Over the last week, the BBC have been making a great deal (press releases: 1, 2, 3, 4) of the results of a poll they comissioned from ICM, the Healthy Britain survey (no direct link to results, at time of writing it hasn’t appeared on the ICM Latest Polls list).

Aside from the fact that I think a lot of this is filler to help pad out a rather slim news agenda at the moment (rather like all the fuss over Alan Milburn’s appointment and the Cabinet reshuffle), and that many of the responses seem to be rather ambiguous, there are some interesting issues raised.

The one that particularly engages me is the renewal of the perennial debate over whether or not people should qualify for free healthcare when they knowingly participate in activities that are detrimental to their health. Two high profile examples cited this week have been smoking and poor diet. My take on this is fairly straightforward and involves asking yourself a couple of simple questions and thinking carefully about the answers.

The NHS is a system of universal healthcare. All citizens pay into the system, and all can call upon it. It goes without saying that some people will take more from the system than others for a huge variety of reasons. The first question you have to ask is whether you want the NHS to continue to be a system that provides care for all our citizens when they need it, or whether you want to start to introduce exceptions.

The UK is a (comparatively) free society. For the most part, lifestyle choices are left up to the individual. The State does interfere in some ways, but fortunately they have not yet begun to dictate our dinner menus. The second question to ask yourself is whether you believe that lifestyle choices should in the main be left up to the individual.

My answers: I want to live in a society where healthcare is a given for all citizens. I instinctively feel that this is a key trait of any truly civilised society - nobody should be left to suffer needlessly. I also want to live in a society that allows it’s citizens as much individual freedom as possible, for similar instinctive reasons (as well as a certain anti-authoritarian streak). One consequence of holding these views is that I have to accept that some people will make choices that mean they place greater demands upon our system of universal healthcare.

Now, I contribute to that system and I’m happy to accept that some people might absorb a bit more of that contribution than others - it’s a consequence of living in a free society. If additional revenue is required to compensate for the impact these behaviours have, then I would argue that taxation on the problem activities is a more acceptable solution that denying people access to healthcare or restricting the people’s freedom.

Fortunately, it seems that the numbers in favour of limiting access to the NHS on this basis were comparatively low, I just thought that I’d add my tuppence anyway. I suppose that I’d better state in public that I am a former smoker, so some might argue that I’m biased. They might be right, but then there’s always the argument that smokers contribute more through taxation than they ever take back to answer (see this BBC report for some figures (admittedly a little out of date): smokers cost the NHS something in the region of £1.4 - 1.7 billion while the Treasury gets somewhere in the region of £8.9 billion in tax revenue from them).