Guest Post: Anything The Government Gives You, The Government Can Take Away

Tyler Durden's picture

Via John Aziz of Azizonomics

From the Guardian:

A majority of doctors support measures to deny treatment to smokers and the obese, according to a survey that has sparked a row over the NHS‘s growing use of “lifestyle rationing”.


Some 54% of doctors who took part said the NHS should have the right to withhold non-emergency treatment from patients who do not lose weight or stop smoking. Some medics believe unhealthy behaviour can make procedures less likely to work, and that the service is not obliged to devote scarce resources to them.

And that’s the trouble with services and institutions run from the taxpayer’s purse, administered by centralists and bureaucrats. It becomes a carrot or a stick for interventionists to intervene in your life. Its delivery depends on your compliance with the diktats and whims of the democracy, or of bureaucrats. Your standard of living becomes a bargaining chip. Don’t conform? You might be deemed unworthy of hospital treatment.

It seems innocuous to promise all manner of services in exchange for taxes. Citizens may welcome the convenience, the lower overheads, the economies of scale. They may welcome a freebie, and the chance to enjoy the fruits of someone else’s labour. They may feel entitled to it.

Many words have been spent on the problems of dependency; that rather than working for an honest living, the poor may be sucked into a vortex of entitlement, to such an extent that they lose the desire to produce. A tax-sucking multi-generational underclass can develop. Individuals can live entirely workless lives, enjoying a semi-comfortable existence on the teat of the taxpayer, enjoying the fruits — financial handouts, free education, free healthcare, a free home — of social engineers who believe that every problem under the sun can be remedied by government largesse and throwing money at problems. And who can blame them? Humans have sought out free lunches for as long as there have been humans.

Welfare dependency is generally assumed to be viewed negatively in the corridors of power. After all, broad welfare programs mean greater spending, and that very often means great debt. And why would a government want to be in debt? Surely governments would prefer it if more of the population was working and productive and paying taxes?

But it is easier to promote behaviour desired by the state when a population lives on state handouts. And for states that might want to influence the behaviour of their citizens — their resource consumption, their carbon footprint, their moral and ethical beliefs, or their attitude toward the state — this could be an attractive proposition. It might cost a lot to run a welfare system, but it brings a lot of power to influence citizens.

And increasingly throughout the Western world, citizens are becoming dependent on the state for their standard of living. In the UK, 92% of people are dependent on the socialist NHS for healthcare. 46 million Americans receive food stamps. That gives states a lot of leverage to influence behaviour. First it may be used in a (relatively sensible) attempt to curtail smoking and obesity. Beyond that, the sky is the limit. Perhaps doctors or bureaucrats may someday suggest withholding treatment or dole money from those who exceed their personal carbon or meat consumption quota? A tyrant could even withhold welfare from those who do not pledge their undying allegiance or military service to a regime or ideology (it happened many times last century). An underclass of rough and hungry welfare recipients is a fertile recruiting ground for military and paramilitary organisations (like the TSA).

With the wide expansion of welfare comes a lot of power, and the potential for the abuse of power. Citizens looking for a free lunch or an easier world should be careful what they wish for. Welfare recipients take note: you depend on government for your standard of living, you open yourself up to losing your liberty.

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hedgeless_horseman's picture



BMI test for SNAP.  Duh.

Rahm's picture

Two snaps up and a twist...

I think I need to buy a gun's picture

I recently heard a certain senator on CNBC suggest an upper tier of health care for them and the elite and everyone else gets the shitter...i want what they got even if i can't afford 12 dollar beers at the blackhawks games

MinnesotaMD's picture

I think that is where we are going . Two tier system.

Dr Benway's picture

Although I fully agree with the main point, this article conveniently sidesteps the fact that so-called socialist countries in Western Europe achieve better patient outcomes while spending roughly half of what the US does per capita on healthcare.



*HALF* of US healthcare spending, at least, is wasteful and inefficient.



