I try to visit the Drudge Report once a day because he has a knack for finding quirky stories. One of his recent gems is a report from the UK-based Sun about an obese man who is suing the government’s healthcare system because he got close to 1200 pounds (assuming I’m right about a “stone” being 17 lbs) before getting weight-loss surgery. [CORRECTION: A “stone” is 14 lbs, so he was close to 1000 lbs]
Man mountain Paul Mason plans to sue the NHS – claiming they ignored his plight as he rocketed towards 70 stone. …Paul said: “I want to set a precedent so no one else has to get to the same size….” At his heaviest Paul was eating 20,000 calories a day – ten times what a normal, healthy man should consume – and the cost of caring for him is thought to have hit £1million in 15 years. …He finally had the £30,000 operation last spring but before it could take place floors at St Richard’s Hospital in Chichester, West Sussex, had to be reinforced at a cost of £5,000 to take his weight.
I’m not a fan of Britain’s wretched health system, but my immediate instinct is to take the side of the NHS and make some snarky comment about personal responsibility. Perhaps, for instance, we should ask Mr. Mason whether a government official was holding a gun to his head and forcing him to eat an average of 20,000 calories every day?
But that’s too easy. So I got to thinking about the public policy issues involved, particularly in the context of second-best solutions. In other words, if I’m not allowed to assume an ideal policy such as the dismantling of the National Health Service and restoration of a genuine free market, how would I deal with the issues raised in this story? There are two difficult questions we have to decide.
The first quiz deals with how to spend taxpayer money, combined with a bit of moral hazard analysis. Which option would you pick?
A. The NHS should have given him the operation right away to save money for the taxpayers in the long run. The operation cost nearly $50,000, but he was already costing taxpayers (I assume) $100,000 every year. Sounds like a smart investment that will pay for itself in just a few years.
or:
B. The NHS should not have given him the operation at all because that is akin to forcing taxpayers to subsidize personal irresponsibility.Moreover, it sends a signal to others that it will be marginally less costly to engage in similar self-destructive behavior. Last but not least, taxpayers probably will still pay through the nose to subsidize Mr. Mason’s annual expenses.
Our other quiz is about Mr. Mason’s lawsuit. As noted above, part of me thinks this case has no merit, but the article notes that it took five years before the NHS got him in the operating room after an initial surgery was canceled. In other words, it appears the lawsuit is happening because of the incompetence and waiting lines of a government healthcare system, so the real issue is the remedy. Which option would you pick?
A. Mr. Mason should win the lawsuit, both to compensate him for the government’s presumed incompetence and to punish the NHS for being so inefficient.
or:
B. Mr. Mason ate his way into trouble, so doesn’t deserve to win his lawsuit. Regarding the NHS, it is horribly inefficient, but any court-imposed damages would just get passed on to taxpayers, so there’s no possible upside.
So how do I answer these questions, assuming the Sun reported all the relevant facts and did so correctly?
For the first question, I reluctantly pick A. I’m guessing that the surgery will somewhat reduce the long-run burden that Mr. Mason is imposing on taxpayers. I realize there’s a genuine moral hazard issue, and that decisions like this make is marginally easier for other people to become morbidly obese (and thus impose costs on taxpayers), but my gut instinct is that surgery is still the best choice from a cost-benefit perspective. Finally, even though I’m not overflowing with sympathy for Mr. Mason, I’m a sucker for happy endings and maybe this will turn his life around.
For the second question, I do realize that governments should not be immune from lawsuits. And I say that even though it galls me that taxpayers pay for any damages awarded, either directly or because tax dollars are used to purchase insurance policies (it would be much better if successful lawsuits meant that damage awards were financed by cuts to agency budgets and/or reduction in bureaucrat pay, but I’m only allowed second-best solutions here). Nonetheless, I still pick B, and I make that choice with a decent degree of confidence. My decision is based two factors. First, I don’t want taxpayers to pay even more just because the government is incompetent. In many cases, that might not matter, but now we come to the second key factor, which is that Mr. Mason’s problems are self-inflicted.
To be sure, a court might be bound by the law rather than what’s right and therefore rule differently, but we already know from a previous blog post that I’m not similarly constrained.
Nobody eats 20,000 calories a day by “accident”, or lack of self-responsibility. There clearly was either a physiological or psychological disease in Mr. Mason’s case, and the NHS is obliged by the taxpayer to provide adequate medical care for both options which, depending on medical and psychiatric assessment, may or may not include bariatric surgery and removal of excess tissue.
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Nevada trust, that would be a contradiction as government can only exist through force. LOL.
the best form of government is a non-violent one.
In regards to question one. Consider that this man after receiving his surgery, may put the weight back on. If he does, then there will be no savings.
As for question two, yes he should sue. The government made a promise and is not holding to the agreement.
the combination of a mixture of cabbage or lettuce or a handful or two of baby spinach with chunks of mango or pineapple or banana has been a cup or two of water or juice. You can also coconut water to the taste further.
Let the bastard die. If the British government literally owns his ass, which is the case under the NHS, then why should the state subsidize his dysfunctional bullshit?
I believe in the right to fail. Eating 20,000 calories per day is CHOOSING to die. He wants to off himself, why should I stand in his way?
