The Times of London reports (“…no surgery until you quit“) that smokers who needed surgery “…would not be added to waiting lists until they had given up smoking.”
While there is vast medical evidence that shows the hazards of smoking as well as the fact that smoking reduces recovery time from surgery, should we really be denying smokers medical care? On the one hand, smokers increase the amount of money British taxpayers contribute towards the NHS; on the other hand, denying certain groups medical care may seem somewhat arbitrary or that the government is acting as a ‘nanny state.’
In a free-market setting, this would not be this problem. Abstracting from issues of second-hand smoke, smoking only affects the health of the smoker. If I decide to smoke, it is likely that I will incur additional medical costs in the future. A person must weigh the additional utility one gains by smoking against the additional costs of smoking, which include worse health and increased medical costs. If a person still decides to smoke, only they will incur the added health costs.
In most developed countries, however, a significant portion of medical care is either provided by and/or financed by the government. Refusing to provide care to smokers is not a problem if the health issue is a direct result of smoking. Refusing care would simply be shifting the cost of smoking from the taxpayers to the smoker. Most illnesses, however, are caused by a myriad of factors–including smoking–and thus directly attributing disease causation to smoking is very tenuous in most situations. Thus, the NHS may be creating a two-tiered health system, one for smokers and one for non-smokers.
One solution to this problem would be for the government to finance a fixed dollar amount of health insurance financing. This would mean that each individual would receive $X to contribute towards the health insurance plan of their choice. Since health insurance is more expensive for smokers, for any given level of insurance coverage smokers will have to pay more. Thus, the additional costs of smoking will be shifted back to the smoker.