Thread by @carolinejmolloy

Charging drunks for NHS care (as discussed on radio 4 yesterday, I'm told) is such an idiotic zombie idea that I am almost lost for words... but let me try...

If you charge drunks because they cost the NHS money, then why not ski-ers, horse-riders, rugby players?

No-one talking about that ofc. But theyre already excluding people with other lifestyle habits - smokers & people who are overweight, for example, are already denied ops in some areas (blanket policy, strongly opposed by doctors). We can't normalise this assault on universalism.

The single biggest lifestyle contributor to Ill-health is poverty and indeed overwork, but the government is actively encouraging all of that.

Poverty and class are strongly correlated with smoking, obesity and destructive drinking of the kind that winds you up in hospital (rich people drink as much as poor, but more spaced out). So any policy to charge for such behaviour is deeply regressive...

And shows zero insight into Public Health #101, which teaches people to have insight into the 'social determinants of health' (eg why people might find life more stressful & have more need for simple pleasure & escapes if they're otherwise in a shit socioeconomic situation with..

No financial security, substandard housing, little access to leisure or green spaces or hopes & dreams, perhaps not even a roof over their heads (all of which are also part of the 'social determinants of health'). So...

...Are we to say that drinking to excess, or indeed smoking or over-eating in such circumstances, is caused by nothing but individual moral failings, rendering those people, disproportionately poor, 'less deserving' of healthcare? After all...

...the 'undeserving' narrative has worked so well in regard to benefits & immigration, hasn't it?

And that's even before I've got to how this would ever work in practice, questions that have been raised by doctors. How do you define someone's problems as alcohol based/self-inflicted? Is it that clear cut? What if there's dual diagnosis with mental health?

And what if someone presents as respectable looking middle class person who says they've just happened to have overdone the Chablis tonight and broken their arm - how likely is it such a policy would treat them in same way as a street drinker, where it's more obvious?

And that's even before I've got onto the fact that alcoholism and addiction are defined as medical conditions by the World Health Organisation. To exclude someone from healthcare because of a health condition is totally unacceptable.

And let's not forget the most egregiously unjust aspect of such a suggestion, which is how the government has decimated funding for alcohol & addiction services (mostly via local government funding cuts) & funding for mental health services with which such patients often overlap.

Basically 'charge drunks for NHS' is an unworkable & profoundly unjust suggestion. The only reason anyone ever suggests it is because it's a handy way to begin to wrench us from the founding principle of the NHS, that of universal healthcare on the basis of need alone.

So shame on the BBC for so regularly giving this terrible idea airtime. If you've got this far, thanks for reading, and let me leave you with some closing words from Nye Bevan, founder of the NHS...

"Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide."

I'm looking forward to the day when concern about all this becomes trendy amongst the political classes (judging by the delayed reaction to NHS #HostileEnvironment, it will be in about 5 years time, if so, will be far too late to save the NHS's founding principle of universalism)

So hopefully this thread might have shown you why we need to urgently legislate "reinstate the duty on the Sec of State to provide universal health care throughout England" (basically scrapped by 2012 Act) - see pqblog.org.uk/2018/04/the-nh… by @AllysonPollock & @KailashChandOBE