Curb your cravings or die on your own dime

An alert to fatties, puffers, boozers and assorted body abusers. It’s time to clean up your act or piss off and die on your own dime.  

Why patch up slow-motion suicides when hard-pressed and limited medical resources could be better allocated elsewhere? All things being equal, someone who survives a bullet to the brain playing Russian roulette — and then belatedly decides that, duh!, it wasn’t such a great idea after all — should always be slotted into the emergency queue behind the accident victim.

A case in point from recent history is the fresh, young liver decanted into the alcohol-ravaged body of former health minister, Manto Tshabalala-Msimang. While still in the recovery ward the dipso-queen was soon sending aides scurrying to keep her supplied with whisky.

A 67-year-old alcoholic with cirrhosis is not by any rational system of resource allocation the best candidate for a transplant. Especially if they can’t or won’t stop drinking. Within a few years Manto was dead of liver “complications”.  It actually wasn’t complicated at all, she had squandered two livers by pickling them in alcohol and was lining up for a third when she died.

At a more mundane level there are the fatties whose knees and hips, after years of having to lug about excessive weights, are succumbing to overload. Four flubbies flummoxed by Medshield refusing payment for joint replacements to anyone with a Body Mass Index (BMI) of 35 or over, had gone snivelling to the Council for Medical Schemes (CMS) appeal board.  

Since the BMI marker for obesity is 30, these folk are not just “traditionally built”, as author Alexander McCall Smith describes it, but severely obese. Nevertheless, the CMS ruled that this exclusion amounted to “unfair discrimination”, so an abnormal load can no longer be used as a reason to refuse payment for joint procedures.

One must wonder how a freely entered into contract that sets out conditions for non-emergency medical procedures can be discriminatory? The finding also flies in the face of reality. 

Physicians have always had to take life or death decisions. Hence triage, the battlefield-developed method to ration medical care efficiently and fairly, to determine the order of treatment.

The medical aids effectively want to apply such rationing to less life-threatening situations, for medical care is not only expensive but the demand is limitless unless controlled. In the private sector the control is having the user cough up financially once certain ceilings are breached. In the “free” state systems, protocols are used to determine one’s place in the long, long treatment queue — for example, an interminable wait for a new liver if you are an unrehabilitated 67-year-old soak.

For those nourishing the delusion that governments can and should pick up any and all tabs, reality can come as a shock. British newspapers recently fretted themselves into a froth over the National Health Service (NHS) increasingly controlling access to its free medical services by screening patients according to lifestyle factors.

Going further than Medshield has done here, the NHS Hertfordshire last year banned knee and hip operations for anyone with a BMI over 30. The ban since has been extended to smokers for all routine surgery, except for neurology, cardiac and cancer operations. Some NHS area trusts also ban in-vitro fertilisation treatment to anyone who has not been a non-smoker for at least six months.

You want an itty-bitty baby just so much? Stop sucking those fags. Simple and elegant.  And so good for mom and baby.

Overeating, excessive alcohol consumption, uncontrolled drug use and smoking are largely, albeit not entirely, afflictions of choice. They are also critical factors undermining the success of many medical interventions and they deplete the reserves of care that can be provided to the truly needy.

If the prospective patient cannot or will not address the problem, it makes absolute sense to limit their access to treatments that are negated by their addictions. Or alternatively they can choose to pay full tariff and waste their own money, rather than that of the taxpayer.

It’s a policy that also brings home two important truths. Firstly, that the public purse is not boundless and, secondly, that one has to take some responsibility for maintaining one’s health.

Best of all, there would soon be fewer gargantuan, whisky-soaked, vile smelling, nicotine puffers around.  