Argument: Denying access to healthcare for smokers would act as a deterrent, discouraging smokers

Governments should do everything they can to discourage smoking. They already attempt to do so in a number of ways, such as through ensuring graphic health warnings are present on all tobacco packaging. Many states have also introduced legislation banning smoking indoors in an attempt to discourage the habit. However, smoking is still a massive problem - millions of people still do it. The refusal of medical treatment to smokers would surely be a massive deterrent to current/potential smokers from continuing/starting the habit. The safety net of modern healthcare being pulled from underneath them would be a powerful incentive to give up the habit, and reduce the estimated $100 billion that the White House believes smokers cost the economy annually through loss of productivity1. 1 USA Today, 15 Jul 11, Do smokers cost society money.. Accessed 15 Jul 11.

Candidate 1: "Denying access to healthcare for smokers will not hurt the economy, for the health care costs of smokers are substantially larger than those of non-smokers. In fact, 'health care costs for smokers at a given age are as much as 40 percent higher than those for non-smokers' . Furthermore, though the opposition points out that because smokers die younger, average health costs are in fact lower than non-smokers, denying access to healthcare will have two effects which will cancel each other out: more people will give up smoking, increasing gross medical costs for the state, but those who don't will die younger for they won't get treatment, which will offset the previous rise."
Candidate 2: "Smokers may have a higher chance of harm from surgery due to complications arising from their habit, but this is not a phenomenon specific to them. Cardiovascular disease, or heart disease to most people, is the number one killer of men and women in the United States1. It is caused by the build-up of fatty deposits that clog the vessels - those at risk are often smokers, but can just as often be those who are overweight, have diabetes or simply high blood pressure. As such, it is not justified to single out smokers when those with unhealthy diets can just as easily cause complications in their surgeries.

