Tuesday, 25 May 2010

Making drinkers pay

You often hear suggestions in the media that people admitted to A&E with drink-related injuries should be required to pay for their own treatment. This idea has occasionally cropped up in the comments here as well. The same principle is then easily extended to expecting smokers and fatties to pay for treatment of related medical conditions.

But this opens up a very dangerous slippery slope. Many health conditions are to some extent caused or exacerbated by lifestyle choices, and many injuries result from from activities where people knowingly accept a higher than average level of risk. Should we be refusing to treat any injuries resulting from rugby, or hang-gliding, or leisure motorcycling, and requiring anyone doing those things to have comprehensive private medical insurance? What about sexually-transmitted diseases acquired through risky sexual practices? Or health problems resulting from the abuse of illegal drugs? It is impossible to draw a hard-and-fast moral line.

There is also the question of what you do with people without the means to pay. People of social classes D and E drink no more on average than those in classes A and B, but they are six times as likely to be admitted to A&E with alcohol-related injuries or conditions. Many of them will be men and women of straw who live from week to week and have minimal savings. You can’t just turn them away untreated, so someone else is going to have to foot the bill, and if people who do have some financial means are at the same time funding the health care of the penniless through taxation, yet being refused the same free treatment themselves, they will be understandably resentful.

While the funding and organisation of healthcare are the subject of legitimate political debate, however much people’s injuries and health problems are caused by their own behaviour, it goes against basic human decency simply to turn the other cheek and let them die in the gutter. This doesn’t happen in the USA (despite what some claim) so why should it be considered remotely acceptable here?


  1. You are correct to say the idea that pissheads pay to get patched up is a poor idea. You would not expect it of other self inflicted conditions.

    To consider it is to consider the whole universality of health care provision either through an insurance system or ensuring risky behaviour is taxed to cover the additional cost of it.

    The current situation where A&E is only an acceptable service Sunday to Thursday cannot continue. Not an easy solution to think up.

    However those pissheads that prove a danger to the staff patching them up really ought to be banged up.

  2. Cause and effect are rarely that easy to connect as these things are rarely 'black & white'. You are right to highlight basic human decency - something that seems to be forgotten all too often these days.

  3. Surely this topic has been done to death by now, hasn't it?

    Hang gliding. Potholing. Mountain climbing. Rugby. Boxing. Surfing. Smoking. Skiing. Drinking. Taking drugs. Street fighting. Crossing the road without looking. Pinching someone else’s pint. Water skiing. Driving too fast. Letting thugs into your home without asking for ID. Solo yachting. Not wearing a seatbelt. Using electrical appliances with wet hands. Fell running. Driving drunk. Unprotected sex with a stranger. Not wearing a cycle/motorbike helmet. Chatting up someone else’s partner.

    A boy at my school broke his neck playing rugby (fortunately no permanent damage); should his parents have been charged for his treatment?

  4. @Cookie - yes, of course pissheads who are a danger to hospital staff should suffer the full weight of the law. I've said before that a lot of our so-called alcohol problems are down to the authorities not using the powers available to them.

    @RedNev - it has been extensively discussed in the comments, but not in a post.

  5. Okay, to quote you, Curmudgeon: "This has been debated elsewhere ad nauseam".

    As far as I know, this is not a serious item on the current agenda of any political party. Let's cross the bridge IF we get to it.

  6. I am all for an insurance based system like the USA. However, as long as we are all forced to pay for the system, the system should provide.

    I think insurance may promote more personal responsibility. What about parents who take thier kids to the A&E every time they bump their heads. Thier premiums would surely be higher than mine.

    Currently, we all have to pay into the system and it could easily be argued that smokers and drinkers pay more than most. As long as that is the situation then treatment should not be equally available to all.


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