On Smoking, and the NHS

I met a chief executive the other day who refuses to employ smokers. Not out of personal antipathy to the habit, but on purely commercial grounds. He has a lot of employees in the US, and offers medical care as part of their remuneration package. This is more expensive if they are smokers.

He made an interesting suggestion. It is increasingly obvious that we cannot afford to maintain the National Health Service in its current form. The drugs are getting more and more expensive, people are living longer and requiring more treatment. This is a fact. The NHS is not, a couple of decades hence, going to be able to continue as it is.

Something will have to be done, and it will require a departure from the founding principles of “free at the point of delivery”. Why not, my chief executive suggested, charge people according to the extent that their lifestyles, smoking, drinking, obesity, whatever, contributed to their need for treatment?

If you are treated for a smoking-related condition, you get charged for treatment. Ditto all those other bad lifestyle choices. Lead a blameless life, as healthy as possible, and you don’t get charged when you need the NHS.

There is one counter-argument. If you smoke, you and your fellows already contribute billions in taxes to the State to help fund the NHS, among others. One Nobel prize winning expert suggested the other day this was the real reason why tobacco had not been banned along with other dangerous substances.

Plus, if you smoke you probably die earlier, and do not create such a burden for the NHS as you grow older. Earlier, and often very quickly.

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On Cigarettes, Again

Many years ago I used to attend press briefings at one of our biggest makers of cigarettes. You would walk into the auditorium and, barely visible through the clouds of cigarette smoke, there would be a row of people waiting to take your questions, almost all puffing away like beagles. The product would be widely available in convenient receptacles, in case you felt like joining them. I think they were making a point.

It barely seems credible today, like smoking on the Tube. Both are wildly illegal now, a very nasty fire at Kings Cross having put paid to the notion that it is a good idea to light up in a sealed container some way underground.

In those days, if you claimed smoking was not very good for people’s health, a glossy document would arrive, full of figures and charts, written by people some with letters after their name, which would conclude that the case for any sort of health risk was not yet proven. Heaven knows where they found those professionals with letters after their names, who by their very training must have known better, but the case against smoking was, to be fair, a little less concrete than it is today.

We still have two large cigarette producers based in the UK. I spoke to someone quite senior who works for one of them this week. I have never dared ask the question: how can you? How do you square it with your conscience, working for a business whose main product will kill one in four people who choose to consume it over an extended period?

If you were living in an area of high unemployment, and the only factory in town was making fags, I can see how you might explain it. The habit is legal. Why should I deprive my family on a point of principle?

The senior people at these companies, the marketing men, the PR and HR professionals, the technicians, the executives all the way up to board level, all have skills that are highly transferable. They could work for any large corporation. They don’t have to work for one that kills people. What do they tell their friends, over the dinner party table? And I bet not many of those educated professionals smoke.

On smoking

Phil Everly has died. He died as a direct consequence of his smoking habit, in much the same way as you would die of being hit by a train if you lay down on the tracks in front of one.

One in four smokers will die likewise, as a direct result of their habit. I have no idea of the numbers, but I suspect that is in the same region as the number of people who develop a heroin addiction, and then die as a consequence.

Not all heroin addicts die; some give up, and survive. Not all smokers die; some carry on unaffected. My own father has been a heavy smoker all his life, and he is still alive, and smoking, at 82. Though it has not done him or his health any favours.

As a liberal, I have a problem with smoking. Heroin is banned, and rightly so. On the above logic, cigarettes should be banned as well. Except that, as a liberal, I do not like banning things. It is the same old paradox – to what extent should you legislate, in a free society, to protect people from the effects of their own stupidity.

I rather suspect that this is one of the few things the last government got right. Their policy was to make it so difficult, logistically, to smoke, with bans in the workplace, public places, etc, that a number of people will have given up rather than continue with the sheer inconvenience.

Meanwhile they shoved the cost of smoking up, by means of increased taxation, so consumption was by definition being limited, and by the poor in particular.

This brings with it two additional problems, though. One, the higher the price, the more smuggling. Some statistics suggest that one in five cigarettes smoked in the UK came in from outside. The kind of people who engage in large-scale cigarette smuggling tend to be the same sort of organised criminals who are involved in much worse, such as people smuggling, prostitution, drugs, etc. Shove the price up too far and you encourage them. See the inevitable comparison with Prohibition and the rise of the Mafia, cocaine and narco-terrorism.

The second is that, once you establish the principle that you can act against social ills by raising taxes, this itself becomes habit-forming. People drink too much? Bang up taxes on alcohol. Obesity? A tax on sugar, or foods that busybodies and other vested interests disapprove of and feel you and I should not be allowed to indulge in. For our own good, because Nanny knows best. And it’s good for the Exchequer, so who can complain? This is not a route we want our society to go down.

The trouble with this softly-softly approach is that it does not seem to be discouraging the young from taking up the habit. I am staggered how many of my teenage daughter’s friends smoke. They are intelligent people, they know the risks, they understand the statistics. And yet there are all these used butts on the terrace outside our back door.

There was a serious theory, in my youth when the drug culture first took root, that this was a problem that would solve itself, because all the junkies would die and no one would then be silly enough, having seen the evidence, to take up the habit thereafter. It didn’t work out that way. The same with smoking too, then. I don’t know the answer to this one.