Sure, spending too much is bad, but spending too much and stupidly to boot is unforgivable.

Michael's picture

It should be an internationally agreed upon policy, No nuclear missiles and aircraft delivered nuclear bombs be pre-programed with any specific targets. The USA can deliver nuclear missiles anywhere on the planet in one hour.

Harlequin001's picture

Yes Dr Benway but that's not the point of the article is it? The article highlights the means by which govt can induce hardship on the populace, create more welfare to make citizens dependent and then use it to ultimately control them.


To be brutally frank, in this case, success rates are largely irrelevent...

smiler03's picture

The author has taken an alarmist headline and failed to read the article more carefully. Perhaps the most important statistic is that the 593 Doctors were "self selected". Try taking a survey of ZH readers who think the US economy is fucked. You're starting with a strongly biased sample. Anyway, so having just cherry picked the headline the author makes no mention of the following points in the same Guardian article in which every relevant body is against the proposed idea.

Things omitted are: (my emphasis)

1. 593 (54%) of the 1,096 doctors who took part in the SELF-SELECTING SURVEY answered yes when asked: "Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?"

2. Dr Clare Gerada, chair of the Royal College of General Practitioners, said the survey findings and trend towards "lifestyle rationing" was "very disturbing".

She said: "It's the deserving and undeserving sick idea. The NHS should deliver care according to need. There was no medical justification for such restrictions on smokers, as giving up nicotine would not necessarily enhance an operation's chances of success. Clearly, giving up smoking is a good thing. But blackmailing people by telling them that they have to give up isn't what doctors should be doing.". Doctors should not back such bans unless there was "overwhelming evidence" that stopping smoking reduces the patient's risk of suffering complications or dying, she said.

3. The Royal College of Physicians, which represents hospital doctors, said it opposed the practice. "Lifestyle rationing is creeping into the NHS. There are reported examples where treatments have been restricted by PCTs and we wouldn't agree with that," said Professor John Saunders, chair of the college's ethics committees.

4. The Department of Health took a similar stance. "There is no excuse to deny care on the basis of arbitrary blanket bans — the individual needs of patients must be taken into account," said a spokeswoman.

5. Dr Mark Porter, chairman of the British Medical Association's consultants committee, blasted treatment bans as "wholly unacceptable". But he added: "There are occasions where a doctor may advise an obese person to lose weight before surgery can safely go ahead. This is a clinical rather than a rationing decision."

Beam Me Up Scotty's picture

They are able to do that because they are borrowing from the future. That is about to end just like here. When the ponzi collapses there won't be anymore free or "cheap" healthcare.

dick cheneys ghost's picture

Japan has gone roughly 20 yrs since the bubble long can the "oil" Backed $Dollar ponzi last?


will it last as long?..........longer?............or shorter?

Dr Benway's picture

The fact that healthcare (indeed all public) spending has been largely funded by debt in Europe is utterly irrelevant here. On a per capita basis, Americans spend roughly twice that of Western Europeans for healthcare, how that money is raised is not what we are discussing.


Americans have a disastrously ponzified and inefficient healthcare system, and as a result Americans pay twice as much as Western Europeans while not achieving superior patient outcomes. Monopolistic cleptocratic insurance industry and litigation culture are two major culprits.

NidStyles's picture

You're so off-base that it isn't even funny.

Dr Benway's picture

Look, facts are facts whether you like them or not. They exist independent of your opinions.



The fact is that the US spends vastly more per capita on healthcare than other countries without commensurate benefit, due to inefficiency and waste in the system.

Ghordius's picture

+1 either that or Americans are vastly healthier

Acet's picture

It's measured as a percentage of GDP.

Americans spend about 14% of GDP in health care, while Britons, with their "socialist" NHS spend a bit over 7% with better outcomes (for example, infant mortality is greater in the US).

