptions, most modern chronic illnesses are caused to a varying extent by lifestyle choices. Athletes wear out their joints. Sunbathers crisp their skin and grow cancers. Workaholics punch up the mercury, and pop cerebral arteries. The list is endless. And, as the saying goes, people in glasshouses shouldn’t throw stones, let alone blast away with both barrels at those less fortunate than themselves.
For one day, perhaps not too distant, they may discover that they too now find themselves staring down the barrel of the health fascist’s gun. Consider hormone replacement therapy. In the absence of medical indications, HRT is – all said and done – a lifestyle choice to mitigate the effects not of an illness, but of a natural process – the menopause. For some, the price of that oestrogen glow will be cancer; and in cause and effect Sarah with her HRT triggered breast cancer is inseparable from Susan with her smoking induced lung cancer. And so it must be that the health fascist who would exile Susan from the NHS must now also exclude Sarah.