Current Events International Health Care Systems

No hip replacement for you, fatso!

Bob is a British citizen and is 50 years old. He has never been unemployed and has paid thousands of pounds in taxes into the NHS system. Up until now, he has been very healthy and has not had much need for the NHS system. Recently, however, Bob found out that he needed hip replacement surgery. After visiting his GP looking for a referral to a specialist and for the NHS to foot the bill, he is shocked to learn that the NHS refuses to pay for the procedure. Bob is 6’2” tall and 245 pounds and the NHS considers this obese according to their height-weight table. Obese people do not qualify for NHS-funded hip replacements.

Although this anecdote comes from my own imagination, it may not be unrepresentative of health care in the UK in the future. A story in The Daily Mail (‘NHS should not treat those with unhealthy lifestyles’) discusses how certain groups deemed to be living ‘unhealthy lifestyles’ may be denied care.  The article states that:

“…heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act. Those who abused the system – by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries – could also be penalised.”

The story also describes the creation Health Miles Card whereby people who lose weight, stop smoking or get regular health screenings can receive “…discounts on gym membership and fresh fruit and vegetables, or even give priority for other public services – such as jumping the queue for council housing.” Those who are already non-smokers and who are fit, will not benefit from the Health Miles Card, however, since you only gain points by losing weight or stopping smoking.

Dr. Richard Fogoros of GUTHealthcare makes a more sensible argument in his forthcoming Fixing American Healthcare book. He claims that “we should treat all underlying diseases or disabilities, whether mediated by lifestyle choices or not, as constraints imposed by nature.” It is very difficult to see which diseases are caused from poor lifestyle choices and which are due to genetic predispositions. Of course, if the survival probabilities of individuals of obese individuals who undergo heart surgery is very low, care should be withheld on a case by case basis, but refusing care in such a top-down manner seems draconian. I am not sure that smokers would have a significantly lower survival probability from a hip-replacement–assuming the smoker and non-smoker were both healthy. On the other hand, we can see that once health care is put in the hands of politicians, politicians re the ones who ration medical care.

To me, this seems like just too much government telling individuals how to live their life.


  1. Private insurers are interested in doing the same sorts of things. Discussions on these topics have happened on and off at major insurers for years (I work in the industry). One of the biggest barriers to private US insurers being punitive or triaging coverage, ironically, is the government.

    If ADA and other laws in the US did not forbid this kind of discrimination by private payers, would you object to it? Or is the fact that government does it key here for you? If the issue is choice, in England people can buy supplemental insurance. Those worried about not being able to get hip replacements because they are too fat can buy an extra policy that has no such restrictions.

    So I don’t think I get your point. The payer, whether government or private, is always going to be exploring ways to cap costs. More and more, the focus is on getting those whose behaviors contribute to their illness to change their behaviors. This is very much happening in the US as well.

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