While there is a case to be made about the problems that come with state dependency (not just via social security, but also the dependency on subsidies and state guarantees of many companies), pointing at the one thing the state does which has huge proven efficiencies versus comparative private systems (i.e. healthcare costs half as much in the UK as in the US) is a self-defeating argument.

The article makes an argument which only works with people that are ignorant on how that system works.

The really ridiculous bit of the article is that those people who might be denied treatment can simply take health insurance (just like in the US) and have access to private healthcare: it's still cheaper here in the UK than in the US. In other words, people are complaining because they might be denied access to the "socialist" NHS and instead be forced to go to the "capitalist" system of private healthcare like in the US. So the argument made is senseless: the "socialist" NHS is worse and private healthcare is best because people complain that might be forced out of the NHS and have to use private healthcare (if the later is so great, people should be happy about it).

Frankly if the author of the article had managed to ditch his McCartist brainwashing and FOX-News-fueled ignorant small-mindedness, he could've pointed out at the true problems with social security and made a much stronger argument.


Gavrikon's picture

"(for example, infant mortality is greater in the US)."

From what I have read, (and correct me if I am wrong), that is just about the ONLY statistic you can quote to support your position.  And, as I have read, there are cultural and social reasons for that, not medical.

But please, as I say, do enlighten me.  Here in Germany, I notice that our doctors are VERY good at emergency medical care (like a heart attack), but not so good at preventative care.  While I lived the the US, my family doctor was very thorough at identifying anything that looked suspicious, getting me tested, and prescribing something (meds or therapy) to keep the problem from getting worse.  She also was quite careful to take plenty of time to explain the condition to me, the dangers, and best ways to deal with it.  I am lucky if my German doctor explains anything to me.

Dr Benway's picture

What looked like conscientious care to you was actually defensive overtreatment. Because of the legal environment in the US, doctors are much more likely to initiate unnecessary tests and treatments. This is not only costly but bad for patient health. People tend to think that more is better when it comes to healthcare but that is certainly not true.

BigDuke6's picture

Defensive medicine is alive and well should know that 'Dr'.

And the USA actually does have superior outcomes for those lucky enough to be in the system.

again most doctors are aware of that fact.

i was interested to see a doubling of maternal mortality in london in the last 5 years blamed on obese patients.

i would have blamed it on hordes of sickly fast breeding new arrivals from the 3rd world , dodgy, half trained foreign doctors and a palpable decline in surgical standards.

but i'm a dour bastard and why spoil the fatty excuse?

jwoop66's picture

Yes, for instance, stillborn babies are counted in US stats, but not in European stats for one thing.  

BeetleBailey's picture

Per Capita Per Schmapita.....

Thrown in the same per capita ILLEGAL ALIENS into the mix over there in Europe and re-compute.

The apples to oranges Europe vs. the US never works, as to the above alone.

Dr Benway's picture

So for illegal aliens to double the per capita healthcare cost, there would have to be as many illegal aliens as Americans. Hmm. So that might not be it.



In this thread: Americans defending their supercrappy cleptocratic healthcare industry, despite it running double costs compared to the rest of the world.

No OB Wan Kenobe's picture

Healthcare is not a right. Where does it state in the Constitution that it is?
The pursuit of healthcare is, just like the pursuit of happiness is.
If an individual wants to spend a lot on healthcare, that's his right. No one should be forced to pay for someone else's health care.

Dr Benway's picture

I am fairly libertarian but I think a certain level of basic care should be provided to citizens, to avoid to great disparaties that inevitably lead to crime.


Stupid miserly randians who don't realize its better to pay off the masses with a bit of money rather than have them rioting later deserve a spanking.

flattrader's picture

The vast money they save on eliminating the so-called "wasteful spending" on a bare-bones safety net will be paid out in private security costs, so they can sit in their homes unmolested, let their children, play in the yard, get back and forth to work, etc...

What's amusing is that many of the libertarian rank and file that I know are upper middle income at best.

