When we insure our homes, or our cars, for example, we are expected to maintain and use locks when we are away from home and to make sure that our cars are properly maintained in a roadworthy condition. These expectations are part of a contract between us and insurers who will help us to cope with accidents or with circumstances beyond our control. Should we fail to close and lock our windows before going away, or should our failure to maintain our car result in an accident, our insurers would rightly see us as negligent and decline to help us. This seems reasonable. If insurers did not protect their clients in this way the rest of us would face much higher premiums as we paid, not for sharing risks, but for others’ irresponsibility.
When National Insurance was welcomed just after the Second World War, it included among other things, benefits such as the NHS and state pensions. The state, in other words the rest of us, would act as an insurer. In the matter of health problems, these would be taken care of by the state.
Seventy years on the NHS is in crisis, with an aging population making increasing demands. At the same time we are told that obesity is now a greater problem among Britons than among Americans, that children fail to undertake sufficient exercise and, combining this with poor diets, we are building up health problems for ourselves and for the community that tries to take care of us. Today (June 14th 2018) the press is blaming social media for the increase in mental health problems among children and young adults.
It would not seem unreasonable to expect a more adult, a more thoughtful and responsible attitude to our own health if we expect others to provide for us when we are ill. Like car insurers, the state in its role as health insurer, has a responsibility to encourage, if not to insist upon responsible behaviour from its clients. But how could it do this?
A civilised society treats unfortunate members well. How should it treat those members who make it difficult for it to exercise this care? Denied treatment they will probably become even more difficult and expensive to help, for they, and their dependents, cannot be abandoned.
How might we feel were they registered as irresponsible and made to wait for NHS services until others’ needs had been met? How might we respond to overweight children being fostered with responsible parents until the natural parents changed their ways?
There are no simple ways here, such as those pursued by house insurers and the like. But these questions do need to be asked. For all our sakes answers are required.