False choice – the problem goes back to the original error of the government getting into health-care at all.
It is not moral to take the earned wealth of one by threat of force to another. Health care should be totally in the private sector.
Acting as if these pragmatic choices are correct supposes the acceptance to the original error.
Pragmatism is evil.
The UK in addition to the NHS has fee for service doctors and hospitals. Long before he reached a thousand pounds he could have elected to go the private route.
Since he is asserting that his welfare is not his control and that the govt must assume complete responsibility for his weight and health; I’d incarcerate him in a place where his total need can be monitored and regulated. Military detention, asylum, nursing home etc.
I would honor his wishes by removing from him all his choices. He has made poor ones and surrendered his responsibility and authority over his care.
A diet of high fiber and low fat along with as much physical exertion as possible…all carefully monitored.
One could pay staff and housing costs from his reduced health burden and govt burden (assuming his disability makes him a recipient of govt funds for housing, food and clothing)
Those who volunteer for govt servitude should be accommodated. Those who think so little of their personal freedoms that they will abdicate all responsibility and authority should have their demands honored.
I’m voting ‘Present’ on the first question. As for the second:
“B. Mr. Mason ate his way into trouble, so doesn’t deserve to win his lawsuit. Regarding the NHS, it is horribly inefficient, but any court-imposed damages would just get passed on to taxpayers, so there’s no possible upside.”
By scheduling the first, cancelled surgery, the NHS committed itself to provide treatment; once that commitment was made, Mason’s prior irresponsibility was no longer the point afaic. The upside to passing the cost of damages to the taxpayers is that it might help push the taxpayers to deal with the monster they have allowed to be created in their name.
So, by elimination, I vote for A.
IMHO the Libertarian response to both questions is “none of the above”. The government should not be in the business of controlling healthcare.
Wow… Where to begin…
I am a Physician. I believe that weight-loss surgery, while effective, is only effective in the short run. It forces the patient to eat smaller meals, but over time the pouch will stretch and the patient will learn to work around the smaller pouch (i.e. continuously eat high calorie/inappropriate foods). Without understanding why he was choosing to eat 20K a day, and how he was getting that number of calories to his bedside, it is impossible to understand the breadth of the problem.
Look, the NHS in the UK is a flawed health system. It has necessarily turned to rationing care as a means of controlling costs, and results in stories just as this. As a limited government Constitutionalist (small “l” libertarian) it is neither the job of the government to solve this individual’s problems, nor is it the responsibility of government to pay for his individual choices. Nobody (at least nobody from the government) was standing over him forcing food into his stomach.
Dudes… please. The man has a mental illness, an eating disorder. He was able to recognize this, and requested treatment for the mental illness. They tried to fob him off with an appointment with a “nutritionist”, and with advice to “ride a bike”. This went on for years.
ANY insurer or medical practitioner would be at risk of a lawsuit for failure to diagnose and adequately treat such a serious illness. (And yes, severe OCDs such as eating disorders are very serious, and not cured by telling the patient to “just stop” doing whatever the harmful compulsion is.) The same issue would exist in a completely free medical-care market, since it’s an issue of professional incompetence.
Hi Steve.
Was his overweight a personal decision or the result of some underlying condition?
Even if there was no underlying condition officially recognized that proves little. Medicine is still discovering stuff. Look up the history of fibromyalgia (those folks wanted massive doses of opiates before the condition was understood – they were considered garden variety addicts).
So let me go with insufficient information.
Which would then tend to incline me towards NHS (the insurance company) should pay.
It is indeed a false dichotomy.
When I was young and considered myself a pacifist (I’ve grown up since then) there was a classic question I kept getting tossed into my face: “What if you’re sitting behind a machine gun and enemy soldiers are charging. Do you shoot or not?”
It took me years to finally come up with an answer: if a pacifist finds himself in such a strange situation, then he has ALREADY committed a deeply unethical act sometime in the past, and there is no longer any “right” way out.
That’s the same situation with your question. My answer to your first question is “C. There should not be an NHS.”
My answer to your second question is “C. If there is no NHS then your question is moot.”
P.S. “At his heaviest Paul was eating 20,000 calories a day – ten times what a normal, healthy man should consume”
And it’s really unlikely he could get up to cook it. 2nd question: who was feeding him? You obviously aren’t a libertarian. He never could have become that fat without help.
For the second, 2C – I’d counter-sue him for the costs he ran up for his care.
What Brian Macker said.
Who, exactly, was paying for the food he was eating? Dig a bit. The man was on the dole.
1A (purely on cost-efficiency grounds; B throwing hundreds of thousands of pounds in cost at the guy to teach him a lesson) and 2B.
As an English law student, I don’t think the lawsuit will succeed – I don’t think you can say that scheduling a surgery and then delaying it would be considered a voluntary assumption of responsibility, and in any case there’s a strong argument that he is entirely the author of his own misfortune and that his acts would therefore be a novus actus interveniens. I can’t be bothered to look up precedents to see if there has ever been a case where the NHS delaying surgery has been found to be actionable negligence; nor whether the other demands on the NHS’s budget would mean that they acted reasonably (hence no breach). But, in the absence of a contract or positive misfeasance, I don’t think mere nonfeasance should be actionable.
False dicotomy. The correct answer lies with a different option.