They don't seem to understand that gated-communities, private patrols, trained security drivers etc...are very expensive and in their own way a "safety tax."

As former law enforcement, I will be happy to contract with them...and bleed them green in the process.

Of course to keep costs as low as I can, I will have to hire the kind of people who would prefer to just "do" them.

False Capital's picture

I suggest you read the preamble.

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

jwoop66's picture

Yes.    General (Everyone- rich,poor,middle) welfare.   Doesn't say anything about each individuals medical care.  Then it discusses liberty and the ability to secure Posterity.

Exactly.    nothing about govt imposed medical care or wages for not working.   When did the program we call  "Welfare" come about?   Maybe someone thought that name could be used to support their agenda later...

covsire's picture

Hey "Dr", the US also performs the vast majority of medical research, something your european pals all benefit from without the fuss of having to eat unfruitful research costs. 

False Capital's picture

So, centrally planned healthcare research by the NIH (and I forget what ridiculous percentage of healthcare funding is provided by it) is a paragon of efficiency?

Dr Benway's picture

Sure. The problem isn't the estimated $55 billion that is spent on defensive anti-litigation measures and procedures. Or the cosily government-tied-clepto insurance industry.


It's all that medical research. 

Gavrikon's picture

". . .countries in Western Europe achieve better patient outcomes . . ."


Stick around, my friend.  Our unproductive, third-world immigrants are contributing virtually nothing into the system, while taking out of it hand-over-fist.  It is small wonder that the system is looking for ways to cut costs, e.g., not treating smokers or the obese (not that I am completely in disagreement with that philosophy), but soon, the overwhelmingly white European aged.  People had better drop those ciggies and that extra mug of Bier and hit the Alpine trails if they want any kind of decent quality-of-life in their later years.  The government will NOT be there for them.

Dr Benway's picture

The Ponzi Operators, aka the 1%, want exactly what you are serving.


Turning one half of the 99% against the other half. Richer vs poorer, educated vs uneducated, smoker vs nonsmoker.

jwoop66's picture

I don't know what the 1% wants, but I do know that the socialists/statists want this class warfare you speak of...

Calmyourself's picture

You lie or are ignorant or perhaps dying young is the outcome of chocie under socialist healthcare systems..

"Europe’s survival rates are lower than in the US, where 66.3 per cent of men and 62.9 per cent of women survive for five years, compared with 47.3 per cent of European men and 55.8 per cent of women."

False Capital's picture

You're cherry picking the data, sir.

smiler03's picture

Check international life expectancy.

The US is 38th in the world.

So not only is is by far the most expensive in the world but it is pretty damn inefficient with it.

jwoop66's picture

Check the news, dude.   Europe is going broke!    That's with us paying for their defense!   Let's check those "stats"  after Austerity is fully implimented across all of Europe. 

jwoop66's picture

Yeah,  its called socialism.   Statism for those that will drone on about the "ism" meme.  

If govt is responsible for your health and wellbeing,  It has a right to tell you how to live.   Fuck the Constitution.   It's such an old document; written by evil white slaveholding rich men.   Blah blah occupy blah...

Bottom line- if we don't get rid of this obamacare abomination we are ALL fucked.  Well, we who are  not in the ruling class are fucked. 

Wake up folks!   We are the only nation with a constitution dedicated to limited govt.  If we throw it out, it's gonna be a long time before we get a bunch of smart guys in a room to write another one.

bankruptcylawyer's picture

blame that on the private healthcare providers and plaintiffs bar for unduly infuenceing government. 


I'm not advocating one way or another because there are subtleties here. the general point in taken about government largess being a problem of dependency at the individual level. 


BUT PLEASE -----address the issue of private tyranny here. doctors cannot just sell their services because there is a whole INSURANCE INDUSTRY WORKING AGAINST THEM. DO YOU REALIZE THAT ALMOST NO ONE STARTS THEIR OWN PRIVATE CLINIC ANYMORE???????????HELLLLLLOOOOOOOO?


