Do You Smoke?: Twelve Easy Steps to Figuring Out

Ted Bromund /

Britain’s National Health Service is under fire, again, this time for the hideous conditions in the Mid Staffordshire NHS Foundation Trust that killed between 400 and 1200 patients in a three year period. As always, bad news encourages others to come forward. An anonymous NHS doctor has just leaked [1] the flow-chart he is supposed to use to answer the simple question “Do you smoke?” It is incomprehensibly complex.

But it’s worse than that. The failures in Mid Staffordshire occurred because institution’s managers were so obsessed by meeting centralized targets and winning Trust status in order to escape that control that they ignored their responsibility to care for their patients.

And the NHS’s stop-smoking program is a superb example of this top-down, intrusive fallacy. Doctors are responsible not only for applying this flow-chart to every one who comes into the office, but also – to fulfill a massive nationwide data-gathering exercise on people’s private lives – for pursuing all current and former patients to ascertain whether they smoke as well..

Why bother? Because smoking costs the NHS a lot of money. So does drinking. So does obesity. So does too much salt in the diet, not taking enough exercise, and eating too many prawn crisps. And as costs continue to explode in the NHS, it tries ever harder to reach into and control people’s private lives to save money.

The health hazards of smoking are well known. But liberal advocates of national health care systems should ask themselves two questions. First, do you want to be responsible for paying for everyone else’s bad habits, or should people bear some responsibility for their own behavior? And second, do you want the government to get involved – as it inevitably will – in regulating the details of your private life so it can try to save a buck?

And if you answered yes to the second question, here’s a third one: why do you call yourself a liberal?