The front page of the Times carries an amazing story on the governments latest proposed reform of the health service. Under the proposals those who don’t lead a healthy enough lifestyle will not be entitled to treatment. Those in the firing line initially are heavy smokers and those who don’t take enough exercise, though how these conditions are defined and whether they might be extended is not clear.

Apparantly patients will be forced to sign contracts promising to eat sensibly, give up smoking etc in return for access to healthcare. This is a legal and moral minefield to say the least and throws up a number of questions:

1. Haven’t fat people paid taxes to fund the NHS in exactly the same way as their slimmer counterparts. If this is the case why should they be denied access to healthcare ?

2. Overweight people and those who smoke tend not to live as long as those who are slimmer and don’t smoke. They are actually much less of a “burden” than those who survive into their 70’s, 80’s and 90’s and who often require frequent access state-funded healthcare. Should people who are over- fond of cream cakes and Marlboro Lights be penalised for living fast and dying young even when in purely economic terms they may well pay more in tax than they get out of the system in the form of healthcare.

3. The legal effect of such a patient-doctor agreement seems to me to be fraught with potential problems. Can a patient be forced to sign-away his rights to healthcare gauranteed by statute ? I can’t see how it can be unless the whole rationale of the NHS is revisited and it’s remit revised so that it is obliged only to offer healthcare to healthy people.

Having said all that I am more than aware aware that reform of the NHS is neccessary. I’m just not sure that these proposals are going in the right direction.