Intended for healthcare professionals

Rapid response to:

Feature Head to head

Should smokers be refused surgery?

BMJ 2007; 334 doi: (Published 04 January 2007) Cite this as: BMJ 2007;334:20

Rapid Response:

Re: Re: Separate Policies

Yes, Walt I understand your point but I don't think you see mine. I
was negligent in not mentioning alcohol abuse and other forms of high risk
behavior. And even low risk behaviors a.k.a. couch potato. Though I would
dare say it is not my advice nor do I see it as destroying the 'social

It is not my idea/advice, if we look at Massachusetts in the United
States which has implemented mandatory health insurance requiring all
residents to purchase health insurance or face legal penalties. They have
'Balkanized' by allowing youths 18-25 to be part of a special group, with
lower fees, because they are young, strong and don't get sick a lot. Now
California is soon to follow. The logic of these 'Balkanized' groups is
sound and if a liberal states like Massachusetts and California don’t see
it as ripping up the social contact who am I to argue.

I would say that 'Balkanizing' health care is strengthening the
'social contract' by holding people responsible for and paying for their
own behavior. That in turns lets the rest of us know they are holding up
their end of the 'social contract'. And just what is an individual's
responsibility to the 'social contract'?

I do like your analogy of skiers vs. couch potato. I have always
asked myself why do we feel we must rescue or repair people who make a
choice to indulge in unnecessary risks? Maybe smokers don't have a choice
as addicts or maybe they do.

Again, I don't believe smokers or anyone else for that matter should
be denied health care but they should have to pay the extra costs for
their behavior.

Competing interests:
None declared

Competing interests: No competing interests

12 January 2007
Randall Anderson
Systems Analyst