In the Guardian, Nick Cohen explains what Brits will need to do to maintain the National Health Service as their key defining national institution:
If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.
The one who pays the piper calls the tune, and when it’s the government paying the need to keep healthcare costs down will first encourage and later mandate more and more restrictions on the freedoms of the people. Oddly, although he starts out strongly, the rest of the piece falls short of the more stringent restrictions that logic would dictate, concentrating on the relative trivia of expanding pedestrian and bicycle access to downtown areas and corresponding restrictions to private vehicles, plus moving fast food outlets further away from schools.
I can feel the force of the objections. When we imagine a healthier future we are also imagining a more authoritarian state. Individual choice will be constrained and wisdom of the crowd rejected. Women will wonder who will chop the vegetables and cook the dinners when ultra-processed food is taxed to the point of extinction.
Beyond gender lies an undoubted class element in public health campaigns. Sugar and fat addiction, like all addictions, provide a temporary respite for the poor, the depressed and the disappointed. Perhaps we should offer them better lives rather than snatch away the few comforts they enjoy. This sounds a stirring counter-argument. But as any reader who has been an addict will know, addiction prevents you finding a better life. For when you suffer the multiple morbidities of diabetes, arthritis, cancer and strokes, your sicknesses are your life. You do not have the freedom to choose to change it.
God knows, there are good reasons to mistrust experts re-engineering societies from above. But as with tobacco, freedom of choice in the food and car markets has left us with no choice but to trust them.
To safeguard the NHS from bankruptcy, the government will end up looking at quite draconian efforts to reduce or eliminate risks to public health (generously interpreted). First the minor nudges, like raising the prices of alcoholic beverages and tobacco products to discourage smoking and drinking, then perhaps the same for whatever foods are currently considered to be Public Enemy Number One (last year it was fat, this year it’s sugar, next year it might be carbohydrates in general). Then, when the nudges haven’t achieved their intended ends, harsher measures are called for and will need to be implemented over a wider range of products, services and activities, as human beings have an amazing capability to sidestep or avoid what their betters want for them. Exercise will be first encouraged, then demanded, and finally required. Dangerous activities will first be discouraged, then penalized, then finally outlawed.
We’ve already seen the beginnings of the move from mere nudges to more open control, as smokers and the obese are starting to face restrictions on their access to the NHS until they show more than a token obedience to medical authority. Your doctor will slowly morph from mere caregiver to guardian to overseer. All in the name of public health, of course.
H/T to Natalie Solent for the original link.
