>>That was a predictable response Pericles.<<

If it were that predictable, BN, you'd have prepared a more convincing rebuttal.

Your starting point was, let me remind you:

>>Why should society be the net to catch those who have entirely preventable conditions?<<

You now modify that with:

>>The clear difference between a car crash and obesity is that obesity is something that takes months and years of neglect to create - it is not a situation which happens in the blink of an eye, which a car crash often happens.<<

OK, so you have added a time factor to the preventability factor. Why should that be a determinant? Simply because it takes years to become obese or to succumb to the effects of smoking doesn't diminish the impact of "neglect" on the health system. Whether the neglect is over decades or in the space of a millisecond doesn't affect the outcome: individual "neglect" has a financial impact on all of us.

In a normal compassionate society, people are prepared to cope with the foibles of others without begrudging them a little flexibility. To insist, as you do BN, that only people whose lifestyles you personally approve of should be treated, you say more about yourself than about our Health system.

Mirko demonstrates limited understanding of health economics as well as the role of the doctor in providing advice on surgery.

Doctors do not refuse patients treatment because on their own judgements of their relative merit to society (based on their lifestyle or any other factor).

Decisions regarding offering surgical procedures are made by doctors based on a calculation of benefits versus harm to the individual patient. It is well documented that morbidly obese individuals are high risk patients to operate on. They are more risky to anaesthetise, perform operations on, have longer operation times and higher complication rates. The risks of their operation outweigh the potential benefits. That is not to say that should their situation improve as a result of lifestyle or medical intervention they would not be reconsidered for the procedure.

Secondly, although it is not our role to assess a patients net worth to society prior to offering or declining them treatment at some point we need to rationalise service provision. There is obviously not a infinite amount of health care resources and some justification must be used when allocating resources. A commonly cited instance of medical arrogance is the refusal of coronary artery bypass surgery to patients with heart disease who are still smoking. When you consider that smoking is the single biggest accelerator of coronary artery atherosclerosis, if a given surgeon can only operate on 200 patients a year (limited by theatre time, nursing staffing, medical staffing, hospital beds) should they operate on the non/ex smokers, for which he is likely to provide sustained benefit and many years of extra life? Or operate on smokers as well, whom will have higher rates of post op wound infection and reclag their arteries within a few years?

Every treatment whether medication, operation, vaccine or health promotion has to justify provision. Any drug subsidised by the PBS must demonstrate significant benefit (cost per person year saved) acceptable to the public purse. Operations are no different and for reasons detailed above, the sums stack up differently for smokers than for non smokers.

As far as I am concerned smokers are the scum of the earth, and any political party that would be brave enough to prevent smoker's from taking up valuable resources in hospitals would get my vote even if they were the KKK.

For it seems that non smoker's like myself (never smoked in my life) can't even walk down the street without some smoker/s stinking up my space, and droping their butts on the ground. Office smoker's should be singled out for special treatment as they seem to spend most of their work time outside of their building's with their friends smoking instead of working.

As for obese people, send them all to Uluru in a truck and let them walk home, they will either survive and get thin or die of starvation.

'The Federal government must immediately pass laws prohibiting health discrimination on the basis of consumption choices.

This raises more issues rather than offer answers. Should drug addicts continue to get needles free when some diabetics struggle to pay for them. Should naval officers get free breast implants and others not. I am sure you will find justification for anything on psychological grounds. It seems impossible to come up with discrimination laws that don't discriminate! Don't airlines discriminate forcing some very obese people to buy 2 tickets?

Too true, Shonga.

c-bearup

Some good points, however, does the priority list mean that smokers and the obese are second class citizens who are denied treatment due to government stuff-ups?

What is disgraceful is the fact that Mr Howard has forced Medicare payers who are employed, to also subscribe to a private health fund and those who fail to, are penalised with an additional Medicare surcharge.

One could naively believe that Howard's way was to relieve pressure on the public health system.

No so - the public health system in every state is under seige and citizens are dying as a result.

It clearly reveals that Australian governments are responsible for direct mismanagement and lack of foresight. It is now time for THEM to take personal responsiblity.

The Director of Health in Western Australia receives a salary in excess of $500,000/pa and the public health system in that state is an abysmal failure.

With my private insurance, specialists are available at the ready. Without the insurance, I may have to wait years for medical treatment even if the condition is not "self-inficted."

One should not hold citizens (in need of any type of treatment) responsible for this ignominious state of affairs.

If we accept the article's naive view that we have "virtually infinite medical resources", it would be wrong to turn away people from medical care regardless of what life choices they have made. However since this isn't the case in reality, we need to make some hard choices about who pays for the medical care, how much should a person be responsible for their own choices, and how effective a treatment will be. I think the biggest issue is that people who make choices that increase their need for health care, should not expect everyone else to pay for the increase in costs.

"It is nothing but indecent to stand-by and allow others to endure preventable suffering."

What if the doctor's judgment is the short term suffering may result in a behaviour change to the betterment of long term health? Should the doctor assist in the degradation of health problems through poor lifestyle choices? Compare it to a case where an athlete is injured; should the doctor administer paid medication so the athlete can still compete even though it will result in further injury?

"Their flawed conduct is self-regarding - it does not hurt others... "

In the case of smoking, second hand smoke can cause harm; either way there is the financial harm done to society from increased medical costs.

"..and in all probability they have a number of redeeming features."

Everyone is a mixture of positive and negative features. To excuse the bad with the good is to ignore the potential for improvement. Shouldn't we encourage people to lead better lives?

"They should not be subjected to the puritanical indecent whims of a morally deficient medico."

While I am sure that there are many cases of bad judgment, after all medical professionals are human, I think this is quite an unwarranted attack on the medical community. Medical professionals spend their lives trying to improve the health of other people. I think it's understandable if they get a little frustrated when people throw their health away smoking a toxic substance or stuffing their face full of sugar and lard.