THERE IS A PUBLIC INTEREST IN AFFORDEABLE MEDICINE. sort of sad to talk about this from a one sided perspective here. there is definitely a balance here. and what you are focussing on , the 'elite' bearacracies and politicians, is just like explaining the story from the one side without talking about how these so called 'elites' are very much serving the narrow interests of a privatised industry that has edged out ALL capitalist competition at the price level of the individual providers, doctors themselves. you want a free market? it's not even possible with the convoluted lobbying and financial strucutues in place that have operated to seal off any public political choice. 


SoCalBusted's picture

Congress already has its own (elite) health care system.

flattrader's picture

Maybe people arean't aware that your much lauded non-government private insurer in the US can choose to not to cover or treat you for any variety of illnesses once they decide they are "pre-exisiting conditions" after their voodoo practitions apply creative post-underwriting criteria.

Worst case--No coverage for you.  You die.

Best case--Initially covered and treated...then they decide not to pay some or all of the bill and you get to go Medical 7 in bankruptcy court...and then you just wish you were dead.




smiler03's picture

Very good point. Americans can easily go bankrupt with with quite minor illnesses, your health or your wealth?

jwoop66's picture

I don't think I should be penalized for pre-existing conditions on my Auto or Home owners ins either. 

As it is, if I apply for Homeowners ins after the fire is burning my house, those insensitive capitalist greedmongers tell me my house isn't covered because of  "pre-existing conditions"!  

If my house burns down I'll lose everything!   How is that fair!    Greedy capitalists!  

flattrader's picture

Don't be an idiot.  It doesn't work that way with homeowners or auto insurance and you know it...but you are the perfect shill, now aren't you?

Some witchdoctor underwirter can decide you had a "pre-existing" condition after your first visit to the ER or first admission for an ailment you never knew you had or ever had a problem with before you presented yourself for treatment.

I had a nephew with a kidney ailment who was working and insured.  The insurance underwriters claimed it was a congenital defect and therefor a "pre-existing" condition.  His doctor never indicated that to my nephew or in the medical records.

My nephew never had a problem with it until his first trip to the a child, teenager or young adult.

He fought the ins. co. as did the doctor and the hospital.

He started out life in his late-20s with a Medical 7 Bankruptcy.

Hope it happens to you.  You may "get it" at that pont.  Some people have to learn the hard way.

jwoop66's picture

Sounds like your nephew had a "pre-existing condition"  dipshit.   If the condition is known prior, it can not be Insured against.    Insurance is mitigating potential and unknown risk.    If you are covering a known condition it is NOT insurance.   SHill.  

If you think someone else(me, if you want govt health insurance) should pay for your nephew, just say so.   Too bad about his condition, it is most unfortunate and you have my sympathy,  but I do not feel it is my responsibility.  Further more; I don't want my Insurance company to pay his bills if they knew he had the condition beforehand.   Shill.   I have bills and expenses as well.   If you are concerned, why don't you help him pay for his medical bills. Shill? 

If this "not covering pre-existing conditions meme" is the whole point of govt healthcare, why not just get a govt program to help people with pre-existing conditions and leave the rest of us alone?  

jwoop66's picture

Of course this in not how auto and homeowner insurance works because that would be stupid and unworkable!   That is the point.  Shill.

Rahm's picture

No salt for you! Two years!!

Cursive's picture

Well, my brother's a doctor and he recently treated me to a profanity-laced tirade about the $200k in federal income taxes he just had to pay and he could give a flying fuck about smokers and fatasses (he is both).

MinnesotaMD's picture

I didn't know I had a brother to bitch too

dolph9's picture

What your brother hasn't realized yet is that he's a peon.

If you are working and paying taxes in America, you're a serf.  There's no question about it.  The oligarchs do neither, and they've accomplished the great trick of forcing half the serfs to pay for the section 8, food stamps, healthcare, and welfare of the other half.