Controversy in the Moose household

There was much heated debate in the Moose household yesterday evening, sparked by Panorama. After disagreeing on what we thought Jeremy Vine's BMI is we moved on to the real debate.

At first sight it seems appalling to discriminate against fat people or smokers. They have, like everyone else, paid their National Insurance contributions for years and should expect the same level of care as anyone else. Whatever next? Will we turn people away from A&E when they've had a car crash if they were driving over the speed limit? Not treat the long term unemployed because they haven't paid in as much as people in work? Except of course unemployed alcoholic smokers who have paid much more in duty?

The fundamental issue though, is that we do not fund the NHS properly. It's too easy to argue that their are massive inefficiencies within the system. Of course there are. But even if it was the best run health service in the world - a more realistic target than a perfectly run service - there would still not be enough money to treat everybody of everything, and that straight away with no waiting lists.

So the inconvenient truth is that we have to make choices about who we treat and how long we make them wait. We are not living in the ideal world of free treatment for all at the point of need. We possibly could be if people weren't so selfish and were willing to pay the higher tax rates that people pay in countries that do have better health services than we do. My personal experience of Germany highlights this. Marvellous health care. And very expensive it was too - both directly for my health insurance and indirectly through an average tax rate in excess of 50%.

And if we have to make choices about who we treat and how long people wait then somebody is going to be 'discriminated' against. Personally, I don't think it's too unreasonable to 'discriminate' against those who in some way have contributed to their need for treatment through their lifestyle OR who have contributed to their poor chances of recovery from certain treatments through that same lifestyle. And if we are not to pick on the fat and the smokers, who will we pick on instead? For as long as the NHS remains underfunded, the one certainty is that we will have to choose not to treat some people.

Having said that, BMI is clearly the wrong measure. And I'm not just making excuses for myself...although I do fall into the category of people whose BMI is in the upper reaches of the zones and still would be even if I were to lose a reasonable amount of weight. I cannot deny that I am overweight. If a doctor told me I had to lose weight in order to qualify for treatment, I'd actually think it was fair enough. I might even appreciate the added incentive!

Unfortunately many don't see it that way. For example, the woman on Panorama who waited 2 years and then went to Malta for her op - what on earth was she doing during those 2 years? How much weight could she have lost if she'd focussed her energy into that instead of into insisting on her right to be treated even though she was too heavy? I appreciate she couldn't exercise, but that's probably only 10% of losing weight. They should have shown what she ate in an 'average' week - Dr Gillian McKeith stylee - I would wager a considerable sum that people's opinions would probably have changed then!