Should government pay for the medical care of irresponsible people?

This is a tough question, especially where funds are limited. DA leader Helen Zille has called for a public debate on the effects of personal "life-style choices" that burden our medical resources to the detriment of others who need care through no fault of their own (see here)

She noted that 80% of the public health budget is spent on irresponsible behaviour ranging from unprotected sex, to alcohol and drug abuse, and the resulting trauma and violence.

A recent case in Northern Ireland highlights the dilemmas even in a wealthy society with a state health system.

The family of 19-year-old Gareth Anderson campaigned for him to have a liver transplant when he was at death's door after several drinking binges. Doctors said he could not be put on the transplant waiting list until he was alcohol-free for six months. He did not help his case by leaving his hospital bed and crossing the road to order a drink at a local pub.

Our former Minister of Health Manto Tshabalala-Msimang set an appalling example with her drinking habits, and seemed to jump the queue for her liver transplant.

Smokers have a tough time in Britain's National Health Service as they are often denied heart surgery when over a certain age. Obese people are sometimes denied joint replacements. These decisions are defended on clinical grounds, taking into account risk factors and chances of survival.

It is useful to make the distinction between health care and medical care, which are often confused.

Mormons live a decade longer than other Americans. Is this because doctors who treat Mormons are better, or because Mormons avoid a lot of things that shorten people's lives?

American scholar Thomas Sowell observes that health care is largely in our hands, but medical care is in the hands of doctors.

This is a major reason why American longevity is a bit lower than other developed countries even though medical cure rates are better in areas like heart surgery and cancer.

When medical care is funded by public money, rationing is bound to happen as decisions are based on resources rather than the limits of medical science.

Kidney dialysis, for instance, will not be done if you are over a certain age and not a candidate for a kidney transplant.

The major preventable disease in South Africa is HIV/Aids, which chews up a huge proportion of the budget. Since male behavior is the main transmitter of HIV/Aids, it could be argued that females should have preference in receiving treatment.

But this is not only unconstitutional, it loses the critical focus on the individual, as women could also be to blame in certain cases. The change we need is at the individual level, where responsibility starts.

There is too much blame on external factors, instead of individual responsibility for life decisions, including health care.

It is very unfashionable to talk about stigma, but it is an important social control mechanism in an era where far too much is excused in the 1960's spirit of "anything goes".

The limits of free choice are crossed when individuals harm others, either directly or indirectly

It would help a lot if such behavior was scandalised more often.

Jack Bloom is a DA MPL in the Gauteng legislature. This article first appeared in The Citizen.

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