Wednesday 23 January 2019

Leo's health insurance remarks are just more smoke

Eight out of 10 smokers, according to the HSE, want to quit
Eight out of 10 smokers, according to the HSE, want to quit

Andrew Kealy

'Anyone who can afford to smoke 20 cigarettes a day can afford a Gibson Les Paul 57 goldtop custom electric guitar," is what Health Minister Leo Varadkar didn't say yesterday. But he might as well have. Instead the minister, speaking to Pat Kenny on Newstalk, made an equally spurious comparison: "Anyone who can afford to smoke 20 cigarettes a day can afford to take out health insurance."

Aside from being glib, this is an undeniable statement of arithmetic fact: a low-cost health insurance policy can be had for around €400; a 20-a-day cigarette habit costs more than €3,600 per year. Implicit in the minister's comparison, however, is the argument that any smoker without insurance ought to divert a portion of their tobacco spend towards buying a health policy. This argument is facile. There are lots of ways to spend €3,600 if you have it lying around - including the aforementioned electric guitar. But for a smoker with a fully-formed 20-cigarettes-a-day habit, it is nonsense to suggest that they can simply divert elsewhere the money they spend on tobacco. The usual rules of 'opportunity cost', whereby a consumer, by buying something, misses out on the opportunity to buy something else, don't apply.

While starting smoking is a poor decision, the same cannot be said for not quitting. Because whether to quit or not is a decision informed by chronic addiction. According to the UK's National Health Service "nicotine can be more addictive than heroin".

Eight out of 10 smokers, according to the HSE, want to quit. And the remaining 20pc are under no illusions about the health implications. Yet only 40pc attempt to quit each year. And on the first attempt, most of these fail.

Were we to apply Mr Varadkar's rationale more widely, we would have to consider how else a smoker must spend their money before they're allowed have a fag - "No Marlboro Lights until you've insulated the attic."

People from poorer communities are more likely to smoke and smoking accounts for half the gap in life expectancy between a rich person and a poor person.

The HSE's 'Smoking in Ireland 2014' report states: "The highest cigarette smoking prevalence rates were in the lower socioeconomic groups (C2, 22.7pc, DE, 24.1pc ). The lowest smoking rates (13.8pc and 10.8pc) were among higher socioeconomic groups (AB) and farmers (F)."

But if you are a smoker in a lower socio-economic group, Mr Varadkar is, in effect, saying you are not poor - you have a spare €3,600, which you are choosing to waste on cigarettes.

This has echoes of 2011 study on poverty put out by a US think tank. The Heritage Foundation report, 'Air Conditioning, Cable TV, and an Xbox: What is Poverty in the United States Today?', was interpreted by many as suggesting certain items in their homes should disqualify people from being considered as living in poverty. Having an Xbox and a packet of fags doesn't mean you're not broke. It doesn't mean you can afford health insurance. It doesn't excuse the shortcomings of the public health system.

The HSE is threatening to seek an injunction to prevent the publication of a HIQA report into hospital standards; a European Court of Justice initial ruling found that junior doctors' working hours are in breach of EU law; 380 people were on trolleys in hospitals yesterday.

Mr Varadkar ought to think carefully before making smart-alecky comments.

It is reasonable to encourage smokers to quit by increasing both prices and social stigma. It is reasonable to provide support, as the HSE does through

But telling nicotine-addicts to go and buy health insurance instead of cigarettes is just more smoke.

Andrew Kealy is currently a former smoker


Irish Independent

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