1. Daily News, 13 Jul 11, Cardiovascular disease: Defend yourself by lowering the risks.Accessed 14 Jul 11."
Candidate 3: "Goods provided by the state, like healthcare, are often, and necessarily, subject to certain provisions. For example, in order to get unemployment benefits, a person must prove that they are regularly looking for a job and a means to get themselves off benefits. Denying access to healthcare for smokers does not mean denying them healthcare access forever; they can regain unlimited access if they stop smoking. Therefore, prioritizing non-smokers for healthcare in certain cases is not impeding upon smokers' basic liberties but a recognition that those who care about their own health enough to not smoke should be prioritized."
Candidate 4: "The added cost to public healthcare that comes as a result of diseases brought upon by smoking is vastly outweighed by the amount of money governments around the world receive in taxes on tobacco. The UK currently takes around 60% of the cost of a pack of cigarettes in tax duty. In 2008, the US took over $16 billion in tobacco tax revenue1. Such high tax duties and revenues can hardly be justified if smokers are not even to get healthcare for their money. And without the taxes, cigarettes would be much cheaper, encouraging more people to smoke. Moreover, because smokers tend to die earlier than non-smokers, per head the average health care costs are lower than those of non-smokers2. 1 Tax Policy Centre, US Tobacco Revenue Statistics, 2 USA Today, 15 Jul 11, Do smokers cost society money.. Accessed 15 Jul 11."
Candidate 5: "There are realistic and practical ways in which the policy of denying healthcare to smokers could be carried out. Smoking is a habit that has clear and demonstrable physical effects, which often correlate with the regularity and longevity of the habit; doctors are trained to recognize such symptoms and do not need patient confirmation. Furthermore, if the bill made it quite clear that healthcare was to be denied to present smokers, the hypothetical presented by the opposition is easily negated. The goal of such a bill would to be to ensure that both smokers gave up the habit and non-smokers did not take up the habit. In this case, the man taking up smoking is in the wrong and is acting contrary to the law. He would have little room for complaint."
Candidate 6: "There is no evidence that limiting access to healthcare would act as a deterrent. In fact, in the developing world, where a smoker would on average have worse access to healthcare, tobacco consumption has increased significantly over the last decade.1 Furthermore, governments have indeed acted to discourage smoking through a variety of methods. These have included advertising campaigns and banning smoking in public places and they seem to have worked. Cigarette use in the developed world has declined over the last 50 years. In the UK, smoking rates have dropped by half between 1974 and 2009, from 45% down to 21%2. A majority 59% have never taken up the habit3. 1 World Health Organization, The Tobacco Atlas, 2 Daily Telegraph, 22 Jan 09, Lowest ever number of smokers after public ban and health campaigns.Accessed 14 Jul 2011. 3 Daily Telegraph, 22 Jan 09, Lowest ever number of smokers after public ban and health campaigns.Accessed 14 Jul 2011."
Candidate 7: "Many smokers do not choose to harm themselves, they simply can't help it. The 1988 US Surgeon General's report on the addictive nature of cigarette smoking provides proof of what is now widely accepted – smoking cigarettes is highly addictive. Moreover, there are high correlations between people smoking and being under stress or having parents that smoke. All of this suggests that people do not necessarily choose to smoke and may not be able to choose to give up. Given that smokers can therefore be portrayed as suffering from involuntary addiction, it would seem sensible to tackle this addiction alongside physical health issues, as oppose to dismissing smokers altogether."
Candidate 8: "The opposition fails to recognize the impact that such a policy will have on smokers. Access will only be denied to smokers who continue to smoke once the bill is in place, if it is proven that they have given up, they will be free to access healthcare. Therefore, the only smokers who will be turned away, and who will potentially die from preventable illnesses are those who place their habit above that of their life."
Candidate 9: "In practice, it is both viable and beneficial, in certain cases, to prioritize non-smokers for healthcare. Where there is more chance of a transplant being successful in a non-smoker for example. It is true that people can knowingly damage their health in other ways, such as drug taking or alcohol abuse and it may well be viable to limit access to healthcare in these cases also. This does not mean that every factor in a patient's life must be scrutinized in order to decide where they are placed on a doctor's waiting list. In public policy, the line must be drawn somewhere. Prioritizing non-smokers can mean that more people can be helped with same amount of resources and, where this is the case, it should be practiced."
Candidate 10: "Denying, or even reducing, access to healthcare for smokers is impractical, and therefore an unrealistic policy goal. First, the extent to which care is denied is questionable. Does the proposition model include denying palliative care? If it does, this literally means leaving people to suffer agonising pain in emergencies while they try to locate private prescription painkillers, if they can afford them. Further, does it include denying emergency procedures such as resuscitation in the case of a heart attack? If it does, where are patients supposed to go? Private emergency rooms are few and far between, or non-existent, in many countries – never mind private ambulances. Second, in order to encourage smokers to stop smoking, the process needs to involve reactivating access to healthcare if smokers quit. But any cut-off point at which the right is re-activated will necessarily be arbitrary. Some studies have suggested that, for instance, teenagers do irreparable damage to their respiratory systems even if they stop smoking young. If all citizens make an informed decision to smoke, as the proposition argues, isn’t it the case that teenagers make an informed decision to do inordinate damage to their bodies? If it is, then why should there be an absolute cut-off point at which one reassumes healthcare rights? Should there be a relative scale? Wouldn’t this be impossible to construct on a scientific basis?"

There is no evidence that limiting access to healthcare would act as a deterrent. In fact, in the developing world, where a smoker would on average have worse access to healthcare, tobacco consumption has increased significantly over the last decade.1 Furthermore, governments have indeed acted to discourage smoking through a variety of methods. These have included advertising campaigns and banning smoking in public places and they seem to have worked. Cigarette use in the developed world has declined over the last 50 years. In the UK, smoking rates have dropped by half between 1974 and 2009, from 45% down to 21%2. A majority 59% have never taken up the habit3. 1 World Health Organization, The Tobacco Atlas, 2 Daily Telegraph, 22 Jan 09, Lowest ever number of smokers after public ban and health campaigns.Accessed 14 Jul 2011. 3 Daily Telegraph, 22 Jan 09, Lowest ever number of smokers after public ban and health campaigns.Accessed 14 Jul 2011.
